Abstract
Objective: For the MATCH intervention, assess concurrent validity of a single item Stage of Change (SOC) measure and association with effectiveness. Methods: Observational pre, post intervention study in 17 schools in North and South Carolina. Subjects included 908 youth with all measures (908/1,468=62%) who participated in an interdisciplinary seventh grade wellness program called Motivating Adolescents with Technology to Choose Health (MATCH). Measures included: Pre and Post-MATCH self-reported SOC, frequency of fruit and vegetable intake (F/V) and Physical Activity (PA) and measured Body Mass Index z-score (zBMI). Concurrent validity was assessed using Wilcoxon rank tests (pre-action vs. action SOC category for F/V and PA at pre- and post-MATCH) and Spearman correlations (between change in SOC, F/V and PA). Change in SOC category distribution was assessed with McNemar’s test; association between change in SOC and change in zBMI was investigated with multiple regression. Results: Both PA and F/V were found to be statistically significantly higher for students in the action SOC category (p<0.0001). Greater increase in SOC was weakly associated with a greater increase in PA (correlation 0.1069, p=0.0013). Participation demonstrated a shift in SOC post-MATCH (% in “action” SOC 47% pre, 53% post; p=0.003). ZBMI decreased significantly from pre- to post-MATCH (p<0.0001). A significant association existed between baseline SOC and change in zBMI: students with higher baseline SOC tended to have more decrease/less increase in zBMI (all overweight subgroup, b=-0.040, p=0.0108). Limitations: lack of a control group, survey questions not validated for individual behavior change. Conclusion: The SOC measure appears to be valid. Participation in MATCH may improve SOC and baseline SOC may predict increased effectiveness; however this result must be considered cautiously in this observational study.
Highlights
Childhood obesity is a major public health problem in the United States
There is increasing evidence to suggest school-based interventions, especially in elementary grades, targeting dietary and Physical Activity (PA) behaviors contribute to a Body Mass Index (BMI) reduction in children [3], less is known about the effectiveness of school-based intervention in middle and high school grades [4,5]
A change in fruit and vegetable consumption was not associated with a change in Stage of Change (SOC) score, the results demonstrating an association between change in PA and change in SOC score provide support for the concurrent validity of the staging measure
Summary
Childhood obesity is a major public health problem in the United States. Even though the rates of obesity among youth have not changed significantly between 2003-2004 and 2011-2012, the reported prevalence rates remain considerably high at 17% [1]. Combating childhood obesity requires modifying behaviors on both sides of the energy equation, dietary intake and Physical Activity (PA) [2]. The public school system can serve as an effective medium for behavioral interventions to reach large numbers of students. There is increasing evidence to suggest school-based interventions, especially in elementary grades, targeting dietary and PA behaviors contribute to a Body Mass Index (BMI) reduction in children [3], less is known about the effectiveness of school-based intervention in middle and high school grades [4,5]
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