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Participants
All participants were enrolled in a YMCA-based after-school care program
in the southeast U.S. The treatment group consisted of 146 African American
preadolescents where the Youth Fit For Life program was administered.
The control group consisted of 123 African American preadolescents who
were scheduled to receive the program during the next sequence that it
was offered. Treatment and control locations were randomly derived. Data
from non-African American enrollees (less than 3%, overall) were excluded.
No significant difference (p-values >0.30) was found between the treatment
and control group on age, male/female ratio, socioeconomic strata, and
BMI percentile, so aggregated data are reported. The overall mean age
was 10.6 years (SD = 1.1), and 59% were female. Based on household income
and participation in the free and reduced-cost lunch program, nearly all
were in the lower and lower-middle socioeconomic strata. Mean age-adjusted
BMI for the girls corresponded to the 79th percentile, and for the boys
the 82nd percentile. Participation was voluntary. After-school care registrants
were not aware of the Youth Fit For Life program at time of registration,
so a self-select bias associated with recruitment was unlikely to have
affected the data for either group. The present data were derived from
program evaluation records from January to April 2006, where no names
or identifiers of participants were retained. African American children
were assessed because of their high prevalence for overweight and inactivity,
and high need for effective intervention.
Measures
Self-description: The Self-Description Questionnaire-I (Marsh, 1990) is a self-report survey intended for use with
children ages 8 through 12 years. The general self scale and physical
appearance scale of the survey were used here. The general self scale
relates to, "… perception as an affective, capable individual, proud
of and satisfied with the way he is." (Marsh, 1990, p. 7). The physical appearance scale relates to,
"… self-concept regarding his physical attractiveness as compared
with others, and the perception of how others think he looks." (Marsh,
1990, p. 5). Responses range from 1 (False) to 5 (True).
The factor structure was supported across 8 studies, and demonstrated
independence between scales. Each scale has 8 items. Items for the general
self scale include, "Overall I have a lot to be proud of," and
"I can do things as well as most other people." Internal consistency
was 0.81. Sample items for the physical appearance scale include, "I
like the way I look," and "I have a good looking body."
Internal consistency was 0.83. Although usual test-retest methods were
considered inappropriate due to expected changes in self-perception over
time, findings suggested systematic changes over 6 months that supported
the scales' stability (Marsh, 1990).
Task self-efficacy: The physical self-concept scale of the Tennessee
Self-Concept Scale: 2 Child Form (Fitts and Warren, 1996) is a self-report survey intended for use with children
ages 7 through 14 years. The physical self-concept score relates to the
construct (within self-efficacy theory) of task self-efficacy (Annesi,
2006), or "… the individual's view of his body, state
of health, physical appearance, skills, and sexuality" (Fitts and
Warren, 1996, p. 23). A single score is recorded from responses ranging
from 1 (Always False) to 5 (Always True) on 12 items. Item clusters, however,
include identity (eg, "My body is healthy"), satisfaction (eg,
"I don't feel as well as I should"), and behavior (eg, "I'm
not good at sports and games"). Factor analysis supported the physical
self-concept scale items relative to the other 5 scales of the Tennessee
Self-Concept Scale: 2. Internal consistency for the 9- to 12-year-old
age group averaged 0.70, and test-retest reliability over 1 week was 0.71
(Fitts and Warren, 1996).
Self-regulatory efficacy: The Exercise Barriers Self-Efficacy Scale
for Children (Annesi et al., 2005)
is a self-report survey that assesses the construct (within self-efficacy
theory) of self-regulatory efficacy, or the degree one believes he or
she possesses the ability to overcome social, personal, and environmental
barriers to participating in physical activity (Annesi, 2006). Construction of the 10-item survey, each item beginning
with the stem, "I am sure I can exercise three or more days per week
even if…", was based on previous research (Marcus et al., 1992), and adapted for the ages of 8 through 12 years. Responses
range from 1 (Not at all confident) to 5 (Definitely confident). Items
include, "I was nervous being around other people" (social barrier),
"My body felt uncomfortable while exercising" (personal barrier),
and "The weather was bad (very hot, rainy, very cold)" (environmental
barrier). Internal consistency averaged 0.79, and test-retest reliability
over 1 week was 0.77 (Annesi et al., 2005).
Mood: The tension and vigor scales of the Profile of Mood States
- Short Form (McNair et al., 1992) are self-report surveys of five items each. Responses
range from 0 (Not at all) to 4 (Extremely). Items for the tension scale
include "nervous," "anxious," and "tense;"
and for the vigor scale, "energetic," "active," and
"lively." Internal consistency (adult samples) averaged 0.91
and 0.88, respectively. Test-retest reliability over 3 weeks was 0.70
and 0.65, respectively (McNair et al., 1992). Profile of Mood States scales were used with children
starting at 9 years of age (Annesi, 2005; Berger et al., 1997). Internal consistency for the present sample was 0.74
(tension) and 0.79 (vigor).
Voluntary physical activity: Voluntary physical activity is defined
as physical activity completed of one's own volition, outside of when
it is mandated based on requirements and/or expectations from structured
settings. For example, when a student completes a bout of physical activity
within a PE class, it would not be considered as voluntary physical activity
as it would if he chooses to ride his bicycle after school. Consistent
with recent research (Annesi, 2006; 2007;
Berger et al., 1997), a single-item scale was used to assess the number of
days a participant voluntarily completed a moderate-to-vigorous ("made
you breathe harder than usual") bout of physical activity or exercise
over the previous week, excluding such physical activities completed during
school (eg, during PE class) or after-school programs (eg, during a Youth
Fit For Life session). The item was based on review of the extant physical
activity recall research (Piera et al., 1997), and adapted from recent research with 12-year-olds from
Canada (Tremblay et al., 2000). Test-retest reliability over 1 week was .79. Significant
correlations between reported days of voluntary moderate-to-vigorous physical
activity, and time to complete a 1-mile (1.61 km) run/walk (r = -0.39,
p < 0.01) and distance covered in a 6-minute run/walk (r = 0.33, p
< 0.01), supported the scale's validity. A significant correlation
of 0.70, with no significant difference in means, was found when the present
scale was administered during the summer, then winter (and counterbalanced),
suggesting that responses were not biased by season. Possible responses
ranged from 0 to 7 days. Although a single item scale is sometimes discouraged,
appropriate reliability, validity (especially, for purposes of this research,
predictive validity), and applicability was clearly demonstrated.
Changes on each measure (ie, difference scores) were derived by subtracting
scores at baseline from scores at week 12.
Procedure
Participants already registered for a 12-week segment of YMCA after-school
care volunteered to enroll in the investigation. Based on location of
enrollment either the Youth Fit For Life protocol (treatment group) or
an equal amount of time for unstructured physical activity (control group)
was incorporated. All other aspects of after-school care were the same
(eg, consumption of a snack, completion of homework). Parents and legal
guardians were provided information packets, and were required to sign
an informed consent form indicating a desire for their child to participate,
and sufficient health to avoid undue risks through participation. Information
on how collected data were to be handled, including how all identifiers
were to be destroyed, was also provided. The contact information of the
principal investigator was given so than all concerns and questions could
be promptly addressed.
Youth Fit For Life consisted of 3, 45-minute sessions per week, and was
delivered in elementary school multi-purpose rooms by after-school counselors
whose training in PE methods was generally limited to a 6-hour block of
instruction provided just prior to starting with the treatment. Using
after-school counselors to administer the protocol directly facilitated
testing in a manner that is consistent with the most efficient dissemination
of the intervention. Participant-to-counselor ratios averaged approximately
12:1, and were limited to 15:1.
The Youth Fit For Life curriculum was supported by a manual, videotape,
and quality control processes from wellness staff members of sponsoring
YMCAs (National Cancer Institute, 2008).
Its 4 components were cardiovascular exercise (noncompetitive games and
tasks designed to maximize moderate-to-vigorous physical activity time
for 20 minutes, 3 days per week), resistance exercise (age-appropriate
use of resistance bands for 20 minutes, 2 days per week), nutrition/health
information (1 new theme each week; 5 to 7 minutes, 3 days per week),
and behavioral skills training intended to increase the quality of structured
physical activity and increase amounts of voluntary, moderate-to-vigorous
physical activity completed outside of structured programs incorporating
exercise. Behavioral skills training was adapted from an exercise behavior
change protocol for adults, and was administered 1 day per week for 20
minutes. It consisted of an assortment of brief, interactive group lessons.
Self-management and self-regulatory areas covered were (1) methods for
goal setting (short- and long-term), (2) establishing a system for progress
monitoring which related to goals set, (3) the use of facilitative self-talk
(eg, thought-stopping, cognitive restructuring), (4) identifying appealing
physical activity types, and (5) recruiting social supports (eg, family
and peer support; participation in a team or group activities). An interactive
workbook supported the behavioral skills training component, and was referred
to frequently. In addition, in groups led by the after-school counselors,
participants discussed their efforts to utilize the behavioral skills.
All surveys were administered to both treatment and control group participants
in a private area at baseline and week 12. Ethics required that participants
were not provided opportunities to compare and contrast their personal
data, and that all identifiers were promptly removed and destroyed. Without
affecting validity, children were given an explanation of how their participation
may serve to help develop programs to improve the health of children.
In research such as this, it is important that the interests of the child
participants and their parents be balanced against the advancement of
health promotion research.
Data
analysis
Statistical significance was set α = 0.05, 2-tailed, throughout.
As suggested by Jaccard, 1998, a modified Bonferroni correction procedure was incorporated
to adjust α-values for multiple tests, where appropriate. Assessment
of sex differences were initially made on all variables. Dependent t-tests
were next calculated to assess within-group changes in the 4 self-appraisal
and 2 mood variables, and days per week of voluntary physical activity,
over 12 weeks. Contrasts of changes between groups were then made using
independent t-tests.
Regression analyses were next conducted for the treatment group only,
to assess relations between changes in the self-appraisal and mood variables,
and voluntary physical activity changes. Linear bivariate correlations
were calculated between changes in the self-appraisal and mood variables,
both controlling for baseline scores and not controlled, and voluntary
physical activity changes. Thus, both bivariate and partial correlation
coefficients are reported. Based on relationships indirectly suggested
within social cognitive and self-efficacy theory, a series of linear multiple
regression equations, with simultaneous entry of changes in the measures
of self-appraisal, mood, and both self-appraisal and mood, were then conducted
to assess their explained variance on voluntary physical activity changes.
Although use of change scores has sometimes been questioned, it has been
considered advantageous when, as here, it is driven by a priory theory
(Fitzmaurice, 2001). In addition, tests for skewness and kurtosis suggested
that the score changes over 12 weeks were appropriate for use in parametric
tests for these data. Baranowski and colleagues indicated the importance
of accounting for the dynamic nature of changes in health behaviors (Baranowski
et al., 1998). Thus, consistent with previous research (Annesi, 2006), actual changes in scores were incorporated into the
multiple regression analyses rather than controlling for baseline values.
As previously suggested (Fitzmaurice, 2001; Williams and Zimmerman, 1996), this enabled analyses of changes while retaining the
naturally occurring array of actual (rather than statistically adjusted)
baseline scores, and their changes. The sample size had sufficient experimental
power to detect a medium effect size at a .90 level (Cohen, 1988).
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