Physical Activity In Underserved Adolescents Research Articles

An overview of the Connect through PLAY trial to increase physical activity in underserved adolescents

BackgroundThe Connect through Positive Leisure Activities for Youth (Connect through PLAY) trial is a prospective, randomized controlled trial implemented within pre-existing afterschool programs (ASPs) comparing a staff-based social development physical activity (PA) program to a health curriculum active control. The efficacy trial aims to improve staff capacity for implementing effective physical activity (PA) programming within ASPs serving underserved youth (minority, low-income) through enhancing the influence of ASP staff as key change agents and addressing the social development needs of adolescents. Design and settingThe 5-year cluster randomized trial will involve 30 ASPs that are randomized to either the Connect through PLAY intervention or the active health curriculum control. InterventionThe Connect through PLAY intervention employs a novel theoretical framework that targets three key social mechanisms for increased and sustained PA of staff and youth including youth-peer connections/friendships, group belonging, and staff-youth connections. All components of the intervention are designed to improve staff capacity for facilitating a PA context that supports these social mechanisms and increases the influence of ASP staff as positive PA role models and agents of change. Compared to control sites, ASPs receiving Connect through PLAY are expected to show greater improvements from baseline to post- and 6-month follow-up on youth PA, staff PA, and social mechanisms. ImplicationsThe results of the Connect through PLAY trial will demonstrate the efficacy of the intervention and will assist in developing a model of training, motivating, and empowering ASP staff to address social mechanisms that promote youth PA.

A Longitudinal Study of the Effects of Instrumental and Emotional Social Support on Physical Activity in Underserved Adolescents in the ACT Trial

Few previous studies have examined the influence of instrumental and emotional social support on physical activity (PA) longitudinally in underserved adolescents. This longitudinal study was a secondary analysis of the Active by Choice Today (ACT) trial examining whether instrumental social support predicts increases in PA in underserved adolescents, above and beyond emotional social support provided by family or peers. Students in the sixth grade (N = 1,422, 73% African American, 54% female, M age = 11years) in the ACT trial participated. At baseline and 19weeks, previously validated measures of social support (family instrumental, family emotional, and peer emotional) were completed and moderate-to-vigorous PA (MVPA) was assessed using 7-day accelerometry estimates. A mixed ANCOVA demonstrated that baseline (p = 0.02) and change in family instrumental support (p = 0.01), but not emotional support from family or peers, predicted increases in MVPA across a 19-week period. Future interventions in underserved adolescents should enhance opportunities for instrumental support for PA.

Weight Status as a Moderator of the Relationship Between Motivation, Emotional Social Support, and Physical Activity in Underserved Adolescents

This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

The Role of Motivation in Understanding Social Contextual Influences on Physical Activity in Underserved Adolescents in the ACT Trial: A Cross-Sectional Study

Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA). Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates). Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA. These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

A qualitative study of staff's perspectives on implementing an after school program promoting youth physical activity

Minimal effects found across youth physical activity (PA) interventions, and increased attention to circumstances that impede adequate delivery of program components, has highlighted the importance of learning from staff what is needed to foster staff comprehension and engagement for developing, adopting, and successfully implementing PA-based youth interventions. The purpose of this study is to address this knowledge gap by conducting a qualitative assessment of school staff perspectives on the positive aspects and challenges of implementing the 17-week ACT program, an after-school intervention that integrated motivational and behavioral components to promote PA in underserved adolescents. Interviews were conducted with one school staff member from each participating school for all four trial cohorts (N=12). Transcripts were coded by independent coders (r=.84) and content analyses of themes was performed using QSR NVivo. Themes were organized into five meta-themes: (1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects. Findings indicate that staff can be successful at understanding, valuing, and reaching fidelity in implementing climate-based mediation components. The insight gained from this study lays the foundation for understanding the components needed for establishing well-implemented, effective, and generalizable interventions for increasing youth PA.

Neighborhood and Parental Supports for Physical Activity in Minority Adolescents

Few studies have examined environmental, home, and parental supports for physical activity in underserved adolescents (low income, ethnic minority). Given the increasing incidence of obesity in minority adolescents, it is important to better understand ecologic determinants of physical activity in these youth. This study used an ecologic model to evaluate the significance of neighborhood, home, and parental supports for physical activity on moderate-to-vigorous (MV) physical activity in underserved adolescents. The study was a secondary data analysis of a randomized controlled school-based trial "Active by Choice Today" (ACT) for increasing physical activity in underserved sixth-graders. Schools were matched on school size, percentage minorities, percentage entitled to free or reduced-price lunch, and urban or rural setting prior to randomization. This study used a randomly selected sample of parents (n=280) from the intervention and control schools whose adolescent was enrolled in the larger trial. A total of 679 6th-grade students (mean age=11.4 years, 70% African-American, 76% free or reduced-price lunch, 52% female) participated in the larger trial. Parents of 280 youth were contacted to participate in a telephone survey and 198 (71%) took part in the study. The ACT trial was designed to test the efficacy of a 17-week (1 academic year) motivational plus behavioral skills intervention versus comparison after-school programs on increasing physical activity. A telephone survey was developed and was administered within 6 months after the trial began on parents of 198 adolescents from the ACT randomized school-based trial during 2005-2007. The primary outcome measure was adolescent MVPA based on 7-day accelerometry estimates from baseline to mid-intervention. The data were analyzed in 2010-2011 and included both parent and adolescent self-reports of environmental, home, and family supports for physical activity. Regression analyses indicated a significant effect of parental and neighborhood supports for physical activity on adolescent MVPA. Adolescents who perceived higher (vs lower) levels of parental support for physical activity engaged in more minutes of MVPA (B=3.01, SE=1.38, p<0.05) at mid-intervention. Adolescents who lived in neighborhoods with more (vs fewer) supports for physical activity (parks, lighting), also engaged in more minutes MVPA (B=4.27, SE=2.15, p<0.05). Support from parents and neighborhood quality are both associated with increased physical activity in underserved adolescents.

The Relationship Between Psychosocial Correlates and Physical Activity in Underserved Adolescent Boys and Girls in the ACT Trial

Previous research suggests motivation, enjoyment, and self-efficacy may be important psychosocial factors for understanding physical activity (PA) in youth. While previous studies have shown mixed results, emerging evidence indicates relationships between psychosocial factors and PA may be stronger in boys than girls. This study expands on previous research by examining the effects of motivation, enjoyment and self-efficacy on PA in underserved adolescent (low income, ethnic minorities) boys and girls. Based on previous literature, it was hypothesized the effects of motivation, enjoyment and self-efficacy on moderate-to-vigorous PA (MVPA) would be stronger in boys than in girls. Baseline cross-sectional data were obtained from a randomized, school-based trial (Active by Choice Today; ACT) in underserved 6th graders (N=771 girls, 651 boys). Intrapersonal variables for PA were assessed via self-report and confirmatory factor analyses were conducted for each predictor. MVPA was assessed with 7-day accelerometry estimates. Multivariate regression analyses stratified by sex demonstrated a significant positive main effect of self-efficacy and motivation on MVPA for girls. Boys also showed a positive trend for the effect of motivation on MVPA. The results from this study suggest motivation and self-efficacy should be better integrated to facilitate the development of more effective interventions for increasing PA in underserved adolescents.

A qualitative study of parental modeling and social support for physical activity in underserved adolescents

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10-14 years, 85% African-American) participated in a focus group (6-10 per group, same gender). Focus groups were audiotaped, transcribed and coded by independent raters. Inter-rater reliabilities indicated adequate agreement [inter-rater reliability (r) = 0.84]. Themes were identified for parental role modeling and parental social support. Regarding parental role modeling, adolescents reported that parents engaged in a variety of different types of physical activities with their children such as walking, cycling and playing basketball; however, activity was infrequent. Sex differences were noted in parental social support indicating that female adolescents reported receiving more emotional and negative support for physical activity (being required to play outside with a sibling), while boys reported receiving more tangible types of support for physical activity. Adolescents also generated ideas on how to increase parental social support and in particular tangible support was highlighted as important by both males and females. This study suggests that future interventions should focus on improving parental engagement and tangible support that involve direct participation from parents in physical activities with their adolescents.

An overview of “The Active by Choice Today” (ACT) trial for increasing physical activity

Background Although school-based behavioral interventions for increasing physical activity (PA) in children and adolescents have been conducted, little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days. The overall goal of the “Active by Choice Today” (ACT) trial is to expand the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents (low socioeconmic status, minorities) during their middle school years. Design and setting An overview of the ACT study design, theoretical framework, process evaluation, and primary hypotheses is presented. The trial involves twenty-four middle schools (1560 6th graders) in South Carolina that are randomly assigned to one of two after-school programs (motivational and life skills intervention, or general health education). Intervention The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA. The intervention targets skill development for PA outside of program days and the after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) is designed to positively impact cognitive mediators (self-efficacy, perceived competence), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Main hypotheses/outcomes It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA (based on 7-day accelerometry estimates) at post-intervention as compared to the general health education program. Conclusions Implications of this innovative school-based trial are discussed.

Brief Report: A Qualitative Study of Gender Preferences and Motivational Factors for Physical Activity in Underserved Adolescents

This study used focus groups to identify preferences for physical activity (PA) and motivational themes for increasing PA in underserved adolescents. Fifty-one adolescents, on the free lunch program (25 males and 26 females; ages 10-13 years; 72% African-American, 19% white, and 9% other minorities) participated in focus groups (6-10 children per group; same gender). The data were transcribed and coded into themes. A content analysis was performed using QSR NVivo. Boys rated their favorite activities as playing basketball, football, soccer, and baseball. Girls rated their favorite activities as playing basketball, swimming, and roller-skating. For motivational themes, boys and girls most frequently stated that they would participate in PA if it was a fun, provided a health benefit, and if there were a variety of choices offered. Being involved with friends was also identified as important to both boys and girls. The findings from this qualitative study suggest that including components of choice and a variety of physical activities may be important elements for intervention programs in underserved adolescents.

The Role of Peer Support on Vigorous Physical Activity in Underserved Adolescents

The Role of Peer Support on Vigorous Physical Activity in Underserved Adolescents

The Role of Peer Support on Vigorous Physical Activity in Underserved Adolescents

1031 The increasing prevalence of obesity in U.S. children and adolescents, especially among minority and low social economic status (SES) populations, is a major health threat to our society. Studies indicate a 50% decline in PA for youth between the ages of 6 and 16 years old, with underserved adolescents (minorities, low SES) being the least physically active. PURPOSE: The present study examined the role of peer support for physical activity (PA) on PA in underserved adolescents. METHODS: Twenty-eight students in an intervention school were matched (based on race, percentage on free or reduced lunch program, gender, and age) with 20 students from a control school that did not participate in after-school activities (total sample = 30 females, 18 boys; 10–12 years old; 83% African-American; 83% on free or reduced lunch). The student-centered intervention was consistent with Self-Determination (Motivation) Theory and Social Cognitive Theory in that it emphasized increasing intrinsic motivation and behavioral skills for PA. Intervention adolescents took ownership in selecting PA activities that were fun (i.e., intrinsic motivation) and generated their own coping strategies for engaging their friends in PA (e.g., having a physical activity sleepover). Participants completed measures of peer support for PA (reliability = 0 .89) and a motivational measure of PA (reliability = 0.90). PA was measured over five consecutive days at baseline, during a PA sleepover (n = 13), and post-treatment using Acti Graph accelerometers. RESULTS: Repeated measures analyses, controlling for sex and BMI showed significant increases in time spent in moderate PA (MPA), moderate-to-vigorous PA (MVPA), and vigorous PA (VPA) from baseline to week 4 for the intervention (vs. comparison) group (p < 0.05 for all). Students in the intervention showed a greater increase in PA during the sleepover as compared to post-intervention for MPA and MVPA (p < 0.05 for both). Linear regression analyses including both peer support for PA, motivation for PA, and BMI further demonstrated that social support from peers (R2 change = 0.37) and BMI (R2 change = 0.27) were a significant predictors of vigorous PA during the sleepover (controlling for baseline PA; R2 = 0.79, p < 0.05). CONCLUSIONS: These preliminary findings suggest that peer support for PA may be instrumental for increasing VPA in underserved adolescents.