Effects of fitspiration on believability and intention to exercise

Introduction

Although Fitspiration is purportedly intended to motivate people to be fit and healthy, a body of research has demonstrated negative effects of these media in men and women. Understanding mechanisms can help create more targeted interventions aimed at mitigating the negative effects of Fitspiration. This research examined if selected implicitly or explicitly measured constructs moderated or mediated the effects of Fitspiration. The purposes were to examine the believability (finding the media truthful) of Fitspiration (study one; data from 139 women and 125 men aged 18-33 years were analyzed), the effects of Fitspiration on exercise intention (study two; data from 195 women and 173 men aged 18-30 years were analyzed), and whether these effects were moderated by exercise-related cognitive errors (negatively biased perception of exercise) or mediated by implicit (evaluative responses to stimuli) or explicit (reasoned evaluation of stimuli) attitudes.

Methods

In two separate studies, self-identified men and women first completed a measure of exercise-related cognitive errors, then viewed gender-specific Fitspiration media, followed by measures of implicit attitudes, explicit attitudes, believability, and demographics. In study two, participants were randomly assigned to Fitspiration or control media conditions and also completed measures of fitspiration-related cognitive errors and intention to exercise. In the first study, one model was tested for each gender sample. It was hypothesized that implicit and explicit attitudes would be positively related to believability, and that exercise-related cognitive errors would moderate these relationships. In study two, separate models were tested with exercise-related or Fitspiration-related cognitive errors as the moderators with each gender sample. It was hypothesized that implicit attitudes, explicit attitudes, and believability would be positively related to intention, that the control media would lead to greater intention to exercise than the Fitspiration media, and that exercise-related cognitive errors and Fitspiration-related cognitive errors would moderate these relationships.

Results

The majority of hypothesized relationships were not supported. A negative relationship between exercise-related cognitive errors and believability was found.

Discussion

Overall, these studies identify and exclude factors that predict Fitspiration believability and the role that factors such as cognitive errors and attitudes may play in that.

Experiences of Size Inclusive Physical Activity Settings Among Women With Larger Bodies

Purpose: Size inclusive physical activity settings may help mitigate the impact of physical activity-related weight stigma. In this interpretive description study, we aimed to understand how women with larger bodies experienced size inclusive physical activity settings. The study was informed by a settings-based approach to health promotion. Method: We interviewed nine women with larger bodies who participated in size inclusive physical activity and used an inductive approach to analyze the data. Findings: At the individual level, size inclusion was experienced as an enhancement of well-being, self-worth, and belonging. This was closely tied to the interpersonal level, whereby weight-neutral practices used by fitness instructors and lack of judgment from other exercisers contributed to experiences of size inclusion. At the organizational level, the organization's culture, marketing, programs, and physical spaces could enhance or limit inclusion and participation. However, weight stigma was prevalent in women's experiences outside the physical activity setting. Conclusion: We provide recommendations to improve size inclusion in physical activity settings.

Physical activity information seeking among emerging adults attending university

Objective To assess preferred sources of information for seeking physical activity (PA), and how PA information seeking may contribute to participation in a campus PA program. Participants: Students attending a large, Western Canadian university between April 2015 and April 2018. Methods: Secondary analysis of an annual campus-wide survey. Results: Students sought PA information for general health. Females sought information about weight loss for appearances; males sought information for muscle gain for appearance. Internet and friends were primary sources of PA information. Regression analysis indicated females 2.49 (95% CI 1.98-3.13), domestic students 2.86, 95% CI (2.04-4.02), and first year students 24.88, 95% CI (18.12-34.17) were most likely to participate in a campus PA program. Only health reasons significantly contributed to participation 1.42, 95% CI (1.06-1.89). Conclusions: Emerging adults attending university may benefit from PA promotion that makes use of their preferred information sources.

Examining differences in parents' perceptions of children's physical activity versus screen time guidelines and behaviours

AIM

Most Canadian and Australian children do not meet Physical Activity Guidelines (PAG) or Screen Time Guidelines (STG). Regarding the social issue advertising believability model (SIABM), parental support for these behaviours may depend upon how believable parents find guideline messages. The aim of the study was to examine differences in parents' SIABM variables and perceived behavioural control for PAG and STG messages.

METHODS

Data were collected online; 499 Canadian parents with at least one child aged 5-11 years (75.6% mothers) participated. Differences in model variables were analysed using analyses of variance.

RESULTS

Parents demonstrated greater issue involvement, attitudes towards the issue, parental support attitudes and perceived behavioural control for the PAG compared to the STG (d > 0.10). Mothers believed the messages more and had more favourable attitudes towards the issues as compared to fathers (d > 0.21).

CONCLUSIONS

Parents' evaluations of PAG messages and corresponding supportive behaviours were generally more positive than STG. Future messages should emphasise supportive behaviours for screen time reduction that are feasible and enjoyable for children.

Examining the Relationship Between Exercise-Related Cognitive Errors, Exercise Schema, and Implicit Associations

To better understand exercise-related cognitive errors (ECEs) from a dual processing perspective, the purpose of this study was to examine their relationship to two automatic exercise processes. It was hypothesized that ECEs would account for more variance than automatic processes in predicting intentions, that ECEs would interact with automatic processes to predict intentions, and that exercise schema would distinguish between different levels of ECEs. Adults (N = 136, Mage = 29 years, 42.6% women) completed a cross-sectional study and responded to three survey measures (ECEs, exercise self-schema, and exercise intentions) and two computerized implicit tasks (the approach/avoid task and single-category Implicit Association Test). ECEs were not correlated with the two implicit measures; however, ECEs moderated the relationship between approach tendency toward exercise stimuli and exercise intentions. Exercise self-schema were differentiated by ECE level. This study expands our knowledge of ECEs by examining their relationship to different automatic and reflective processes.

Effects of physical-activity-related anti-weight stigma materials on implicit and explicit evaluations

Objective

Although there exist videos and images created by Obesity Canada and similar organizations (e.g., the Rudd Center for Food Policy and Obesity), it is not known if the materials have the desired effect of reducing stigma against people with obesity and might have the opposite effect of increasing stigma. Therefore, two studies used implicit and explicit evaluations to examine the effectiveness of images and videos intended to reduce weight stigma.

Methods

Study 1 participants (N = 284; M_age = 31.47 years [SD = 11.26]; 177 self‐identified as women; 83 self‐identified as living with obesity) completed two implicit measures (one with images of people living with obesity and the other with control images) followed by a weight stigma questionnaire. Study 2 participants (N = 308; M_age = 31.54 years [SD = 11.35]; 153 self‐identified as women; 59 self‐identified as living with obesity) were randomly assigned to view an obesity and exercise video and images of persons with obesity, control video and images of persons with obesity, obesity and exercise video and control images, or control video and control images, followed by the implicit measures and explicit evaluation questionnaire.

Results

Implicit evaluations of the control images were more positive than the images of persons with obesity. Participants with no history of obesity who saw the control video and control images had lower weight stigma compared to participants in the other conditions.

Conclusions

Materials created to reduce weight stigma might not be effective among people with no history of obesity themselves or via a family member or friend. Intervention and health promotion researchers may wish to investigate effects of the images in combination with other messages because simply using the nonstigmatizing images is likely not enough.

The Believability of Exercise Blogs Among Young Adults

It is unknown how lifelong digital media users such as young adult women perceive exercise information found online. A total of 141 women aged 18-30 years and residing in Canada were randomized to read either a factually incorrect or a factually correct blog article. Participants completed Go/No-Go tasks to measure automatically activated believability and evaluations and questionnaires to explicitly measure believability, affective evaluations, and intentions to exercise. Participants did not show evidence of automatically activated believability of the content found in either blog article. However, participants reading the factually correct article reported significantly greater explicit disbelief than those reading the factually incorrect article, though this did not predict intentions. Being factually correct may not be an important component of message believability. Exercise professionals need to remain aware of the content of popular online sources of information in an effort to curb misinformation.

Leveraging Professional Sports Teams to Encourage Healthy Behavior: A Review of 4 Years of Calgary Flames Health Training Camp Events

Professional sporting teams may be well-positioned to act as promoters of health behaviors given their fixture within a community, and association with physical activity, nutrition, and other healthy behaviors. Over 4 years, the Calgary Flames Sport and Entertainment Corporation in conjunction with local health promotion professionals, delivered a health promotion event to the public, The Calgary Flames Health Training Camp (FHTC) in Calgary, Alberta, Canada. The purpose of these annual events has been to inspire and encourage healthy behavior uptake and adherence. A description of the FHTC over each of 4 years (2015–2018), lessons learned, and some evaluative work done alongside the event on 2 of the 4 years. In 2017, self-report surveys were administered to event attendees to assess current health status including physical activity, socio-cognitive variables, health information preference, and intention to make healthful behavior change based on event attendance. Biometric data was collected including blood pressure, height, weight, and resting heart rate. Evaluations of the four consecutive events showed that the Calgary Flames Sport and Entertainment Corporation has an ability to attract substantial numbers of the general public to attend FHTC events. Self-report measures from 2017 suggest that already-active populations may be most interested in attending however, the events do appear to inspire attendees to consider behavioral changes for health. The events helped to identify individuals with health risks requiring medical attention but has not yet resulted in known behavior changes. Positive community health impacts may arise from collaboration between health promoters and professional sporting organizations.

Coping Versus Mastery Modeling Intervention to Enhance Self-efficacy for Exercise in Patients with COPD

The literature suggests self-efficacy is a determinant of physical activity and management of Chronic Obstructive Pulmonary Disease (COPD). The purpose of this study was to (1) test the effects of two vicarious experience interventions, coping versus mastery modeling, on self-efficacy in COPD patients performing a cardiopulmonary exercise test (CPET), and (2) determine the type of self-efficacy most strongly related to physical activity in COPD patients. After a baseline assessment of self-efficacy (task, coping for exercise, coping for breathing, scheduling, and walking) and potential moderators, 120 COPD patients watched a mastery model or coping model CPET video, or received usual care verbal instructions. Then, self-efficacy was assessed, followed by a CPET, and another assessment of self-efficacy. Fitbits tracked participants' step count the week following contact. Repeated measures MANOVAs assessed the intervention effects and multiple regressions assessed the contribution of self-efficacy subtypes to step count. All self-efficacy subtypes improved in the mastery and coping conditions, although greater improvement of self-efficacy for coping with exercise barriers was observed in the coping condition. Self-efficacy did not improve in the control condition and no moderators were identified. Self-efficacy for coping with exercise barriers was the self-efficacy subtype most strongly related to step count. This research suggests modeling is a useful intervention technique to enhance self-efficacy in COPD patients, although coping models may be more beneficial than mastery models for enhancing capability beliefs during complex tasks. Future interventions in COPD patients should target self-efficacy for coping with exercise barriers.

Motivated, Fit, and Strong-Using Counter-Stereotypical Images to Reduce Weight Stigma Internalisation in Women with Obesity

BACKGROUND

This study aimed to use implicit retraining to change automatic associations between body size and physical activity (PA) in women with obesity to reduce weight bias internalisation (WBI).

METHODS

A Solomon-square experimental design was used to determine the effect of a four-week online implicit retraining intervention on WBI (primary measure) and PA attitudes, self-efficacy, and self-reported behaviour (secondary measures). The intervention was a visual probe task pairing counter-stereotypical images of active individuals with obesity with positive PA-related words. In qualitative telephone interviews, a sub-sample of participants provided feedback and recommendations for using counter-stereotypical images in PA promotion.

RESULTS

Women completed the intervention (n = 48) or a control task (n = 55). Results of a RM-ANOVA showed no interaction or main effect of group on WBI. A main effect of time demonstrated that both groups had reduced WBI between pre-test and post-test, through to one-week follow-up. There were no differences between groups or over time for PA attitudes, self-efficacy, or behaviour. Women who completed interviews (n = 16) discussed several benefits and drawbacks of using counter-stereotypical images.

CONCLUSION

Implicit retraining did not reduce WBI but qualitative findings support the use of counter-stereotypical PA images.

Automatic associations of breast cancer and heart disease with fruit and vegetables and physical activity

Objectives:

This exploratory research examined if breast cancer or heart disease is automatically associated with physical activity compared to fruit and vegetable stimuli; if reading messages about reducing risk of breast cancer or heart disease through physical activity and fruit and vegetable consumption would affect automatic associations; and if automatic associations were related to intentions to be physically active or consume fruit and vegetables.

Methods:

Participants were 80 women who completed pretest measures of automatic associations, then read a breast cancer, heart disease, or control message, followed by posttest measures.

Results:

There was a significant association of breast cancer–related words with fruit and vegetables compared to physical activity. Heart disease was also more strongly associated with fruit and vegetables than physical activity at pretest but not at posttest. There were no other significant findings.

Conclusion:

This research highlights that fruit and vegetables rather than physical activity are more strongly associated with perceptions of breast cancer and heart disease. Automatic associations are an attitudinal construct, and the strength of association between fruit and vegetables, rather than physical activity, indicates how messages may be processed.

Intentions of Canadian health professionals towards recommending exercise for people living with ALS

Background

To provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS (pALS).

Methods

An online survey of physician and non-physician health professionals (HPs) working in academic ALS clinics across Canada.

Results

The response rate was 48% (84/176) with 30% of respondents identifying as physicians, 63% as other HPs and the remainder as administrative or research personnel. Respondents were sharply divided in their intentions to provide exercise counsel: 24% unlikely and 45% likely. Respondents with low intentions were HPs that considered this activity outside their scope of practice. Measures of intention and attitude were more positive for flexibility compared to strength and aerobic exercise. Perceptions of social pressure and ability to provide exercise counsel were significantly correlated with intention across the three exercise modes in all respondents. Qualitative themes identified as barriers to exercise prescription were lack of confidence or competence (31% physicians, 32% HP), patient tolerance (30% HP), lack of evidence (22% physicians) and lack of infrastructure (22% physicians).

Conclusions

While “lack of evidence” for the benefit of exercise was a deterrent for physicians, the larger issue for all respondents was building competence and confidence in exercise prescription for pALS.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1426-z) contains supplementary material, which is available to authorized users.

Political Orientation and Public Attributions for the Causes and Solutions of Physical Inactivity in Canada: Implications for Policy Support

Objectives: To examine how public attributions for the causes and solutions of physical inactivity and individuals' self-identified political orientation are associated with support for different policy actions in addressing physical inactivity. Methods: A secondary data analysis was conducted with a sample of 2,044 Canadian adults. Two sets of 2 X 3 analyses of variance and post-hoc analyses were conducted to assess (1) the mean differences by the causes of the issue of physical inactivity (individual, or both internal and external/external) and political orientation (liberal, centrist, and conservative), and (2) responsibility for solutions (private matter, or both private and public health matter, and /public health matter) and political orientation on support for least, moderate, and most intrusive policy actions. Results: No interaction effects existed between causal attribution and political orientation on policy support, but a main effect of causal attributions for physical inactivity and political orientation was significant. Those who held internal attributions for the cause of physical inactivity showed less support for policies compared to those who held external causal attributions or both internal and external causal attributions. Conservative individuals reported the least support for all policy actions in comparison to liberal or centrist orientations. There were interaction effects between responsibility for solutions and political orientation on policy support. Conservative individuals who perceived the responsibility for solving physical inactivity as a private matter had less support for all three policy actions. Conclusions: Public acceptance of policy actions addressing physical inactivity varies by the attributions the public have regarding causes and responsibility for solving the problem, and by political orientation. Advocacy and messaging for policy implementation in the physical activity arena needs to be communicated in ways that encourage reflective and informed deliberation that is representative of the Canadian population.

Assessing the social climate of physical (in)activity in Canada

BACKGROUND

Ecological models suggest that a strategy for increasing physical activity participation within a population is to reconstruct the "social climate". This can be accomplished through 1) changing norms and beliefs, 2) providing direct support for modifying environments, and 3) implementing policies to encourage physical activity. Nevertheless, surveillance efforts have paid limited attention to empirical assessment of social climate. This study responds to this gap by assessing the social climate of physical activity in Canada.

METHODS

A representative sample of Canadian adults (n = 2519, male/female = 50.3%/49.7%, Mage = 49.1 ± 16.3 years) completed an online survey asking them to assess social climate dimensions including social norms of physical (in)activity, perceptions of who causes physical inactivity and who is responsible for solving physical inactivity, and support for physical activity-related policy. Descriptive statistics (frequencies) were calculated. Multinomial logistic regressions were constructed to identify whether demographic variables and physical activity participation associated with social climate dimensions.

RESULTS

Physical inactivity was considered a serious public health concern by 55% of the respondents; similar to unhealthy diets (58%) and tobacco use (57%). Thirty-nine percent of the respondents reported that they often see other people exercising. Twenty-eight percent of the sample believed that society disapproves of physical inactivity. The majority of respondents (63%) viewed the cause of physical inactivity as both an individual responsibility and other factors beyond an individuals' control. Sixty-seven percent of respondents reported physical inactivity as being both a private matter and a public health matter. Strong support existed for environmental-, individual-, and economic-level policies but much less for legislative approaches. The social climate indicators were associated with respondents' level of physical activity participation and demographic variables in expected directions.

CONCLUSION

This study is the first known attempt to assess social climate at a national level, addressing an important gap in knowledge related to advocating for, and implementing population-level physical activity interventions. Future tracking will be needed to identify any temporal (in)stability of these constructs over time and to explore the relationship between physical activity participation and indicators of the national social climate of physical activity.

The short-term effects of a mass reach physical activity campaign: an evaluation using hierarchy of effects model and intention profiles

Background

Mass reach physical activity campaigns are designed to deliver physical-activity related messages to a large population across different media including print, television, radio, and websites. Few evaluations have examined the short-term effects of a mass reach campaign on participants who were engaged with the campaign. The current research examined the short-term effects of the ParticipACTION 150 Play List, a mass reach physical activity campaign, on participants who registered with the campaign website.

Methods

Participants (N = 7801) completed a registration questionnaire measuring demographic information, awareness and recall of physical activity and sport advertising, and self-reported number of activities tried or planned to try from the 150 Play List. A follow-up survey was completed by 1298 participants from the original sample. Additional questions assessed experience with the 150 Play List and attitudes towards campaign advertisements.

Results

Approximately 14.5% of participants cited the ParticipACTION 150 Play List and 23.6% mentioned a ‘getting active’ message when recalling advertisements. Those who named the 150 Play List or getting active reported more activities tried and more activities planned than those who did not. They were also more likely to say they had tried a new activity and planned ongoing participation. It was also found that participants with a disability were more likely to have tried a new activity compared to those not in a minority group. Other correlates of trying new activities at follow-up were younger age, more positive reported experience with the 150 Play List, and more favourable attitudes towards campaign advertisements. Those who did not intend continued participation, or who were unsure at baseline and then decided against continued participation at follow-up, reported they were less sedentary or encouraging others to be active.

Conclusions

This research addresses the gap in evidence regarding the efficacy of mass reach physical activity campaigns by informing whether a year-long campaign like the 150 Play List can be effective in influencing the behavior of those engaged with the campaign. The results reinforce the idea that ‘top of mind’ awareness should be measured. Investigating intention profiles can help inform campaign impacts and continuation intentions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6218-7) contains supplementary material, which is available to authorized users.

Can The Moblees™ Move Canadian Children? Investigating the Impact of a Television Program on Children's Physical Activity

Background: The effects of messaging about physical activity and sedentary behavior purposefully integrated into children's TV programming on children's behavior is unknown. The Moblees is a Canadian childrens' show that explicitly promotes physical activity. Two studies were conducted to (1) examine whether children were more physically active when watching a Moblees episode, and (2) explore parental perceptions of the show. Methods: Study 1 was an experimental study with 21 families randomized to watch an episode of The Moblees vs. a control condition. Movement was assessed through accelerometry and observation. A Chi-square test was used to compare the direct observation proportions of children sitting between intervention and control conditions. Independent t-tests were performed to examine the differences in total vector magnitude counts between the experimental and control groups. Study 2 was an online cross-sectional study with 104 parent/child dyads that included viewing an episode of The Moblees. To identify correlates and predictors of parent-reported child PA during viewing The Moblees compared to other TV programs, Pearson's correlations and a linear regression were calculated, respectively. Results: In study 1 there was a significant association between condition and whether or not children remained sitting χ² = 55.96, p < 0.001. There was a significant difference in counts between the two conditions, t_{(13, 61)} = 2.29, p < 0.05. Children randomized to the experimental group (i.e., Moblees) moved more compared to control. In study 2 the majority (76%) of parents reported that their child engaged in some physical activity during viewing. Parent encouragement during viewing was the strongest predictor of child physical activity while viewing (β = 0.30, p < 0.01). Conclusion: Television content that includes messaging about physical activity and sedentary behavior, and positive portrayals of physical activity may influence the physical activity of young children. Although the benefits of such modest movement are not clear without further evidence of accumulation over time and/or transfer to other settings, television programming might provide a far reaching medium for knowledge translation.

Examining implicit cognitions in the evaluation of a community-wide physical activity program

The purpose of this study was to incorporate measures of attentional bias and implicit attitudes in the evaluation of a community-wide physical activity program, UWALK, by examining the relationships among proximal, intermediate, and distal outcomes of the program as outlined in the hierarchy of effects model. UWALK incorporated various communication and marketing strategies via mass media, on- and off-line platforms. Participants (N = 127) reported unprompted then prompted awareness of UWALK followed by measures of attentional bias and implicit attitudes, watched a 30-second UWALK video, then completed a thought listing task and questionnaires measuring instrumental and affective attitudes, leisure time physical activity, and demographics. Results showed that participants with unprompted awareness of UWALK demonstrated attentional bias toward UWALK images, positive implicit attitudes, and greater physical activity participation compared to unaware counterparts. Attentional bias, awareness, and implicit attitudes significantly predicted behavior, accounting for 15.2% of the variance. This study emphasizes the importance of including measures of automatic cognitions during evaluation can further inform the effects of a program. The results also showed that it is problematic to assume that visiting a website indicates a program will be remembered and related cognitions will be affected.

Examining the Relationship between Message Variables, Affective Reactions, and Parents' Instrumental Attitudes toward Their Child's Physical Activity: The "Mr. Lonely" Public Service Announcement

This study examined the relationship between message variables and affective reactions with parents' attitudes after seeing a physical activity mass media public service announcement (PSA). It was hypothesized that there would be a positive relationship between message variables (i.e., personal relevance, novelty of information, and feelings toward sponsoring organization) and parents' attitudes toward their child/children's physical activity after viewing the PSA. Furthermore, we explored whether discrete affective reactions were related to attitudes, beyond the effect of message variables. A secondary data analysis was conducted with parental responses to an online campaign evaluation survey (n = 267). Hierarchical regression analyses showed an overall positive relationship between all three message variables and attitudes. Furthermore, two discrete affective reactions were positively related to attitudes. Parents who endorsed feeling motivated or guilty after viewing the advertisement had more positive attitudes toward their children's physical activity levels. This study represents an ecologically valid assessment of how message variables and affective reactions are related to attitudes within the context of a physical activity mass media campaign. The results provide guidance for the effective design of mass media physical activity campaigns.

The Relationship of Explicit-Implicit Evaluative Discrepancy to Exercise Dropout in Middle-Aged Adults

Discrepancies between automatically activated associations (i.e., implicit evaluations) and explicit evaluations of motives (measured with a questionnaire) could lead to greater information processing to resolve discrepancies or self-regulatory failures that may affect behavior. This research examined the relationship of health and appearance exercise-related explicit-implicit evaluative discrepancies, the interaction between implicit and explicit evaluations, and the combined value of explicit and implicit evaluations (i.e., the summed scores) to dropout from a yearlong exercise program. Participants (N = 253) completed implicit health and appearance measures and explicit health and appearance motives at baseline, prior to starting the exercise program. The sum of implicit and explicit appearance measures was positively related to weeks in the program, and discrepancy between the implicit and explicit health measures was negatively related to length of time in the program. Implicit exercise evaluations and their relationships to oft-cited motives such as appearance and health may inform exercise dropout.

What older adolescents expect from physical activity: Implicit cognitions regarding health and appearance outcomes

OBJECTIVE

To explore older adolescents' reflective and impulsive thoughts about health- and social/appearance-related physical activity (PA) outcomes and investigate how those thoughts relate to their PA behavior.

PARTICIPANTS

One hundred and forty-four undergraduate students (109 women; 35 men) aged 17-19 years (M = 18.11, SD = 0.65) participated in this study in October 2015.

METHODS

Participants completed a Go/No-go Association Task that assessed automaticity of associations between PA words and either health outcomes or social/appearance outcomes. Questionnaires assessing PA behavior, attitudes, outcome expectations, and body image were also completed.

RESULTS

Participants demonstrated a positive automatic association between PA and social/appearance outcomes, F(1, 136) = 4.403, p < .05, η² = .031, but they showed no difference in their associations between PA and desirable or undesirable health outcomes, F(1, 136) = 2.405, p = .123, η² = .017.

CONCLUSIONS

Older adolescents implicitly attend to the social/appearance outcomes of PA more than potential health outcomes, indicating that social recognition and a desirable physique may be the key PA motivators for adolescents.

Investigating relationships between ancestry, lifestyle behaviors and perceptions of heart disease and breast cancer among Canadian women with British and with South Asian ancestry

BACKGROUND

Ethnic minority groups including Asians in Canada have different knowledge and perceptions of heart disease and breast cancer compared with the ethnic majority group.

AIM

Examine relationships between perceptions of heart disease and breast cancer, and lifestyle behaviors for Canadian women with British and with South Asian ancestry.

METHODS

Women with South Asian ( n = 170) and with British ( n = 373) ancestry ( M_age = 33.01, SD = 12.86) reported leisure time physical activity, intended fruit and vegetable consumption, disease perceptions (ability to reduce risk, control over getting the diseases, and influence of family history), and demographic information. Mann-Whitney tests and multiple hierarchical linear regressions were used to examine the relationships between lifestyle behaviors and disease perceptions, with ancestry explored as a possible moderator.

RESULTS

Participants with South Asian ancestry believed they had greater ability to reduce their risk and have control over getting breast cancer than participants with British ancestry. Family history influences on getting either disease was perceived as higher for women with British ancestry. Age was positively related to all three perceptions in both diseases. Intended fruit and vegetable consumption was positively related to perceptions of ability to reduce risk and control of both diseases, but was stronger for women with South Asian ancestry regarding perceptions of breast cancer. Leisure time physical activity was positively related to perceptions of control over getting heart disease for women with British ancestry.

CONCLUSIONS

Women's disease perceptions can vary by ancestry and lifestyle behaviors. Accurate representation of diseases is essential in promoting effective preventative behaviors.

Believability of messages about preventing breast cancer and heart disease through physical activity

Background

The purpose of this research was to examine the relationships of self-reported physical activity to involvement with messages that discuss the prevention of heart disease and breast cancer through physical activity, the explicit believability of the messages, and agreement (or disagreement) with specific statements about the messages or disease beliefs in general.

Methods

A within subjects’ design was used. Participants (N = 96) read either a breast cancer or heart disease message first, then completed a corresponding task that measured agreement or disagreement and confidence in the agreement or disagreement that 1) physical activity ‘reduces risk/does not reduce risk’ of breast cancer or heart disease, 2) that breast cancer or heart disease is a ‘real/not real risk for me’, 3) that women who get breast cancer or heart disease are ‘like/not like me’, and 4) that women who get breast cancer or heart disease are ‘to blame/not to blame’. This task was followed by a questionnaire measuring message involvement and explicit believability. They then read the other disease messages and completed the corresponding agreement and confidence task and questionnaire measures. Lastly, participants completed a questionnaire measuring physical activity related attitudes and intentions, and demographics.

Results

There was no difference in message involvement or explicit believability of breast cancer compared to heart disease messages. Active participants had a higher confidence in their agreement that physical activity is preventive of heart disease compared to breast cancer. Multinomial regression models showed that, in addition to physical activity related attitudes and intentions, agreement that physical activity was preventive of heart disease and that women with heart disease are ‘like me’ were predictors of being more active compared to inactive. In the breast cancer model only attitudes and intentions predicted physical activity group.

Conclusions

Active women likely internalized messages about heart disease prevention through physical activity, making the prevention messages more readily available within memory, and active women may therefore process such information differently. The study of how health-related beliefs are created and are related to perceptions of prevention messages is a rich area of study that may contribute to more effective health promotion.

The Utility of Physical Activity Micro-Grants: The ParticipACTION Teen Challenge Program

Youth physical activity levels remain low in Canada and worldwide. Lack of environmental resources (e.g., access to equipment and facilities, transportation options, and participation costs) is a key barrier for youth participation. Micro-grants are small budgets of money awarded via grant applications and may help community organizations facilitate youth physical activity participation by alleviating environmental resource barriers. ParticipACTION Teen Challenge was a national micro-grant scheme administered in Canada. Secondary analysis of survey data from Provincial and Territorial coordinators, registered community organizers, and successful grant applicants were used to evaluate the process and outcomes of Teen Challenge. Results showed that the financial subsidy of 500CAD was used mainly toward equipment, instruction, and transportation. Coordinators and community organizers indicated high levels of satisfaction and benefits for communities and teens. A key benefit for coordinators was leveraging the Teen Challenge network for physical activity promotion. Reported benefits for teenaged participants included leadership opportunities (e.g., helping create and implement programs) and increased physical activity participation. Findings highlight the value of micro-grants for supporting sport and physical activity opportunities for Canadian teens, and show that such schemes address barriers related to environmental resources. The sustainability of micro-grant schemes remains to be seen.

A Systematic Review of Community-wide Media Physical Activity Campaigns: An Update From 2010

BACKGROUND

Mass media campaign is an integral tool to influence physical activity participant behaviors. The purpose of the systematic review was to identify the effectiveness of mass media campaigns in promoting physical activity.

METHODS

Literature update from January 2010 to September 2016 was conducted in 13 databases. Full text articles of 128 were screened, and 23 articles (18 campaigns) were selected from the initial 1692 articles.

RESULTS

All campaigns involved mass media advertisements to promote physical activity to general individuals (n = 2), adults (8), children (4), older adults (2), and parents of children (n = 2). The campaign evaluation designs included clustered RCT (2), cohort (3), quasi-experimental (9), and cross-sectional (9). Eight articles demonstrated significant campaign impact on proximal, 6 on intermediate, 5 on distal outcomes, and 6 on distal change based on either proximal or intermediate outcome.

CONCLUSION

The current review assessed the outcome evaluation of mass media physical activity campaigns that varied in their respective scope, target population and outcomes measured to identify individual changes at proximal, intermediate, and distal level. Results from formative and process evaluation as well as dose-response and cost-effective analysis are suggested to provide valuable evidence for campaign stakeholders and planners.

Moderators of Implicit-Explicit Exercise Cognition Concordance

Investigating implicit-explicit concordance can aid in understanding underlying mechanisms and possible intervention effects. This research examined the concordance between implicit associations of exercise with health or appearance and related explicit motives. Variables considered as possible moderators were behavioral regulations, explicit attitudes, and social desirability. Participants (N = 454) completed measures of implicit associations of exercise with health and appearance and questionnaire measures of health and appearance motives, attitudes, social desirability, and behavioral regulations. Attitudes significantly moderated the relationship between implicit associations of exercise with health and health motives. Identified regulations significantly moderated implicit-explicit concordance with respect to associations with appearance. These results suggest that implicit and explicit exercise-related cognitions are not necessarily independent and their relationship to each other may be moderated by attitudes or some forms of behavioral regulation. Future research that takes a dual-processing approach to exercise behavior should consider potential theoretical moderators of concordance.

Pink Ribbons and Red Dresses: A Mixed Methods Content Analysis of Media Coverage of Breast Cancer and Heart Disease

This research examined media coverage of breast cancer (n = 145) and heart disease and stroke (n = 39) news articles, videos, advertisements, and images in a local Canadian context through quantitative and thematic content analyses. Quantitative analysis revealed significant differences between coverage of the diseases in placement, survivors as a source of information, health agency, human interest stories, citation of a research study, the inclusion of risk statistics, discussion of preventative behaviors, and tone used. The thematic analysis revealed themes that characterized a "typical" breast cancer survivor and indicated that "good" citizens and businesses should help the cause of breast cancer. Themes for heart disease and stroke articulated individual responsibility and the ways fundraising reinforced femininity and privilege. Findings provide insight on how these diseases are framed in local Canadian media, which might impact an individual's understanding of the disease.

Taking a hard look at the Heart Truth campaign in Canada: A discourse analysis

The Canadian Heart and Stroke Foundation launched the Heart Truth campaign to increase women’s awareness of heart disease. However, little is known about how such campaigns intersect with broader understandings of gender and health. This discourse analysis examined the construction of gender, risk, and prevention within campaign material. Two primary discourses emerged: one of acceptable femininity, which outlines whose risk, survivorship, and prevention matters, and another of selfless prevention. Women of diverse ethnic, sexual, and socio-economic background were largely absent. Prevention was portrayed as a personal choice, eclipsing conversations about social determinants of health and the socio-political context of heart disease.

Heart disease and breast cancer perceptions: Ethnic differences and relationship to attentional bias

Differences in perceptions of susceptibility, seriousness, and fear of heart disease and breast cancer were examined and related to attentional bias for disease-related words among Canadian women of various ethnic ancestry. Women (n = 831) completed an online survey, and 503, among them, also completed an attentional bias task. Perceived seriousness of breast cancer predicted attentional bias for breast cancer in women of South Asian ancestry. Lifestyle behaviors were related to breast cancer attentional bias in women with British ancestry. Understanding relationships between modifiable risk factors, disease risk perceptions, and attentional biases among different ethnic groups can help create targeted promotional campaigns.

Evaluating the ParticipACTION “Think Again” Campaign

Introduction. ParticipACTION’s 2011 “Think Again” campaign aimed to draw parents’, and specifically mothers’, attention to the amount of physical activity (PA) their children do relative to the national guidelines (physical activity guidelines [PAG]). Purpose. To evaluate ParticipACTION’s “Think Again” campaign in the context of the hierarchy of effects model. Methods. Data were drawn from “Think Again” campaign evaluations conducted among two cohorts of parents with children ages 5 to 11 years (3 months postcampaign launch [T1], n = 702; 15 months postlaunch [T2], n = 670). Results. At T2, campaign awareness was weakly associated with parents agreeing that their children were not active enough ( p = .01, d = .18). Parents who were aware of the campaign showed greater knowledge of PAG ( ps < .01, ϕs > .14), had higher outcome expectations about their children engaging in PA ( p < .01, d = .16), had stronger intentions to help their child meet the guidelines ( p < .01, d = .18), and engaged in more parental support behaviors ( p < .001, d = .31) as compared with parents who were not aware. At T1, parents aware of the campaign had greater perceived behavioral control (PBC) to influence their child’s PA participation ( p < .01, d = .22), whereas parents not aware of the campaign had greater PBC to find practical ways to help their child be active ( p < .01, d = .26). Parental awareness of the campaign was not associated with children meeting the PAG at either time point ( ps > .05). Conclusions. The campaign appeared marginally effective for increasing parental knowledge of PAG and for creating realistic awareness of children’s PA levels. Additional intervention strategies are needed to produce larger effects and to change parental behavior.

An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active

The objective of the My ParticipACTION campaign was to inspire Canadian adults to increase their physical activity through messaging that was relevant, engaging, and designed to build self-efficacy to be more active. This research examined the communication effects of the campaign according to the a priori Hierarchy of Effects Model (saliency → cognitive engagement → self-efficacy to become more active → trial behavior) and investigated how these effects related to overall self-efficacy for physical activity, intention to be active, and current activity level. Participants (N = 1,110) were recruited from an existing panel of Canadian adults 18 years and older and completed a short online questionnaire about the potential communication effects. Logistic regression models were constructed to test the communication effects adjusting for age, gender, and education. The relations were consistent with those hypothesized in the model. In addition, some earlier outcomes in the sequence of effects were associated with other outcomes further down the progression. When intention to be active was included, the initial relation between ad-specific self-efficacy and current physical activity disappeared. This analysis suggested that the campaign was successful in increasing self-efficacy to be more active and that using the Hierarchy of Effects Model was useful in guiding the design of campaign messages and assessing communication effects. Given the limited amount of theoretical testing of the Hierarchy of Effects Model, future research employing longitudinal designs is required to further confirm the communication effects of such an intervention and further test the model.

Longitudinal changes in beliefs by stage of physical activity adoption in Iranian girls

BACKGROUND

The aims of this study were to examine the relationships among physical activity (PA)-related beliefs and to determine to what extent Iranian adolescents in different stages of PA adoption differ in perceived benefits and barriers during a 3-year transition from junior high school to high school.

METHODS

Data were collected from female adolescents in 2010 (N = 558), of whom 412 provided follow-up data in 2013. One-way analysis of variance and logistic regression were conducted for statistical analysis.

RESULTS

Participants in the action and maintenance stages reported the greatest agreement with benefits. Pre-contemplators were about 4 times more likely to cite "not enough time" than preparers (OR = 3.95). Pre-contemplators were over 4 times more likely to cite not liking exercise than those in action and maintenance stages at baseline (OR = 4.32 and 4.85), a finding which was maintained at follow-up (OR = 3.66 and 8.65).

CONCLUSIONS

These findings could help with the creation of interventions tailored to encourage pre-contemplators to progress toward adoption of PA. Providing transportation supports, enhancing time management, and mitigating boredom may be helpful strategies either to prevent relapse in adoption stages or to move females in early stages of change toward action and maintenance.

Assessing intentions to eat low-glycemic index foods by adults with diabetes using a new questionnaire based on the theory of planned behaviour

OBJECTIVE

The Canadian Diabetes Association recommends that people with diabetes choose foods with low-glycemic index (GI). This study developed a questionnaire measuring Theory of Planned Behaviour (TPB) constructs relative to consuming a low-GI diet by people with diabetes so as to achieve a better understanding of which TPB constructs, demographic characteristics and diabetes-related variables best predict intention to consume a low-GI diet.

METHOD

A questionnaire to measure intentions to consume a low-GI diet was developed based on TPB constructs and was administered to 369 adults (30 to 75 years) with type 1 or type 2 diabetes. Responses were analyzed using multiple linear regression.

RESULTS

More than 90% of participants (mean age, 56.5±10.8 years; mean body mass index, 30.5±7.2 kg/m(2)) cited reduction and maintenance of healthy blood glucose levels as an advantage of eating low-GI foods. Older age, higher income, female gender, having type 2 diabetes, diabetes treatment (diet only) and understanding of the GI were positively associated with intention to eat a low-GI diet. TPB constructs that significantly predicted intentions to eat a low-GI diet were instrumental attitude (beta = 0.24, p<0.001); subjective norms (beta = 0.13, p=0.007); and perceived behavioural control (beta = 0.55, p<0.001).

CONCLUSIONS

This new questionnaire is a valid tool to assess TPB constructs contributing to intentions to eat a low-GI diet by people with diabetes. Future studies that use this questionnaire can shed light on how TPB concepts in clinical practice can help people with diabetes to change their dietary intake.

Mothers' intentions to support children's physical activity related to attention and implicit agreement with advertisements

BACKGROUND

ParticipACTION's Think Again campaign targeted mothers who think their children are sufficiently active, yet whose children do not achieve recommended amounts of physical activity.

PURPOSE

This research examined the relationship of mothers' intentions to support children's physical activity with explicit believability and implicit agreement with the Think Again campaign message, attention paid to the advertisement, involvement with the issue, concern regarding children's inactivity, and attitudes.

METHOD

Participants were mothers from Edmonton, Canada (N = 102) who viewed one Think Again advertisement then completed a measure of implicit agreement with the campaign message and questionnaires.

RESULTS

The mothers who paid attention to the message and were concerned for their own children were more likely to intend to act on campaign messages. The majority of participants implicitly agreed that children's physical inactivity was a problem, but there was less agreement that physical inactivity was a problem for their own children.

CONCLUSION

Participants automatically tended to agree with campaign messages when the focus was on children in general, but there was greater disagreement when asked about participant's own children. Why most mothers were not in agreement with the reality of how much physical activity their children needs remains to be determined.

An Internet-based intervention for promoting and maintaining physical activity: a randomized controlled trial

OBJECTIVES

To evaluate the efficacy of a Social Cognitive Theory-based Internet intervention designed to promote and maintain leisure-time physical activity in university-aged female students in Thailand.

METHODS

The 3-month intervention was delivered through a website and e-mails with a follow-up evaluation 3 months after the end of the intervention. Female students (N = 220) were allocated to 4 parallel groups.

RESULTS

Significant increases in steps/ day, weekly leisure-time activity score, self-efficacy, outcome expectations, and self-regulation, and reduced resting heart rate were observed at the end of the intervention. With the exception of resting heart rate, the intervention effects on these variables also remained at the follow-up.

CONCLUSIONS

The Internet intervention program was effective in promoting and maintaining leisure-time physical activity in university-aged female students.

Overcoming Challenges to Build Strong Physical Activity Promotion Messages

Physical inactivity is a serious public health issue. Physical activity promotion messages are part of a comprehensive approach to creating a society in which physical activity is the norm. Although public health messages can be influential, they face tough competition from other sources of physical activity information that offer conflicting advice about being active and thus may undermine public health efforts. It is therefore necessary to consider the multiple sources of messages (eg, commercial, public health) that can cause confusion for consumers. This article reviews research on sources of physical activity information, where such information is sought and by whom, and how messages are processed at both automatic (ie, with little thought) and reasoned (ie, deliberate) levels. Having outlined the challenges, suggestions are made regarding how public health messages can be heard in an environment dominated by commercial advertising. These suggestions include tailoring theory-based messages, ensuring the benefits of being active are highlighted, branding, and forging collaborative partnerships within the physical activity sector. By enacting these strategies, public health messages may be more effective at attracting attention and being subsequently read and recalled by consumers, and thus contribute to an active society.

Effects of reading health and appearance exercise magazine articles on perceptions of attractiveness and reasons for exercise

Objective

To examine the effects of reading exercise-related magazine articles (health, appearance, or control) and the moderating effects of exercise self-identity on reasons for exercise and perceptions of attractiveness, among women in first year university. An additional purpose was to use a thought listing technique, the results of which were examined for evidence of internalization of the exercise-related messages.

Participants

Female students in their first year of studies between September 2010 and April 2011 (N = 173; mean age = 19.31 years, mean body mass index = 22.01).

Methods

Participants read a health, appearance, or control article, listed thoughts, and completed questionnaires measuring reasons for exercising, physical self-perception, and exercise self-identity.

Results

Participants in the health condition rated exercise for health significantly higher than control condition participants. Participants with high exercise self-identity rated attractiveness as a reason for exercising significantly higher than low exercise self-identity participants in both the health and appearance conditions. Participants with higher internalization scores (i.e., accepted societal norms of appearance) reported exercising for attractiveness reasons more so than participants with lower internalization scores.

Conclusions

The good news is that health messages may be influential and result in wanting to exercise for health purposes. However, exercising for attractiveness was rated highly by participants with high exercise identity who read either the health or appearance articles. Health and appearance are not necessarily distinct concepts for female undergraduate students and the media may influence cited reasons for exercise.

Source attribution and credibility of health and appearance exercise advertisements: Relationship with implicit and explicit attitudes and intentions

The relationship of attributed source (commercial or nonprofit) and credibility of exercise advertisements to explicit and implicit exercise-related attitudes and intentions was examined. Male and female participants ( N = 227) were randomly assigned to watch health or appearance-related advertisements and then completed an implicit attitudes task and questionnaires. Health advertisements and those attributed to a nonprofit source were rated more credible. Appearance condition participants who attributed the advertisement to a nonprofit source also rated the advertisement as more credible. Participants who rated a commercial advertisement as credible reported higher implicit instrumental attitudes. Implications for exercise promotion are discussed.

Effects of Biggest Loser exercise depictions on exercise-related attitudes

OBJECTIVES

To examine whether participants who watched an exercise-related segment of The Biggest Loser television program would have different explicit and implicit affective exercise-related attitudes than those of control participants.

METHODS

University students (N=138) watched a clip of The Biggest Loser or American Idol, then completed a Go/No-go Association Task, a thought-listing task, and questionnaires measuring explicit attitudes, activity level, and mood.

RESULTS

Participants who watched The Biggest Loser had significantly lower explicit, but not implicit, attitudes towards exercise than did control participants.

CONCLUSIONS

There is a need to examine the influence of popular media depictions of exercise.

Collective knowledge: using a consensus conference approach to develop recommendations for physical activity and nutrition programs for persons with type 2 diabetes

The purpose of this consensus conference was to have a lay panel of persons with type 2 diabetes (T2D) work in collaboration with an expert panel of diabetes professionals to develop strategies designed to improve dietary and physical activity adherence in persons with T2D. Lay panel participants were 15 people living with T2D. The seven experts had expertise in exercise management, cardiovascular risk factors, community-based lifestyle interventions, healthy weight strategies, the glycemic index, exercise motivation, and social, environmental and cultural interactions. All meetings were facilitated by a professional, neutral facilitator. During the conference each expert gave a 15-min presentation answering questions developed by the lay panel and all panel members worked to generate suggestions for programs and ways in which the needs of persons with T2D may be better met. A subgroup of the lay panel used the suggestions created from the conference to generate a final list of recommendations. Recommendations were categorized into (1) diagnosis/awareness (e.g., increasing awareness about T2D in the general public, need for lifelong self-monitoring post-diagnosis); (2) education for the person with diabetes (e.g., periodic "refresher" courses), professionals (e.g., regular interactions between researchers and persons with T2D so researchers better understand the needs of the affected population), and the community (e.g., support for families and employers); and (3) ongoing support (e.g., peer support groups). The recommendations from the conference can be used by researchers to design and evaluate physical activity and nutrition programs. The results can also be of use to policy makers and health promoters interested in increasing adherence to physical activity and nutrition guidelines among persons with T2D.

The Effect of Different Response Formats on Ratings of Exerciser Stereotypes

In this study we examined the relationships of different response formats, respondent gender, and activity level, to ratings of exercise stereotypes. Participants (N = 203) completed 8 question sets about 8 exerciser stereotypes. In each questionnaire, 1 question was inadvertently measured twice with different response options of definitely would not like to do this/definitely would like to do this (NL anchor) or definitely false/definitely true (FT anchor). Results showed that ratings on the FT statements were significantly higher than those on NL statements for 2 stereotypes: judgmental young women and overweight. There were also significant effects of gender by activity level on ratings of runners. Both gender and activity levels were related to ratings of liking to exercise for some, but not all, of the stereotypes.

Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres

In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination.

Implicit and explicit exercise and sedentary identity

We examined the relationship between implicit and explicit "exerciser" and "sedentary" self-identity when activated by stereotypes. Undergraduate participants (N = 141) wrote essays about university students who either liked to exercise or engage in sedentary activities. This was followed by an implicit identity task and an explicit measure of exercise self-identity. Results showed that implicit and explicit exerciser identities were not highly correlated. There were also no significant prime effects, but women showed greater implicit sedentary identity, whereas men showed greater implicit exercise identity. This research suggests that implicit exercise-related identity is a distinct construct from explicit exercise identity. The results also reflect responses to societal pressures for women to be thin and for men to be strong, when free of self-presentational bias.

From paper to practice: barriers to adopting nutrition guidelines in schools

OBJECTIVE

To explore the barriers associated with the adoption of the Alberta Nutrition Guidelines for Children and Youth in schools according to characteristics of the innovation (guidelines) and the organization (schools).

DESIGN

Cross-sectional telephone survey.

SETTING AND PARTICIPANTS

Schools in Alberta, Canada. Principals from 357 schools.

MAIN OUTCOME MEASURE

Barriers to adopting the nutrition guidelines.

ANALYSIS

A 19-question telephone survey, including open- and closed-ended questions, was used to obtain information regarding schools' characteristics and barriers to adopting the guidelines. Qualitative data were coded according to common themes a priori, based on constructs from the Diffusion of Innovations framework.

RESULTS

Schools reported many barriers related to the relative advantage, compatibility, and complexity of adopting the guidelines. Parents' resistance to change and cost were the key reported barriers. Lack of knowledge, student preferences, the physical location of the school, and barriers related to the provision of healthful food were also reported.

CONCLUSIONS AND IMPLICATIONS

Disseminating guidelines without providing adequate support for their implementation may not promote change within the school setting. School nutrition initiatives need to involve the parents and have access to sufficient financial and human resource support.