EAL

NGHC: Childhood Nutrition and Lifestyle Factors (2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To measure African-American girls' physical activity and associations with:

BMI
Parents' reported self-efficacy and support for helping daughters be active
Girls' perceived support from parents for physical activity
Parents' and girls' perceived neighborhood safety and access to facilities
Family environment.

Inclusion Criteria:

Data used was collected as part of the University of Minnesota field center for Phase 1 of the National Heart, Lung, and Blood Institute-sponsored Girls Health Enrichment Multisite Studies (GEMS)
Participants were from the Minneapolis/St. Paul, Minnesota area
African-American girls
Primary caregiver of the girls
Parent or caregiver provided signed informed consent forms
Girls provided assent.

Exclusion Criteria:

Girls not of African-American heritage
Participants living outside the Minneapolis/St. Paul, Minnesota area
Adults who were not the girls' primary caregiver.

Description of Study Protocol:

Recruitment

Girls were encouraged to take part in an after-school intervention focused on promoting healthy eating and activity among African-American girls
Girls were recruited through:
- School visits
- Fliers
- Recruitment events.

Design

Cross-sectional study.

Intervention

Girls Health Enrichment Multisite Studies (GEMS) pilot study:
- Targeted pre-adolescent African-American girls and their families through an after-school program
- Designed to prevent obesity by focusing on healthy eating and physical activity.
Girls wore an activity monitor for three days to assess activity level
Questionnaires were completed by parents and girls.

Statistical Analysis

Statistical Analysis Software was used
Frequencies, means, and standard deviations were computed for scores of each scale
Pearson correlation coefficients were computed between the girls' average number of minutes per day of moderate to vigorous activity between 12 p.m. and 6 p.m. as assessed with:
- CSA monitor and girls' BMI
- Parents' psychosocial measure
- Girls' psychosocial measures
- Family environment measures.

Data Collection Summary:

Timing of Measurements

Data was collected at baseline during the 12-week pilot GEMS study.

Dependent Variables

Physical activity assessment:

Computer Science Application (CSA) activity monitor:
- Single-plane accelerometer that measures vertical motion
- Stores the signal so both the activity pattern and total activity counts
- Calculates counts per minute and can be retrieved using a computer
- CSA monitor worn for three consecutive days
- Number of minutes of moderate to vigorous activity between 12 p.m. and 6 p.m. each day were summed and averaged over the three days to obtain an activity value for each girl
- Minutes of moderate to vigorous activity were based on childhood cut-off points of more than 3,200 counts per minute.

Independent Variables

Body mass index
- Height and weight measured by trained staff using standardized procedures
- Height recorded without shoes
- Weight was measured with girls wearing a hospital gown
- Each measurement was taken twice and the two values were averaged.
Activity-related psychosocial measures
- Based on social cognitive theory
- Collected as part of the GEMS psychosocial survey
- Girls were read each question and response option and a study staff member marked the girls' choices
- Parents filled out the questionnaire themselves, but study staff was available for clarification
- Scales were created using factor analysis to determine which items were capturing the same construct and should be included on each scale
- Principal components analysis with varimax rotation was used
- Four activity-related psychosocial scales were created:
  - Parent's self-efficacy for doing physical activity with daughter
  - Parent's support of daughter's activity level
  - Two scales assessing girls' perception of parent support for her physical activity level
  - Mean value for all items was used to develop a score for each scale.
Family and neighborhood environment measures
- Collected as part of GEMS psychosocial survey
- Included questions about parents' and girls' perception of neighborhood safety and access to facilities for physical activity
- Family Environment Scale to assess parents' perception of the family environment
- Factor analysis used to determine which questions should be included on each scale
- Mean value for all items in each scale was used to create an overall score
- True or false questions that make up 10 sub-scales
- Four of the Moos and Moos sub-scales:
  - Family cohesion
  - Expressiveness
  - Conflict
  - Control.
- Items were summed up to develop a score for each scale.

Description of Actual Data Sample:

Initial N

52 girls.

Attrition (Final N)

52 girls.

Age

Eight years: 25 (48%)
Nine years: 11 (21%)
10 years: 16 (31%)
Average: 8.8±0.9 years.

Ethnicity

Girls were all identified by parents as African-Americans
Parents identified themselves as:
- African-Americans: 83%
- Biracial: 4%
- White: 13%.

Other Relevant Demographics

Parental caregiver's relationship to girl:
- Mother: 47 (90%)
- Father: Two (4%)
- Grandmother: Three (6%).

Anthropometrics

BMI
- Average: 20.7±4.9
- Range: 14.8 to 34.2
Average daily minutes of moderate to vigorous activity from 12 p.m. to 6 p.m. was 101±47 minutes.

Location

Minneapolis/St. Paul, Minnesota area.

Summary of Results:

Key Findings

Correlations of Factors with Minutes of Moderate to Vigorous Activity per Day (12 p.m. to 6 p.m.)

		Correlation	P-Value
Age		-0.12	0.40
BMI		-0.35	0.01
Parental self-efficacy and support	Self-efficacy for physical activity with daughter	0.45	0.001
Parental self-efficacy and support	Parent support of daughter's activity	0.26	0.06
Girl's perception of parent support	Parent permissiveness of sedentary activity	0.16	0.27
Girl's perception of parent support	Support for physical activity at home	-0.17	0.23
Access to facilities for physical activity	Parent: Is it safe for my daughter to play outside?	0.06	0.65
	Parent: Are there playgrounds, parks, or gyms close by?	0.17	0.22
	Girl: Are there playgrounds near my home?	0.03	0.84
	Girl: Is it safe to play where I live?	-0.25	0.08
Family environment scale	Cohesion	-0.03	0.82
	Expressiveness	0.04	0.76
	Conflict	-0.08	0.56
	Control	0.06	0.70

Other Findings

Scales and questions used to assess activity-related psychosocial measures

Parent self-efficacy to do physical activity with daughter:
- Cronbach's alpha: 0.83
- Question and response option:
  - How hard would it be to...
    - Get your daughter to be physically active instead of watching TV?
    - Get your daughter to go for a walk with you?
    - Be physically active with your daughter each week?
    - Take your daughter to the park?
    - Go for a walk with your daughter?
- Response options: Very hard,1; not hard at all, 4.
Parent support of daughter's physical activity level:
- Cronbach's alpha: 0.69
- Question and response option
  - I try to get my daughter to play outside
  - I try to get my daughter to be active instead of watching TV
  - I do physical activity with my daughter each week
  - I take my daughter to practice, dance or other physical activity programs
  - I take my daughter to the park
  - I go for a walk with my daughter.
- Response options: Almost never, 1; almost always, 4.
Girl's perception of parent support: parent permissiveness for sedentary activities:
- Cronbach's alpha: 0.86
  - My parent(s) or other adult allows me to watch as much TV as I want
  - My parent(s) or other adult allows me to play video games, computer games or Game Boy as much as I want.
- Response options: Almost never, 1; almost always, 3.
Girls' perception of parent support: support for physical activity at home:
- Cronbach's alpha: 0.90
  - It is safe to play outside where I live
  - My parent(s) or other adult tries to get me to play outside when it is nice
  - My parent(s) or other adult tries to get me to be physically active instead of watching TV
  - My parent(s) or other adult goes for walks with me
  - My family is physically active.
- Response options: Almost never, 1; almost always, 3.

Scales and questions used to assess the family and neighborhood environment

Safety and access to facilities for physical activity: Parent
- It is safe for my daughter to play outside
- There are playgrounds, parks and gyms nearby
  - Response options: Strongly disagree, 1; strongly agree, 4.
Safety and access to facilities for physical activity: Girl
- There are playgrounds, parks or gyms nearby
  - Response options: No, 0; yes, 1.
- It is safe to play outside near where I live
  - Response options: Almost never, 1; almost always, 3.
Family environment scale: Parent
- Cohesion scale (nine questions)
  - Cronbach's alpha: 0.71
  - Example: There is a feeling of togetherness in our family. Members of our family help and support one another.
- Expressiveness scale (nine questions)
  - Cronbach's alpha: 0.47
  - Example: We say anything we want to in our house. Members of our family often keep their feelings to themselves.
- Conflict scale (eight questions)
  - Cronbach's alpha: 0.67
  - Example: In our family, we do not believe in raising our voice. Members of our family often criticize each other.
- Control scale (nine questions)
  - Cronbach's alpha: 0.41
  - Example: The rules in our house are "set in stone." There are very few rules to follow in our family.
  - Response options: False, 0; true, 1.

Means and SD of Girls' Perceived Support for Physical Activity, Parent Report of Self-Efficacy and Support of Daughters' Physical Activity, Access to Facilities for Physical Activity and Family Environment

		Mean±SD	Range
Parental self-efficacy and support^a	Self-efficacy for physical activity with daughter	3.35±0.63	1.0 to 4.0
Parental self-efficacy and support^a	Parent support of daughter's activity	2.80±0.61	1.3 to 4.0
Girl's perception of parent support^a	Parent permissiveness of sedentary activity	2.31±0.61	1.5 to 2.6
Girl's perception of parent support^a	Support for physical activity at home	2.24±0.34	1.0 to 3.0
Physical activity home environment	Parent: Is it safe for my daughter to play outside?^a	1.93±0.74	1.0 to 4.0
	Parent: Are there playgrounds, parks or gyms close?^a	1.95±0.99	1.0 to 4.0
	Girl: Are there playgrounds near my home?^b	0.82±0.39	0 to 1
	Girl: Is it safe to play outside where I live?^b	2.48±0.53	1.0 to 3.0
Family environment scale	Cohesion^c	7.50±1.68	0 to 9.0
	Expressiveness^c	5.39±1.60	1.0 to 9.0
	Conflict^d	2.83±1.77	0 to 8.0
	Control^c	5.31±1.5	2.0 to 8.0

^aPossible score one to four
^bPossible score zero to one
^cPossible score zero to nine
^dPossible score zero to eight.

Author Conclusion:

This study identified BMI, parents' self-efficacy for doing physical activity with daughters and parents' support of daughters' activity level as correlates of girls' activity level
These finding suggest parent involvement may be a key component in increasing physical activity among African-American girls.

Funding Source:

Government:

National Heart, Lung, and Blood Institute, NIH

Reviewer Comments:

Data was collected at baseline during the 12-week pilot GEMS study.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	Yes
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		N/A
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	N/A
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		No
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	No
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	No
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	Yes
	8.6.	Was clinical significance as well as statistical significance reported?	N/A
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes