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A dissemination study of an inquiry-based science and nutrition curriculum “Choice, Control

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A Dissemination Study of an Inquiry-Based Science and Nutrition Curriculum
"Choice, Control & Change (C3)" for Middle School Students Using
a Lead Teacher Model
Wendy Sauberli
Submitted in partial fulfillment of the requirements for
the degree of Doctor of Philosophy
under the Executive Committee of the Graduate School of
Arts and Sciences
COLUMBIA UNIVERSITY
2010
UMI Number: 3420853
All rights reserved
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a note will indicate the deletion.
UMI
Dissertation Publishing
UMI 3420853
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Wendy Sauberli
All Rights Reserved
ABSTRACT
A DISSEMINATION STUDY OF AN INQUIRY-BASED SCIENCE AND
NUTRITION CURRICULUM "CHOICE, CONTROL & CHANGE (C3)" FOR
MIDDLE SCHOOL STUDENTS USING A LEAD TEACHER MODEL
Wendy Sauberli
Prevalence of overweight and obesity among children and adolescents is a serious
health concern today. School-based obesity prevention programs are limited in both
quantity and quality. Even when programs have been successful in efficacy studies, few
have described dissemination efforts, and few have investigated student outcomes. The
purpose of this study was to examine the effectiveness of an obesity prevention middle
school curriculum, Choice, Control & Change (C3), shown to be efficacious under
research conditions.
The current study answered the following questions: What are the curriculum
effects on students' behaviors, psychosocial variables, and knowledge? What are the
food-related behavior goals selected by students, and their self-perceived amount of
behavior change? How are these behavioral goals and perceived amount of change
associated with demographics and contextual factors? What is the role of the lead
teachers in facilitating curriculum implementation? How do study outcomes of the
current study differ from the original study?
The study used a pre-test post-test intervention and control condition design with
750 students in a middle school in Michigan where students served as their own controls.
A survey was administered to students 3 times to assess the primary behavior outcomes
(processed packaged snacks, sweet drinks, fast food, physical activity, and sedentary
behaviors), the secondary psychosocial variable outcomes (self-efficacy, outcome
expectations, autonomy, competence.), as well as science and nutrition knowledge
outcomes.
Three of the targeted behaviors (sweet drinks consumption, TV/movies viewing,
and computer/video games playing), and two psychosocial variables (self-efficacy for
packaged snack consumption and physical outcome expectations) showed significant
changes. Science and nutrition knowledge, however, did not improve at the end of the
study. Among students' contextual factors current weight control behavior had a strong
association with self-perceived amount of behavior change.
The impacts of the current study on students were similar in trends as the original
study, even though they were not as strong, suggesting that a lead teacher model may be a
useful strategy for future dissemination of the curriculum.
TABLE OF CONTENTS
I. INTRODUCTION
1
Children Obesity
1
Behaviors Contributing to Obesity
2
Health Consequences of Dietary Behaviors
2
Health Consequences of Physical Activity Behaviors
3
Obesity Prevention
4
The Role of Schools in Obesity Prevention
4
School- Based Behavioral Interventions and Programs .... 5
Rational of the Study
6
Dissemination of the C3 Curriculum
6
Behavior Theories
8
Psychosocial Variables
9
Dissemination
10
Lead Teacher Model
11
Professional Development and Teaching Materials
12
Statement of the Problems
13
Purposes of the Study
14
Research Questions
14
Significance of the Study
15
II. LITERATURE REVIEW
17
Children Obesity
17
i
Behaviors Contributing to Obesity
18
Health Consequences of Dietary Behaviors
20
Health Consequences of Physical Activity
Behaviors
21
Obesity Prevention
23
The Role of Schools in Obesity Prevention
24
Benefits of Nutrition and Physical Activity Intervention.... 25
School-Based Behavioral Interventions and Programs
Inquiry-Based Science and Nutrition Curriculum
"Choice, Control & Change"
26
Behavior Theories
34
Psychosocial Variables
38
Dissemination
43
Lead Teacher Model
49
Professional Training & Teaching Materials
50
III. METHODS
32
53
An Implementation of the Choice, Control & Change
(C3) Curriculum
53
School Context
53
Study Design
54
Study Population
55
Intervention and Delivery
55
Choice, Control & Change (C3) curriculum
57
Professional Development
63
Lead Teacher Model
63
ii
Theoretical Framework
64
Social Cognitive Theory
64
Self- Determination Theory
65
C3 Curriculum Theoretical Framework
66
Measures
68
Instruments
69
Eat Walk Survey
69
Tell Me About You Survey
70
Understanding Science Survey
70
BiteStep Survey
70
Eating, Physical Activity, and Sedentary
Behaviors
71
Potential Psychosocial Variables
72
Knowledge
72
Student Survey
76
Data Analysis
76
Aim 1
76
Aim 2
79
Aim 3
79
Aim 4
79
Aim 5
80
Aim 6
80
IV. RESULTS
81
Demographics of Study Sample
iii
82
Results for Aim 1: Primary Behavior Outcomes
Within-Subjects Tests
83
83
Packaged Snacks
83
Sweet Drinks
87
Fast Food
90
Physical Activity
90
Sedentary Behaviors
92
Between-Subjects Tests
96
Results for Aim 2: C3 Food-Related Behavior Goals and
Self-perceived Amount of Behavior Change
96
Food-Related Behavior Goals Selected by
Students
96
Self-Perceived Amount of Behavior Change
99
Results for Aim 3: Secondary Psychosocial Variables and
Knowledge Outcomes
Within-Subjects Tests
99
101
Self-Efficacy
101
Other Psychosocial Variables
103
Knowledge
103
Between-Subjects Tests
Results for Aim 4: Demographics and Contextual Factors of
Study Participants
Contextual Factors of Study Sample
103
108
108
School Group Activities
108
Sports/Activities after S chool
110
iv
Availability of Sweet Drinks and Packaged
Snacks at Home
113
Weight Control Behaviors
113
Association of Behavior Goals and Self-Perceived Amount
of Behavior Change with Demographics and Contextual
Factors
116
Results for Aim 5: The Implementation of C3 Curriculum
Facilitated by Lead Teacher
118
Results for Aim 6: Comparison of the Current Study
and the Original Study
120
Primary Behavior Outcomes
124
Packaged Snacks
124
Sweet Drinks
124
Fast Food
124
Physical Activity
124
Sedentary Behaviors
125
Secondary Psychosocial Variables Outcomes and
Knowledge Outcomes
125
Self-Efficacy
125
Outcome Expectations
125
Autonomy and Competence
126
Knowledge
126
V. DISCUSSION
127
Primary Outcome Measures
128
Packaged Snacks
v
128
Sweet Drinks
129
Fast Food
130
Physical Activity and Sedentary Behaviors
131
Food-Related Behavior Goals and Perceived Amount of
Behavior Changes
132
Secondary Outcome Measures
134
Psychosocial Variables
134
Self-Efficacy
134
Outcome Expectations
134
Autonomy
135
Competence
136
Knowledge
136
Demographics and Contextual Factors of Students
Contextual Factors
137
137
Physical Activity and Sedentary Behaviors
137
Weight Control Behaviors
138
Availability
Association of Behavior Goals and Self- Perceived Amount of
Behavior Changes with Demographics and Contextual Factors
139
Lead Teacher Model
140
Summary
141
Strengths
141
Limitations
142
Implications for Research
143
vi
138
Implications for Practices
144
REFERENCES
145
vii
LIST OF TABLES
Table
1.
2.
3.
Page
Summary of School-Based Interventions to
Prevent Childhood Obesity
28
Summary of Interventions Examining Potential
Mediators of Dietary Behavior Change in Youth
41
Summary of school-Based Interventions of
Overweight on Psychosocial Variables of Children
44
4.
Choice, Control, & Change Curriculum
58
5.
6.
Measures of Eating and Physical Activity Behaviors
Self-Efficacy Scales for Eating and Physical Activity
Behaviors
71
73
7.
Psychosocial Variables for Eating and Physical Behaviors. 74
8.
Science and Nutrition Knowledge
75
9.
Summary of Study Data
77
10.
Demographic Characteristics of Study Population
78
11.
Repeated Measures ANOVA for Packaged Snacks
Behaviors
85
12.
Repeated Measures ANOVA for Sweet Drinks B ehaviors... 8 8
13.
Repeated Measures ANOVA for Fast Food Behaviors
91
14.
Repeated Measures ANOVA for Physical Activity and
Sedentary Behaviors
93
Summary of Behavioral Changes in the Intervention
Condition Compared to Control Condition
95
16.
Between-Subjects Test for Fast Food Consumption
97
17.
C3 Food-Related Behavior Change Goals
98
15.
viii
18.
Perceived Amount of Behavior Changes
100
19.
Repeated Measures ANOVA for Self-Efficacy
102
20.
Repeated Measures ANOVA for Psychosocial Variables.... 104
21.
Repeated Measures ANOVA for Knowledge
105
22.
Summary of Psychosocial Variables and Knowledge
Changes in Intervention Condition Compared to Control
Condition
107
23.
Contextual Factors of Students - School Group Activities.... 109
24.
Contextual Factors of Students - Hours/Week on
School Group Activities
Ill
Contextual Factors of Students - Hours/W eek on
Activities after school or on Weekends
112
Availability of Packaged Snacks and Sweet Drinks
At Home
114
25.
26.
27.
Contextual Factors of Students - Weight Control Behaviors. 115
28.
Chi Square Table for Food-Related Behavior Goals and
Self-Perceived Amount of Behavior Change
117
29.
Comparison of the Current Study and Parent Study
122
30.
Food-Related Behavior Goals and Gender
204
31.
Food-Related Behavior Goals and Race
205
32.
Food-Related Behavior Goals and Hours of Activity
at School
206
Food-related Behavior Goals and Hours of Activity
After School
207
Food-Related Behavior Goals and Weight Control
Behaviors
208
Food-Related Behaviors Goals and Availability of
Packaged Snacks at Home
209
33.
34.
35.
ix
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
Food-Related Behavior Goals and Availability of
8 Sweet Drinks at Home
210
Perceived Amount of Behavior Change in Increasing
Fruit and Vegetables Consumption and Gender
211
Perceived Amount of Behavior Change in Increasing
Fruit and Vegetables Consumption and Race
212
Perceived Amount of Behavior Change in Increasing
Fruit and Vegetables Consumption and Activities at
School
213
Perceived Amount of Behavior Change in Increasing
Fruit and Vegetables Consumption and Activities
After School
214
Perceived Amount of Behavior Change in Increasing
Fruit and Vegetables Consumption and Weight
Control Behaviors
215
Perceived Amount of Behavior Change in Decreasing
Sweet Drinks Consumption and Gender
216
Perceived Amount of Behavior Change in Decreasing
Sweet Drinks Consumption and Race
217
Perceived Amount of Behavior Change in Decreasing
Sweet Drinks Consumption and Activities at School
218
Perceived Amount of Behavior Change in Decreasing
Sweet Drinks Consumption and Activities after School
219
Perceived Amount of Behavior Change in
Decreasing Sweet Drinks Consumption and Weight
Control Behaviors
220
Perceived Amount of Behavior Change in
Decreasing Sweet Drinks Consumption and
Availability of Sweet Drinks at Home
221
Perceived Amount of Behavior Change in
Decreasing Packaged Snacks Consumption and
Gender
222
x
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
Perceived Amount of Behavior Change in
Decreasing Packaged Snacks Consumption and
Race
223
Perceived Amount of Behavior Change in
Decreasing Packaged Snacks Consumption and
Activities at School
224
Perceived Amount of Behavior Change in
Decreasing Packaged Snacks Consumption and
Activities after School
225
Perceived Amount of Behavior Change in Decreasing
Packaged Snacks Consumption and Weight Control
Behaviors
226
Perceived Amount of Behavior Change in Decreasing
Packaged Snacks Consumption and Availability of
Packaged Snacks at Home
227
Perceived Amount of Behavior Change in Decreasing
Fast Food Consumption and Gender
228
Perceived Amount of Behavior Change in Decreasing
Fast Food Consumption and Race
229
Perceived Amount of Behavior Change in Decreasing
Fast Food Consumption and Activities at School
230
Perceived Amount of Behavior Change in Decreasing
Fast Food Consumption and Activities after School
231
Perceived Amount of Behavior Change in
Decreasing Fast Food Consumption and Weight
Control Behaviors
232
xi
LIST OF FIGURES
Figure
Page
1.
Study Design
56
2.
Social Cognitive Theory
65
3.
Choice, Control & Change (C3) Theoretical
Framework
67
xii
APPENDIX
A.
BiteStep Survey
157
B.
Student Survey
169
C.
Eat Walk Survey
171
D.
Tell Me About You Survey
183
E.
Understanding Science
195
F.
Factors Analysis
202
G.
Chronbach's Alpha for Psychosocial Variables and
Knowledge Scales
203
H.
Chi Square Tables
204
I.
Impact of Choice, Control & Change (C3) on
Behavioral Outcomes
233
Impact of Choice, Control & Change (C3) on
Potential Theory Mediators of Behavior Change
235
J.
xiii
ACKNOWLEDGEMENTS
I want to express my deepest gratitude to Dr. Isobel Contento for including me in
her research team. Working with her was most enriching experience that had a significant
impact on my acquisition of nutrition knowledge and skills. Especially, I am thankful for
her guidance and support throughout the study, which enabled me to successfully
complete this dissertation.
I would like to thank Dr. Randi Wolf for her valuable critiques and suggestions,
which helped me examine and interpret data from different angles. I also want to thank
Dr. Pam Koch for her insights and experiences in working with school teachers and
children, through which I had learned a great deal of curricula implementation. I am
grateful to Dr. Philip Saigh and Dr. Kathleen Keller for being the dissertation committee
member and their valuable comments. They made the process of the defense an
unforgettable and enjoyable experience.
I would like to express my appreciation to Dr. Angela Calabrese-Barton, who
made it possible to conduct this implementation study. Many thanks also go to the lead
teacher and other science teacher at Parkside for devoting their time to teaching the C3
curriculum, completing the study, and returning the surveys.
I would like to express my appreciation to Dr. Jane Monroe for her expertise in
measurement and statistics. With her guidance, I was able to analyze the data with the
most suitable methods.
Finally, I want to thank my husband Alain and my daughter Adeline for their love,
encouragement, and support that have accompanied me throughout this journey.
xiv
DEDICATION
I would like to dedicate my dissertation to my parents, who have taught me that
repetition brings new levels of understanding.
xv
1
Chapter I
INTRODUCTION
Childhood Obesity
Prevalence of overweight and obesity among children and adolescents has
increased rapidly. Recent data from NHANES surveys (1976-1980 and 2003-2006)
show that the prevalence of obesity has increased in the United States: for children aged
2-5 years, prevalence more than doubled from 5.0% to 12.4%; for those aged 6-11 years,
prevalence more than tripled from 6.5% to 17.0%; and for those aged 12-19 years,
prevalence more than tripled from 5.0% to 17.6%. Obesity is a serious health concern for
children and adolescents today. Many studies have shown that high levels of body mass
index (BMI, kg/m2) among children and adolescents are associated with
hyperinsulinemia, hypertension, sleep apnea, social exclusion and depression (Freeman,
Dietz, Srinivasan, & Berenson, 1999; Reilly et al., 2003; Lobstein, Baur, & Uauy, 2004).
Furthermore, longitudinal studies indicate that elevated BMI values in childhood are
associated with obesity, vascular fatty streaks and fibrous plaques, left ventricular mass
(Li., 2004), a high predictive value for adult BMI levels of >=35 kg/m2 (Freedman, Mei,
Srinivasan, Berensons, & Dietz, 2007), and premature mortality in adulthood (Engeland,
Bjorge, Tverdal, & Sogaard, 2004).
2
Behaviors Contributing to Obesity
Obesity is a chronic metabolic disease resulting from an imbalance between
energy intake and energy output (too many calories consumed for the amount of calories
expended) that is mediated by genetic, environmental and behavioral factors (Daniels et
al., 2005). Among those factors influencing body weight, dietary intake, physical activity
and sedentary behavior are the primary ones influencing energy balance, and these
behaviors tend to form early and track from childhood into adulthood (Freedman et al.,
1987). According to the 2007 Youth Risk Behavior Survey in United Sates, between
1999 and 2007, students who had eaten fruits and vegetables five or more times per day
during the past week significantly decreased (from 23.9% to 21.4%), and 33.8% of
students had drunk a can, bottle, or glass of soda (not including diet soda) at least one
time per day in 2007. In addition, students who attended PE classes daily decreased
between 1991 and 1995 (from 41.6% to 25.4%), used computers 3 or more hours per day
increased between 2005 and 2007 (from 21.1% to 24.9%). Among the students who
described themselves as slightly or very overweight, those who tried to lose weight
significantly increased between 1999 and 2007 (from 41.8% to 45.2%).
Health Consequences of Dietary Behaviors
Research has shown that diets high in fat and sugar, and low in fruit, vegetables
and fiber are related to obesity, risk for type 2 diabetes (Salmeron, Mansons, & Sampfer,
1997; Vessby, Uusitupas, & Hermansen, 2001), coronary heart disease (Mann, 2002);
cardiovascular disease (Hooper, 2001), and some cancers (Howe et al., 1992; Cummings
& Bingham, 1998). In addition, the four leading causes of death in the United States
3
coronary heart disease, certain types of cancers, strokes, and diabetes mellitus are
associated with dietary excesses and imbalances (CDC, 2006). Therefore, a small
decrease in risk as a result of dietary change could produce substantial improvement in
the overall health of children (McGinnis and Nestle, 1989)
Health Consequences of Physical Activity Behaviors
A longitudinal study has indicated that children who engage in the least activity
have greater gains in adiposity; and insufficient physical activity may maintain the weight
status of obese children and adolescents and promote further unhealthy weight gain
(Moore et al., 2003). Beside inadequate amount of time spent in physical activity,
American children have increased their sedentary behaviors in television viewing and
screen time involving computer and video games (Robinson & Sirard, 2005), and these
are linked with elevated blood pressure in children (Martinez- Gomez, Tucker, Heelan,
Welk, & Eisenmann, 2009).
Promoting physical activity in young people is important because of its
physiological health benefits, and its potential influence on long-term health. According
to the 2008 Physical Activity Guidelines for children and adolescent published by the
Center for Disease Control and Prevention (CDC), every day they should do 1 hour or
more of physical activity. Most of the 1 hour should be either moderate or vigorous
intensity aerobic physical activity, and vigorous-intensity physical activity should be
included at least 3 days a week. In addition, muscle-strengthening and bone strengthening
should be included on at least 3 days a week as a part of the 1 hour a day of physical
activity.
4
Obesity Prevention
As a result of the rapid recent increases in childhood obesity, the consensus view
among health practitioners and researchers is that prevention is a public health priority
today to decrease chronic disease risk factors among children (Daniels et al., 2005;
Ogden, Carrol, & Flegal, 2008; Freedman et al., 2007). It has also been suggested that
prevention efforts should start at a young age (Lobstein et al., 2004). With the link
between body weight and the major chronic disease well- recognized in children and
adolescents, nutrition and physical activity are key components of health promotion and
disease prevention programs. Establishing healthy behaviors during childhood is easier
and more effective than trying to change unhealthy behaviors during adulthood. However,
overall, the health impact of school education programs on children and adolescents
today is modest due to limited time on nutrition and physical activity topics (Story,
Kaphingst, & French, 2006), and limited funding for nutrition and physical activity
programs according to the School Health Policies and Programs Study (SHPPS)
published in 2006.
The Role of Schools in Obesity Prevention
Research has indicted that establishing healthy behaviors during childhood is
easier and more effective than trying to change unhealthy behaviors during adulthood
(Baranowski et al., 2000). Many school-based behavioral intervention programs have
been implemented aimed at improving diet and physical activity practices and decreasing
sedentary behavior to prevent or reduce childhood overweight and obesity (Brown &
Summmerbell, 2009). Schools can play a critical role in promoting the health of young
5
people and helping them establish lifelong healthy behavior patterns. The nation's
126,000 schools can provide many opportunities for students to practice healthy
behaviors such as eating healthy foods and participating in physical activity; and each
school day is an opportunity for the nation's 56 million students to learn about health and
practice the skills that promote healthy behaviors (CDC, 2006).
School- Based Behavioral Interventions and Programs
Several obesity prevention programs have been conducted to help children and
adolescents balance energy intake and expenditure. These programs have addressed
nutrition, physical activity, television viewing or some combination thereof. Among 64
papers published between 1966 and October 2004 that included a control measurement
and at least a six month follow up period, eight nutrition and physical activity
interventions were included in a meta-analysis and resulted in significantly reductions in
body weight compared with control (Katz, O'Connell, Njike, Yeh, & Nawaz, 2008).
However, as there was a high degree of heterogeneity associated with reporting bias,
differences in the intensity or duration of interventions, the effect size, the robustness of
these findings is limited.
Among the school-based randomized controlled trials to prevent children obesity
published between 1990 and September 2007 (Brown & Summerbell, 2009) with at least
twelve weeks of duration, only fifteen studies showed significant improvement in mean
body mass index. However, with large variation in design, content, participants, methods,
length of the study, and delivery methods in school based programs or interventions, it
was difficult to generalize information about what interventions are effective. In addition,
6
the majority of the studies did not provide adequate data for meta-analysis and in some
cases authors' reporting was the only source for determining significant or nonsignificant effects of the interventions (Brown & Summerbell, 2009).
The overall findings from various studies are limited in both quantity and quality.
In response to these considerations, an inquiry-based science education curriculum was
developed by applying methodological theories and psychosocial variables to address
behaviors of youth, and help them understand why to take action and how to change
behaviors.
Rationale for the Study
Dissemination of the C3 Curriculum
The Choice, Control & Change (C3) curriculum is an innovative inquiry-based
science curriculum designed with the application of social cognitive theory and self
determination theory to provide middle school students scientific and nutrition
information about the complex roles of biology and to provide them with skills to make
healthy food and physical activity choices (Contento, Koch, Lee, Sauberli, & CalabreseBarton, 2007). A twenty-four lesson curriculum focuses on hands-on experiences that
generate enthusiasm and curiosity for children and provide them with valuable learning
experiences. Since children learn best when they can link new information to something
they already know, it is most effective to introduce a new concept by providing children
with inquiry-centered experiences (National Academy of Sciences, 1997). It is
hypothesized that an educational approach that combines curriculum content that is
personally meaningful to the children, inquiry-based science education processes, and
7
skill building from behavioral theory will enhance autonomy, competence, and
relatedness to others, and increase autonomous motivation for healthful eating and
activity behaviors that are likely to help children achieve a healthy weight and reduce the
risk of chronic disease (Contento et al., 2007).
The targeted behaviors for the students to change in C3 curriculum are: adding
fruits and vegetables to the diet, increasing walking time; reducing the intake of
sweetened beverages and packaged snacks; and the frequency of eating at fast food
restaurants with the aim of reducing the risk of obesity. Psychosocial variables associated
with their behaviors and knowledge in nutrition and science are also assessed. To assess
the impact of the C3 curriculum on students' eating and physical activity practices, a
randomized controlled study was conducted in 10 middle schools in New York City in
East Harlem, Washington Heights, and Bronx between 2006 and 2007. The study
outcomes indicated that the C3 curriculum was effective in improving students' physical
activity and sweetened beverage behaviors, the psychosocial variables such as beliefs,
self-efficacy, autonomy, and competence, and knowledge in science and nutrition (Lee,
2009). Although the C3 curriculum was shown to be effective in changing students'
behaviors, it was considered desirable to evaluate the impacts of the curriculum at a
different location under less tightly controlled conditions to see if the same results could
be achieved. Hence, the current study was conducted as a dissemination of the C3
curriculum in a different setting using a lead teacher model.
8
Behavior Theories
Several large intervention trials have evaluated strategies to promote healthful
behavior, and most of these trials have used conceptual models of behavior change
(Glanz, Kristal, Sorensen, Palombo, Heimendinger, & Probart, 1993). For example,
behavioral research has shown that people's behavior is motivated by a strong sense of
being able to exert personal influence over their environment as described in Social
Cognitive Theory (Bendura, 2001), as well as their own behaviors through self-reflective
and cognitive self-regulatory processes as described in Self- Determination Theory (Ryan
& Deci, 2000).
Social cognitive theory (SCT) posits that one's behavior is the result of personal,
behavioral, and environmental factors, and that these factors influence each other (triadic
reciprocal causation) (Bandura, 1986). Self-efficacy (Bandura, 1986) refers to an
individual's perception of his or her skills and abilities to perform a particular behavior
effectively and completely; and personal agency (Bandura, 2001) is a collective system
operating within a broad network of socio-structural influences characterized by a
number of core features including intentionality, forethought involving goal setting and
outcome expectations, self-reactiveness, and self-reflectiveness about ones' functioning
and the meaning and purpose of one's life pursuits. Several school-based interventions
(CATCH (Perry et al., 1990), Planet Health (Gortmaker et al., 1999), Gimme 5 study
(Baranowski et al., 2000), and Pathways study (Caballero., et al., 2003) applied social
cognitive theory to reduce obesity risks and demonstrated some positive results.
Self- determination theory (SDT) postulates three innate psychological needs,
relatedness, autonomy, and competency, which, when satisfied, enhance the individual's
9
intrinsic motivation, self regulation, and well-being (Ryan & Deci, 2000). Some studies
that examined the effectiveness of SDT in enhancing motivation of populations to
decrease risk factors of negative conditions such as BMI, obesity, and body image
(Edmunds, Roche, Stratton, Wallymahmed, & Glenn, 2007; Vierling, Standage, &
Treasures, 2007), and the effects in changing exercise behaviors (Edmunds et al., 2007)
showed some positive outcomes predicted by autonomous motivation which includes
intrinsic motivation and some forms of extrinsic motivation.
Psychosocial Variables
In order to design an effective intervention or program for children and
adolescents to reduce obesity, it is necessary to understand the factors that determine
eating and physical activity behaviors in these populations (McClain, Chappuis, NguyenRodrigues, Yaroch, & Spruijt-Metz, 2009). Baranowski, Lin, Wester, Resnicow, & Hearn
(1997) point out that mediating variables are in a cause-effect sequence between an
intervention and an outcome, and they are the influences on the behaviors of interest and
come from the theoretical or conceptual models of behavior. Programs or interventions
thus change behavior due to changes in the mediating variables, which in turn result in
changes in the desired physiological and anthropometric outcomes. Thus, it is critical to
identify factors and mechanisms that facilitate the translation of behavior-change research
evidence into effective delivery and dissemination of programs in practice (Cerin, Barnett,
& Baranowski, 2009).
Including mediating variables in intervention studies has proved to be beneficial
to understanding the mechanisms of behavior change (MacKinnon & Dwyer, 1993).
Many school-based intervention trials designed to influence psychosocial variables to
change behaviors; and many of them were relatively unsuccessful in changing mediators
(Cerin et al., 2009; McClain et al., 2009; Van Wijnen, Wendel-Vos, Wammes, &
Bernelmasn, 2009). Among those few that seemed to have impacts on behavior change,
outcome expectations, self-efficacy, and habit seem to be most important (Cerin et al.,
2009).
Dissemination
Where effectiveness of school-based nutrition education programs in improving
students' knowledge, attitudes, and behavior has been demonstrated, Basch (1984) called
for investigation of efficient ways to disseminate and implement these health and
nutrition education programs. The impact of a school-based health promotion program
depends not only on its efficacy, but also on the extent to which it reaches its target
audience. Once a program has been found to be effective with specific approach and
methods, dissemination efforts can enable its distribution on a wider scale on the exact
same elements (Kolbe, 1986). However, Anderson and Portnoy (1989) noted that
dissemination remains virtually ignored after researchers have sought funds to develop
and evaluate health promotion materials; and little attention has been given to the future
distribution, implementation and maintenance of materials.
Several studies have evaluated the dissemination of school-based health
promotion programs: the Smart Choices Project (Parcel et al., 1989) was disseminated
using a four-stage diffusion of innovation model including dissemination, adoption,
implementation and maintenance in Texas to understand diffusion of tobacco prevention
11
program in schools; an intervention designed by Steckler, Goodman, McLeroy, Davis, &
Koch (1992) was disseminated to junior high schools in North Carolina to prevent
tobacco use; the Nutrition for Life program (Olson, Devine, & Frongillo, 1993) was
disseminated to New York State secondary schools to implement nutrition teaching; the
Ways to 5 a Day study (Harvey-Berino, Ewing, Flynn, & Wick, 1998) was disseminated
to elementary schools to increase fruit and vegetable consumptions; the CATCH program
(Hoelscher et al., 2004) was disseminated throughout Texas to decrease fat, saturated fat,
and sodium in the diet, and increase physical activity; and the Exercise Your Option
program (Romero et al., 2006) was disseminated to middle schools in California to
promote eating healthfully and being physically active.
Today, how to bridge the gap between health promotion interventions and its
subsequent dissemination and adoption in school settings is not well documented. Despite
the advantages of utilizing school setting for interventions, schools do not typically
incorporate enough nutrition or physical activity in the curricula to influence behaviors.
Numerous factors such as support of school administrators, teacher training and resources
have prevented interventions from being disseminated and implemented fully in the
classrooms (WHO, 1996; Auld, Romaniello, Heimendinger, Hambidge, & Hambidge,
1998).
Lead Teacher Model
Many school districts have initiated a professional development model that uses a
small group of teachers, called lead teachers, who have demonstrated interest and
expertise in science teaching (National Academy of Sciences, 1997). This lead teacher
12
model typically involves a teacher in the role of curriculum resource person to mentor
others in the school in planning and teaching; conduct professional development
activities for other teachers; design approaches and instructions to improve students'
achievement; assist with materials support issues; and provide a bridge between teachers.
Lead teachers also provide leadership and work with family and community leaders on
learning curricula (Reys and Fennell, 2003). For example, in June 2004, The United
Federation of Teachers (UFT) and the NYC Department of Education launched a oneyear pilot "lead teacher program" in 10 schools of south Bronx's district 9. It was an
innovative effort for lead teachers to mentor less-experienced colleagues in some of the
city's lowest performing schools, and increase teacher retention and quality as well as
student achievement.
Professional Development and Teaching Materials
The teacher is a critical classroom component that influences whether or not
intervention occurs and is ultimately successful. Research evidence has indicated that
often the best way for teachers to become motivated and involved in curriculum is by
participating in professional development programs (Fishman, Marx, Best, & Tal, 2003).
In professional development, teachers can gain content knowledge of a curriculum topic
and better understand the rationale behind the curriculum. In addition, changes in the
beliefs and attitudes of teachers that lead to the acquisition of new skills, new concepts,
and new process related to the work of teaching often occur after professional
development (Cohall et al., 2007).
The curriculum materials designed to promote teacher learning as well as student
learning are called "educative curriculum materials" (Ball & Cohen, 1996). Such
curriculum material serve as cognitive tools to help to increase teachers' knowledge in
specific instructional decision making but also help them develop more general
knowledge so they learn how to teach the content and apply it flexibly in new situations
(Davis & Krajcik, 2005). More specifically, Davis & Krajcik (2005) pointed out that
educative curriculum materials can help teachers support teachers' learning of subject
matter; learn how to anticipate and interpret what learners may think about or do in
response to instructional activities; and help teachers consider ways to relate units during
the year.
Statement of the Problem
In recent years school-based interventions have been perceived as an important
approach to preventing childhood obesity. Programs addressing dietary practices and
physical activity implemented in school- settings have shown modest levels of efficacy
(Thomas, 2006). In addition, how to bridge the gap between successful interventions and
their subsequent dissemination in school settings is not well documented. Despite the
advantages of utilizing the school setting for dissemination, schools do not typically
adopt successful interventions or incorporate enough nutrition or physical activity in the
curricula to influence behaviors.
The teacher is a critical component in influencing whether or not dissemination
occurs and its ultimate success. While teachers are viewed as central to the dissemination
process, teaching materials, teacher trainings, teachers' motivation all have impacts on
the likelihood that a teacher will conduct health/nutrition education (Auld, Romaniello,
Heimendinger, Hambidge, & Hambidge, 1999). To support teachers and enhance the
quality of teaching, the lead teacher model has been used in science classes of several
school districts (National Academy of Sciences, 1997). However, studies using a lead
teacher model to disseminate evaluated curricula and further evaluating student outcomes
are lacking today.
Purpose of the Study
The main purpose of the study was to examine the effectiveness of a research
evaluated curriculum in changing students' eating and physical activity behaviors,
psychosocial variables related to behaviors, and knowledge in nutrition and science at
one disseminated location using a lead teacher model. Second, the study aimed to assess
students' food- related behavior goals and self-perceived amount of behavioral change.
Third, the study also aimed to investigate students' demographics and contextual factors
in order to understand their roles on the outcome measures of the students. Lastly, the
study aimed to compare the outcomes of the current study with that of the original study.
This information is important for future dissemination of the curriculum using a lead
teacher model.
Research Questions
The specific research questions are:
1. What are the impacts of the C3 curriculum on eating behaviors (packaged snacks,
sweet drinks, fast food), physical activity (intensive sports and exercise, walking
15
and taking stairs), and sedentary behaviors (TV/movies watching, computer/video
games playing)?
2. What are the food-related behaviors goals (increasing fruit and vegetables intake,
decreasing packaged intake, decreasing sweet drinks intake, decreasing fast food
intake) selected by students, and their perceived amount of behavior change
related to specific goals?
3. What are the impacts of the C3 curriculum on
a. Psychosocial variables (self-efficacy, physical and social aspects of outcome
expectations, autonomy, and competency)
b. Science and nutrition knowledge?
4a. What are the demographics of students (gender, race/ethnicity), and their
contextual factors (activities at school and after school, weight control behaviors,
and availability of sweet drinks and packaged snacks at home) ?
4b. How are self- selected behavior goals and perceived amount of changes
associated with demographics and contextual factors?
5. What is the role of lead teacher in facilitating the implementing the C3 curriculum?
6. How do study design, study sample, study evaluation, and study outcomes
differ between the current study and the parent study?
Significance of the Study
School-based nutrition and physical activity education represents an important
opportunity for improving the health-related knowledge, attitudes, and practices of
children and youth (Healthy People, 2000). This current study will support President
16
Obama's nationwide health campaign launched in 2009 to battle childhood obesity in this
country by teaching American's children about better nutrition and exercise in school.
This current study is the first, to our knowledge, to examine a school- based
nutrition and physical activity curriculum disseminated to a new site led by a lead teacher.
Thus, this study will provide important research data on the role of lead teacher in
facilitating dissemination of the C3 curriculum for future research and practice.
Furthermore, this study will make a significant contribution to research by identifying
external factors associated with eating and physical activity behaviors. Lastly, this study
will also contribute to the existing research on preventing childhood obesity by providing
important information for researchers to understand the gap between theory, science and
practice and to facilitate the translation of behavior-change research evidence into
practice.
17
Chapter II
LITERATURE REVIEW
Children Obesity
Prevalence of overweight and obesity among children and adolescents has
increased rapidly. Recent data from NHANES surveys (1976-1980 and 2003-2006)
show that the prevalence of obesity has increased in the United States: for children aged
2-5 years, prevalence more than doubled from 5.0% to 12.4%; for those aged 6-11 years,
prevalence more than tripled from 6.5% to 17.0%; and for those aged 12-19 years,
prevalence more than tripled from 5.0% to 17.6%. Obesity is a serious health concern for
children and adolescents today.
Many studies have shown that high levels of body mass index (BMI, kg/m2)
among children and adolescents are associated with adverse effects on health. A large
body of evidence has demonstrated that childhood obesity is strongly associated with the
presence of clustering of cardiovascular risk factors in childhood (Reilly et al., 2003). In
the study by Li et al. (2004), young adults aged 20 to 38 years were examined an average
of 6 times for cardiovascular risk factors. The results indicated that adiposity (measured
as body mass index) in childhood, and the cumulative burden of adiposity and systolic
blood pressure from childhood to adulthood were significant predictors of left ventricular
hypertrophy in young adults. In addition, other health risks such as hypertension
(Freeman et al., 1999), hyperinsulinemia, sleep apnea, low self-esteem and depression
have also been seen in severely obese children (Lobstein et al., 2004). In Norwegian
health surveys conducted between 1963 and 1999 to measure height and weight for
adolescents with an average of 9.7 years follow-up, the results indicated that obesity
seemed to be predictive of both adult obesity and mortality (Engeland et al., 2005).
Body mass index (BMI) is a number calculated from a person's weight and height
to provide a reliable indicator of body fatness for most people, and is used to screen for
weight categories that may lead to health problems (CDC, 2009). Children with a BMIfor-age >=95th percentile of the Centers for Disease Control (CDC) growth charts are
considered to be "obese," and with a BMI-for- age >85th percentile and <95th percentile
are considered to be "overweight". Children and adolescents who have high levels of
BMI relative to their sex and age peers are more likely to have multiple risk factors,
excessive adiposity, and a high risk for adult obesity. In addition, the 99th percentile of
BMI-for-age is associated with a greatly increased frequency of biochemical
abnormalities, and has a high predictive value for adult BMI levels of >=35 kg/m2
(Freedman et al., 2007).
Behaviors Contributing to Obesity
Among those factors influencing body weight, dietary intake, physical activity,
and sedentary behavior are the primary behaviors influencing energy balance, and these
behaviors tend to form early and track from childhood into adulthood (Freedman et al.,
1987). According to the Youth Risk Behavior Survey findings in 2007, students who had
eaten fruits and vegetables five or more times per day a week significantly decreased
between 1999 and 2007 (from 23.9% to 21.4%). Overall, the prevalence of having eaten
fruits and vegetables five or more times per day was higher among male (22.9%) than
19
female (19.9%) students; and higher among black (24.9%) and Hispanic (24.0%) than
white (18.8%) students. Further, 33.8% of students had drunk a can, bottle, or glass of
soda or pop (not including diet soda or diet pop) at least one time per day. Overall, the
prevalence of having drunk soda or pop at least one time per day was higher among male
(38.6%) than female (29.0%) students; and higher among white (40.6%) than other
students.
In terms of physical activity, the percentage of students who attended physical
education classes daily decreased between 1991 and 1995 (from 41.6% to 25.4%) and
then did not change significantly between 1995 and 2007 (from 25.4% to 30.3%)
according to the 2007 Youth Risk Behavior Survey System. Only 34.7% of students met
recommended levels of physical activity that increased their heart rate and made them
breathe hard for a total of at least 60 minutes per day on 5 or more days a week. Overall,
the prevalence of attending PE classes was higher among male (57.7%) than female
(49.4%) students; and higher among Hispanic (61.0%) than other students.
In terms of sedentary behaviors, nationwide, 35.4% of students watched television
3 or more hours per day on an average school day (2007). Overall, the prevalence of
having watched television 3 or more hours per day was higher among male (37.5%) than
female (33.2%) students, and higher among black (62.7%) and Hispanic (43.0%) than
white (27.2%) students. Further, the percentage of students who used computers 3 or
more hours per day increased between 2005 and 2007 (from 21.1% to 24.9%). Overall,
the prevalence of using computers 3 or more hours per day was higher among male
(29.1%) than female (20.6%) students, and higher among black (30.5%) and Hispanic
(26.3%) than white (22.6%) students.
In terms of weight control behaviors, a significant linear increase of students
(from 41.8% to 45.2%) tried to lose weight occurred between 1999 and 2007, and 15.8%
of students (2007) took diet pills, vomited or took laxatives to lose weight or to keep
from gaining weight in the past 30 days.
Health Consequences of Dietary Behaviors
Diets high in fat and sugar, and low in fruit, vegetables and fiber have been
related to obesity, and the risks for type II diabetes (Salmeron et al., 1997; Vessby et al.,
2001), coronary heart disease (Mann 2002), and cardiovascular disease (Hooper, 2001).
In the KANWU study, replacement of saturated fat with monounsaturated fat was
associated with improvement in insulin sensitivity, and reduced risk of developing type 2
diabetes since resistance to the action of insulin is the underlying abnormality in most
cases of type 2 diabetes (Vessby et al., 2001). Furthermore, the results from the Nurses'
Health Study indicated that a risk of diabetes was associated with diets high in high
glycemic index foods, and reduced amounts of cereal fiber (Salmeron et al., 1997).
The epidemiological and experimental evidence has demonstrated that saturated
fatty acids have a deleterious effect not only on cardiovascular risk mediated by
lipoproteins, but they also enhance thrombogenesis (Mann, 2002). In a systematic review
(Hooper, 2001) assessing the effect of medication of dietary fat on risk of coronary heart
disease demonstrated that reduction or modification of intake of dietary fat reduced the
incidence of combined cardiovascular events by 16%, and cardiovascular deaths by 9%.
When assessing trials that continued for longer than 2 years, the benefit was even greater
with a 24% reduction in all cardiovascular events.
21
Based on the review by the Committee on Diet and Health, National Research
Council (1989), the evidence is highly suggestive for certain forms of cancers, especially
cancers of the large bowel, breast, and prostate. In a review of 13 pre-1992 case control
studies by Howe et al. (1992), the results indicated that dietary intake of fiber decreased
the risk of colon and rectum cancers. It is also suggested that fruits, vegetables, and fiber
have a protective effect, and up to 80% of bowel and breast cancer may be preventable by
dietary change (Cummings & Bingham, 1998).
Today, four leading causes of death in the United States including coronary heart
disease, certain types of cancers, strokes, and diabetes mellitus are associated with dietary
excesses and imbalances (CDC, 2006). Since dietary factors can be some of chronic
diseases causes, even small modifications in dietary patterns could produce substantial
improvement in the overall health of population (McGinnis et al., 1989).
Health Consequences of Physical Activity Behaviors
At a basic level, obesity is a consequence of an imbalance of in energy intake and
expenditure. A longitudinal study (Moore et al., 2003) indicated that children who
engaged in the least activity had greater gains in adiposity; and insufficient physical
activity might maintain the weight status of obese children and adolescents and promote
further unhealthy weight gain. The results showed that children in the highest tertile of
average daily activity from age 4 to 11 years had consistently smaller gains in BMI,
triceps, and sum of five skinfolds throughout childhood and early adolescence.
Beside inadequate amount of time spent in physical activity, American children
have increased their sedentary behaviors such as television/movies watching, and
computer/video games playing. Reduced energy expenditure from displacement of
physical activity and increased dietary energy intake either during television viewing, or
as a result of food advertising, these behaviors have been suggested as two primary
mechanism of contributing to obesity (Robinson & Sirard, 2005).
A randomized controlled school-based study by Robinson (1999) assessed the
efficacy of 6 month classroom curriculum in reducing television, videotape and video
game use on changes in adiposity, physical activity, and dietary intake. The study results
showed that children in the intervention group had statistically significant relative
decreases in body mass index, triceps skinfold thickness, waist circumference, and waistto —hip ratio compared with control group due to television viewing and meal eaten in
front of television. Furthermore, a cross-sectional study with children by MartinezGomez et al. (2009) showed that sedentary behaviors, particularly TV viewing and
screen time were positively associated with both systolic blood pressure and diastolic
blood pressure in children independent of body composition.
According to the 2008 Physical Activity Guidelines published by the Center for
Disease Control and Prevention (CDC), children and adolescents should do 1 hour or
more of physical activity each day, and include vigorous-intensity aerobic activity at least
3 days per week to improve cardiorespiratory fitness. In addition, muscle-strengthening
activities to make the major muscle groups of the body such as legs, hips, back, abdomen,
chest, shoulders, and arms do more work than usual during daily life; and bonestrengthening activities to produce a force on the bones that promotes bone growth and
strength through impact with the ground should be included on at least 3 days a week as a
part of the 1 hour a day of physical activity.
23
Obesity Prevention
As a result of the rapid recent increases in childhood obesity, the consensus view
among health practitioners and researchers is that prevention is a public health priority
today to decrease chronic disease risk factors among overweight children (Daniels et al.,
2005; Freedman et al., 2007; Ogden et al., 2008). It also been suggested that prevention
efforts should start at a younger age for several reasons (Lobstein et al., 2004): (1)
motivation may be easier to generate and maintain while the child is young; (2) it can be
easier to control and modify behavior in younger individuals since there may be less
resistance to treatment stigmatization; (3) there may be more frequent opportunities for
medical observation during earlier childhood compared with later years. For example, a
cognitive behavioral approach such as education in schools with the provision of dietary
advice, healthful foods and physical activity in groups have been used as prevention
efforts for childhood obesity or to improve the prognosis when it develops (Lobstein et
al., 2004).
With the link between excess weight and the major chronic disease among
children and adolescents well-recognized, many schools have included nutrition and
dietary topics in the health and physical education curricula to improve students' dietary
and physical activity practices. However, overall, the health impact of school education
programs on children and adolescents today is modest partly due to the fact that health
teachers reported on average spending only 5 hours per year covering nutrition and about
4 hours per year to teach physical activity topics (Story et al., 2006), not nearly enough to
affect students' behaviors. In addition, the results according to the School Health Policies
and Programs Study (SHPPS, 2006), a national survey periodically conducted to assess
school health policies and programs, showed that only 32.1% of school districts provided
funding for or offered staff development on nutrition education, and 36.3 % of school
districts provided funding for or offered physical activity programs. Thus, more nutrition
and physical activity programs will be needed to meet growing demand in schools.
The Role of Schools in Obesity Prevention
With the link between body weight and the major chronic diseases now wellrecognized in children and adolescents, the Surgeon General called (2001) for conducting
research on the relationship of healthy eating an physical activity to improve student
health; evaluating school-based behavioral health interventions for the prevention of
overweight in children; developing an ongoing, systematic process to assess the school
nutrition and physical activity environments; and planning, implementing and monitoring
improvements in nutrition and physical activity programs. Such dietary and physical
activity programs can be justified for at least four reasons: (1) the child might receive
immediate benefits in terms of health, cognitive abilities, and emotional functioning; (2)
intervention at critical periods in physical growth and maturation in childhood might
enhance adult health; (3) modifying chronic disease risk factors in childhood might lead
to lower disease rates and risk factors in the adult years; and (4) modifying behavioral
preferences or practices in childhood might lead to altered behaviors in adulthood that
would afford protection from chronic disease at that time (Baranowski et al., 2000).
Reversing the obesity epidemic requires a long-term, well-coordinated approach
to reach young people where they live, learn, and play (CDC, 2008). School is an
important setting for implementation of interventions with its infrasturecture and physical
25
environment and personnel, as they can offer continual, intensive contact with children
during their formative years and have potential to positively influence child health (Katz
et al., 2008). Thus, the nation's 126,000 schools are ideal for reshaping social and
physical environments and providing information, tools, and practical strategies to help
students adopt healthy eating habits and physical activity because more than 95% of
young people, approximately 56 million are enrolled in schools (U.S. Census Bureau,
2009), where they have the opportunity to eat a large portion of their daily food intake
and to be physically active.
To support school practices to address childhood obesity, the Centers for Disease
Control & Prevention (CDC) have identified guidelines containing different
recommendations that are most likely to improve healthful behaviors among young
children. Those guidelines include implementing a high-quality course of study in health
education and physical education to teach skills needed to adopt healthy eating and
physical activity, and provide opportunities to practice those skills and overcome barriers
to adopting behaviors (CDC, 2004).
Benefits of Nutrition and Physical Activity Interventions
Many intervention programs have been implemented aimed at improving nutrition
and physical activity practices and decreasing sedentary behavior to prevent or reduce
childhood overweight and obesity (Brown & Summerbell, 2009). To support each of
these justifications, Baranowski et al. (2000) reviewed and summarized research evidence
in four areas. First, diet has been related to the development and proper function of many
physiological processes, and children who are healthy are also better prepared to learn
and achieve educationally (Dietz, 1998). Second, diet has been related to linear growth
and bone mineralization, and physical activity promotes fat-free mass, bone formation
and growth (Rowland, 1996). Third, in the Muscatine study (Lauer, Clarke, Mahoney, &
Witt, 1993), the results suggested that heavier children were most likely to become
heavier adults. Fourth, in a study of elementary school children, dietary change
intervention related fruit and vegetables intake reduced the tracking of dietary behaviors
over time (Resnicow, Smith, Baranowski, Baranowski, Vaughan, & Davis, 1998).
Among those four justifications, Baranowski et al. (2000) stated that the immediate
benefits for children's health, cognitive abilities and emotional function is the strongest
case for offering behavioral interventions in diet and physical activity to children and
adolescents.
School-Based Behavioral Interventions and Programs
In response to the threat of children obesity, there have been several obesity
studies in recent years conducted at school to regulate the balance between energy intake
and expenditure for children and adolescents. To determine the effectiveness of schoolbased strategies for obesity prevention, a systemic review and meta-analysis was
conducted among the peer-reviewed studies published between 1966 and October 2004
(Katz et al., 2008). Among 64 studies considered for review, only 8 randomized
controlled studies including nutrition and physical activity intervention provided
adequate data for the meta-analyses. The results showed that nutrition and physical
activity interventions resulted in significant reduction in body weight compared with
control; and parental and family involvement of nutrition and physical activity
intervention also induced weight reduction. However, since the robustness of the findings
from the analyses is limited and there is a high degree of heterogeneity among the studies
that is often associated with reporting bias, differences in the intensity or duration of
interventions, a definitive guidance toward the optimal school-based strategies for obesity
prevention and control could not be provided at that time (Katz et al., 2008).
Among the school-based randomized controlled trials to prevent children obesity
published between 1990 and September 2007 with at least 12 weeks of duration (Brown
& Summerbell, 2009), one diet study (Ask et al., 2006), five physical activity studies
(Flores, 1995; Mo-suwan et al.,1998; Stephens et al., 1998; Robinson et al., 1999; Lazaar
et al., 2007), and nine combined diet and physical activities studies (Gortmaker et al.,
1999; Sallie et al., 2003; Kain et al., 2004; Haerens et al., 2006; Spiegel & Foulk, 2006;
Rosebaum et al., 2007; Taylor, 2007; Kafatos et al., 2007; Eliakim et al., 2007) showed
significant improvement in mean body mass index (Table 1).
In the diet study by Ask et al. (2006), BMI increased significantly in both male
and female in the control group, but not in the intervention group. In the physical activity
study by Flores (1995), a statistically significant reduction in BMI between intervention
and control groups among girls at 12 weeks (intervention: 22.1 (SD 6.0), control 22.5
(SD 4.4)) but not among boys. In the study by Mo-suwan et al. (1998), both intervention
and control groups experienced reduction in BMI and not significantly different between
groups at 30 weeks (intervention: 15.76 (SD 2.46), control: 15.94 (SD 2.26)).
In the study by Stephens et al. (1998), the control group gained significantly more
weight, and there was a significant decrease in skin-fold thickness in intervention group
(intervention: 25.8, control: 27.0). In the study by Robinson (1999), the intervention
Reducing TV, videotape, and video BMI significantly decreased in the
games
intervention group
198 (Age 8.9)
425 (Age 7.4)
Robinson (1999)
Lazaar (2007)
Change in anthropometric variables was
greater in girls; and a greater response in
obese children than non-obese children
BMI significantly increased in the control
group
Supplementary program of
physical activity
unclear (Age 8.4)
Stephens & Wentz (1998)
Physical activity program
BMI reduced in both intervention and
control groups and not significantly different
between groups
Aerobic exercise program
310 (Age 4.5)
Mo-suwan (1998)
BMI significantly reduced between
intervention and control girls
BMI significantly increased in the control
group
Results
Aerobic dance program
Introducing breakfast
Intervention
81 (Age 12.6)
54 (Age 15)
No. of Subjects
Flores (1995)
Physical activity intervention
Ask (2006)
Diet Intervention
Author (Year)
Summary of School-Based Interventions to Prevent Childhood Obesity (Brown, 2009)
Table 1
3577 (Age 10.6)
2991 (Age 13)
1013 (Age 9.5)
79 (Age 14)
469 (Age 7.7)
Kain(2004)
Haerens (2006)
Spiegel (2006)
Rosenbaum (2007)
Taylor (2007)
BMI significantly reduced among boys in the
intervention group
Prevalence of obesity among girls reduced
in the intervention group
Results
Diet and PA
Health, nutrition and PA
Multidisciplinary program
Health promotion program
BMI significantly lower in the intervention group
BMI significantly lower in the intervention group
intervention group.
A 2% reduction in overweight youth in the
BMI increased significantly less among girls in
the intervention group
Nutrition and Physical activity BMI significantly increased among boys in the
control group
1109 (Age unknown) Fat intake and PA
Sallis(2003)
Planet Health Program
Intervention
1560 (Age 11.7)
No. of Subjects
Gortmaker (1999)
Diet and physical activity
intervention
Author (Year)
Summary of School-Based Interventions to Prevent Childhood Obesity (Brown, 2009)
Table 1 (Continue)
K>
962 (Age 6)
101 (Age 5-6)
Eliakim (2007)
No. of Subjects
Kafatos (2007)
Diet and physical activity
Intervention
Author (Year)
Health promotion program
Health, nutrition, PA
Intervention
BMI significantly different between intervention
and control groups
BMI significantly lower in the intervention group
Results
Summary of School-Based Interventions to Prevent Childhood Obesity (Brown, 2009)
Table 1 (Continue)
group had statistically significant relative decreases in BMI 18.38 to 18.67 kg/m2
vs. 18.10 to 18.81 kg/m2 in the control group. In addition, intervention group changes
were accompanied by statistically significant decrease in children's reported television
viewing and meals eaten in front of the television relative to controls. In the study by
Lazaar (2007) et al., average BMI remained unchanged overtime; however, the
magnitude of change in anthropometric variables was greater in girls, and there was a
greater response to intervention in obese children than non-obese children.
The majority of the longer-term studies (at least 1 year) were combined diet and
physical activity interventions. However, overall there did not appear to be a consistent
pattern between significant effect and the size and duration of the study.
Today, there is insufficient evidence to determine the specific elements that
contribute to effectiveness of dietary and physical activity interventions to prevent
obesity in school children due to substantial variation in measures used to assess outcome
and most of the studies relied on self-report of diet and physical activity. The overall
findings from various studies suggest that combined diet and physical activity
interventions may help to prevent children becoming overweight in the long term.
However, the totality of the evidence is limited in both quantity and quality.
To support evidence-based health interventions or programs, it is crucial to apply
good methodological theories and psychosocial variables, as well as identify methods for
evaluating effectiveness (Brown & Summerbell, 2009). In responses to these
considerations, an inquiry- based curriculum "Choice, Control, & change (C3)" was
developed to address behaviors of youth that place them at risk for obesity, and help them
understand why to take action and how to change behaviors using behavior theories.
32
Inquiry-Based Science and Nutrition Curriculum "Choice, Control & Change"
Choice, Control, & Change (C3) is an inquiry-based science-education curriculum
that focuses on hands-on experiences that generate enthusiasm and curiosity for children
and provide them with valuable learning experiences (Contento et al., 2007). The
intervention approach with inquiry-based education is to provide children opportunities to
investigate and develop understandings of the complex relationships between their
biology, the environment and personal behaviors as the basis for a meaningful rationale
for why to take action. In addition, the curriculum activities provide opportunities for
children to develop a sense of autonomy in their investigations and personal agency to
manage their actions (Bandura, 2001; Contento et al., 2007). Thus, with the inquiry-based
curriculum, children learn about making choices in selecting better food and being
physically active to regulate their body weight.
The QuESTA (Questioning, Experimenting, searching, Theorizing and Applying
into LIFE) Learning Cycle that frames science process in this curriculum is introduced to
students. In the Questioning phase, students explore their prior knowledge and
experiences related to the area of study; share their conceptions about the topic, and
develop meaningful questions to guide further inquiry. In the Experimenting phase,
student conduct experiments to identify problems, state hypotheses, select methods,
display results, and draw conclusions to answer the questions within the area of study. In
the Searching phase, students find additional information about their topics in the lessons
through searching in the library or on the computer, or interviewing people. In the
Theorizing phase, students develop their own theories and give evidence to support their
arguments, and appropriately challenge the theories of others. In the Applying to Life
phase, students process what they learned through the units and develop new questions to
for future exploration in the area of study.
There are several advantages of using inquiry based curriculum to teach students
about diet and physical activity behaviors. First, in this type of curriculum teachers
partner with students in seeking answers or explanations through experiments and present
findings instead of answering student questions. Second, asking open-ended questions to
promote reflection and further question using the QuESTA lesson resources as a guide is
important to enhance students' scientific habits of mind. Third, by connecting the topics
addressed in the curriculum to everyday life, students will learn about their own food
choices and physical activity behaviors, and make positive changes to their choice based
on what they learn and discuss in the class. Fourth, inquiry-based curriculum promotes
hands-on learning and active participation, teamwork, and collaboration to draw on
different viewpoints and skills for solving problems. The questions asked at the end of
each unit in the curriculum are to encourage students to think, explore, question,
investigate, analyze, synthesize and act, and to help reinforce the concepts (Contento et
al., 2007).
To assess the impact of the C3 curriculum on students' eating and physical
activity practices, a randomized control study was conducted in 10 middle schools in
New York City in East Harlem, Washington Height, and Bronx between 2006 and 2007
that the schools were matched based on the size of school, ethnicity, percentage of
students qualifying for free/reduced lunch, and reading and math test scores. The
intervention schools received C3 curriculum, and the comparison schools received
standard science curriculum provided by their schools and received the C3 curriculum in
the following term as a delayed intervention (Lee, 2009).
The targeted behaviors in C3 curriculum were: adding fruits and vegetables to the
diet, increasing walking and taking stairs; reducing the intake of sweetened beverages
and packaged snacks; and reducing the frequency of eating at fast food restaurants with
the aim of reducing the risk of obesity. In addition, psychosocial variables such as
intention to change, beliefs about outcomes of behavior, perceived barriers, self efficacy,
and self- determined motivation associated to behaviors and knowledge in nutrition and
science were also assessed at the end of curriculum.
While the study outcomes indicated that the C3 curriculum was effective in
improving students' physical activity and sweetened beverage behaviors and the
psychosocial variables such as beliefs, self-efficacy, autonomy, enjoyment, and
competence, and knowledge in science and nutrition (Lee, 2009), it is important to
evaluate the impacts of the curriculum when it is implemented at a different location
under less tightly controlled condition, so that the results can be used for future
dissemination purposes on a larger scale.
Behavior Theories
Several large intervention trials have evaluated intervention strategies to promote
healthful dietary behavior, and some of these trials have used conceptual models of
dietary behavior and behavior change. Behavior theories provide systematic sets of
hypothetical constructs, definitions, and propositions that explain or predict behavior
change by specifying the relationships between their key concepts (Cerin et al., 2009). It
is well recognized that the application of theories to the development and implementation
35
of behavioral interventions can enhance their effectiveness (Michie et al., 2008). Whereas
theories applied to behavioral interventions pinpoint possible determinants of dietary
behavior, findings from theory-based interventions provide a foundation for theory
development and refinement. Thus, there is a synergetic feedback loop between dietary
interventions and theories (Cerin et al., 2009). For example, behavioral research has
shown that people's behavior is motivated by a strong sense of being able to exert
personal influence over their environment, as well as their own behaviors through selfreflective and cognitive self-regulatory processes as described in Social Cognitive Theory
(Bandura, 1997) and Self-Determination Theory (Ryan & Deci, 2000).
Social cognitive theory (Bandura, 1986) posits that one's behavior is the result of
personal, behavioral, and environmental factors, and that these factors influence each
other (triadic reciprocal causation). This view of human interactions ascribes a role to
cognitive processes in which the individual observes others and the environment, reflects
on that in combination with his own thoughts and behaviors, and revises his own selfregulatory functions accordingly. Bandura (1986) states that self-efficacy is a specific
ability that influence people to choose which challenges to undertake, how much effort to
expend in the endeavor, how long to persevere in the face of obstacles and failures, and
whether failures are motivating or demoralizing.
Bandura (2001) also points out that personal agency is a broad aspect of socialstructural influences with several core features such as intentionality, forethought, selfreactiveness, and self-reflectivenss. An agent has to be not only a planner with intention
for future course of action to occur; a forethinker to set goals for themselves, and select
and create courses of action likely to produce desired outcomes; a motivator to self-
36
regulate as well to monitor one's pattern of behavior; and but also a self-examiner of
one's own functioning through evaluating motivation, values, and the meaning of life
pursuits.
Several school-based interventions have applied Social Cognitive Theory to
reduce obesity risks and demonstrated some positive results. The Child and Adolescent
Trial for Cardiovascular Health (CATCH) health curriculum (Perry et al., 1990; Luepker
et al., 1996) was designed to teach children to identify, practice, and adopt healthy eating
and physical activity habits to reduce risk factors of heart disease, high blood pressure,
and obesity. The Planet Health (Gortmaker et al., 1999) study was designed to impact 6th
to 8th grade students' behaviors to decrease television viewing and high-fat foods intake,
and increase fruit and vegetable intake, and moderate and vigorous physical activity. The
Gimme 5 study (Baranowski et al., 2000) was implemented to impact 4th and 5th grade
children's fruit, juice and vegetable consumption and related psychosocial variables. The
Pathways study (Caballero et al., 2003) targeted 3rd, 4th and 5th grades students to
promote healthful eating behaviors and increased physical activity, food service to reduce
percentage of energy from fat and increase the use of lower fat foods and fruit and
vegetables. It also targeted families to create a supportive environment for children to
adopt positive health practices and demonstrated some positive results.
Self-determination theory (SDT) postulates three innate psychological needs,
relatedness, autonomy, and competency, which, when satisfied, enhance the individual's
intrinsic motivation, self regulation, and well-being (Ryan & Deci, 2000). Relatedness
refers to the need to experience authentic relatedness with others and to experience
satisfaction in participation and involvement with the social world; autonomy refers to
the need to actively participate in determining one's own behavior, and to experience
one's actions as results of autonomous choice without external interference; and
competence refers to the need to experience oneself as capable and competent in
controlling the environment and being able to reliably predict outcomes (Ryan & Deci,
2000). Different types of motivation such as extrinsic motivation (where the behavior is
engaged in order to achieve outcomes that are separable from the behavior itself, and
intrinsic motivation (where the behavior is engaged in for the enjoyment and satisfaction
inherent in taking part) are identified in the theory.
Research evidence has shown that nutrition education programs are more likely to
be effective if they address motivators as well as knowledge (Baranowski, Cullen,
Nicklas, Thompson, & Baranowski, 2003). For example, In a study to examine the
relationship between motivation and physical activity behavior and attitudes, and
autonomy support for physical activity in high risk minority youth sample (Vierling et al.,
2007), the results showed that students who perceived autonomy-support toward physical
activity by their teachers and parents experienced greater levels of need satisfaction for
autonomy, competence and relatedness, and further positively predicted autonomous
motivation towards physical activity. In a study to assess perceived autonomy support,
psychological need satisfaction, self-determined motivation and exercise behaviors in
overweight and obese patients (Edmunds et al., 2007), the results showed that individuals
who adhered more reported more self-efficacy to overcome barriers to exercise, and those
individuals who showed greater adherence demonstrated an increase in relatedness need
satisfaction over time.
38
Psychosocial Variables
Prevention and intervention programs are designed to change mediating
constructs hypothesized to be causally related to health outcomes (MacKinnoon & Dwyer,
1993). For example, many obesity prevention programs are designed to change mediating
variables of diet and physical activity, and increase knowledge and skills that are
hypothesized to have a causal effect on the risk of obesity. Thus, the success of such
prevention and intervention programs can be determined by effects on outcome variables
such as weight or disease.
The mediating variable approach has been described by Baranowski et al. (1997)
to provide a framework for involving behavioral theory in designing and understanding
behavior change intervention. Baranowski et al. (1997) pointed out that mediating
variables are factors that are highly correlated with the behavior of interest and that by
influencing these mediators through an intervention, behavior change should result. As a
result, programs or interventions thus change behavior due to changes in the mediating
variables, which in turn result in changes in the desired physiological and anthropometric
outcomes. For example, interventions are more likely to be effective if the mediating
variables are strongly related to behaviors to reduce obesity, and if procedures for
manipulating these mediating variables in obesity prevention are available.
MacKinnon & Dwyer (1993) point out that including meditational variables in
intervention studies have proved to be beneficial in several ways to understand the
mechanisms of behavior change. First, program effects on mediating variables provide a
check on whether the intervention program has indeed produced a change in the construct
it was designed to change. For example, if a program is designed to increase skills to
select low fat food, then program effect on the educational measures to increase such
skills should be found. Second, the program effects on mediators indicate which program
components need to be strengthened or require improved measurement. For example, if
program effects on a measure of knowledge to select low fat food are not found, then the
program needs to improve on providing information such as health consequences of
eating high fat food or label reading to help people selecting low fat food. Third, program
effects on mediating variables in the absence of effects on outcome measures suggest that
mediator was not critical in changing behavior. For example, if the study conclusion
indicates that social norm is not causally related to obesity, then there is a non-significant
difference in obesity outcome among prevention and control groups.
Despite the importance of meditational variables not only in providing evidence
on how the prevention program achieved its effects, but also in providing information to
increase understanding of the mechanisms underlying changes in the outcomes, few
prevention studies have reported program effects on mediating variables and few have
tested the link between effects on mediating variables and effects on outcomes variable
(MacKinnon & Dwyer, 1993; Baron and Kenny, 1986).
Some school-based interventions developed to change behaviors were designed to
influence psychosocial variables that are believed to have an impact on behavior; and
many of them have been shown to be relatively unsuccessful in changing mediators
(Cerin et al., 2009; McClain et al., 2009, van Wijnen et al., 2009). A comprehensive
search of published interventions by Cerin et al. (2009) was to examine mediators of
dietary behavior change in youth (age 5-18 years) and provide recommendations on ways
to enhance theory evaluation (Table 2). The results indicated that among those that
seemed to have impacts on behavior change, only few studies reported mediated effects
with 95% confidence intervals in the original outcome metric. Thus, with the variability
in the design and target populations across studies, it was difficult to draw conclusions
regarding the mediators of dietary behavior change in youth.
To understand better dietary behavior among youths, cross-sectional and
prospective studies published between 1990 and May 2009 were selected for a review to
examine determinants of dietary intake among children and adolescents age 3-18 years
(McClain et al., 2009). The results indicated that perceived modeling and dietary
intentions had the most consistent and positive associations with eating behaviors.
However, since the studies were diverse in the measurement of the psychosocial variables
as well as dietary intake and samples, it was difficult to conclude which psychosocial
variables were strong correlates of eating behaviors. Additionally, most studies relied on
self-report of dietary intake and authors often combined conceptually similar
psychosocial determinants into one category, which may have introduced bias (McClain
et al., 2009). With the review outcomes, it was concluded that more prospective studies
on the psychosocial determinants of eating behavior using broader theoretical
perspectives should be examined in future research.
To understand the extent to which psychosocial effects of obesity prevention
intervention programs in childhood obesity and the methods used to measure the
particular psychosocial aspects, 2901 published papers between 1990 and February 2008
were selected for a review (van Wijnen et al., 2009). The results of the review indicated
that among seven interventions measured psychosocial variables, Plant Health study
(Gortmaker et al., 1999) and the intervention by Robinson et al. (1999) were the only two
Sample
N (Age)
854 (Age 12.7)
1582 (Age 12.0)
788 (Age 12.9)
1506 (Age 15.8)
Author (Year)
Chin (2008)
Dzewaltowski
(2009)
Haerens (2007)
MacKinnon (2001)
SCT, TBP, HBM
TTM, TPB, SCT
SCT
TPB, HST, DPT
Theories
Outcome
Variables
(Reliability)
Team norm (<x=0.76-0.82) (+)
Peer norms (a=0.84-0.88)( +)
Belief in media (0.75-0.81)(-)
Attitude (a=0.83)
Self-efficacy (a=0.38)
School support (a=0.71)
Perceived benefits (a=0.83)
Perceived barriers (a=0.85)(+)
Self-efficacy (a=NR) (-)
Proxy efficacy-school (a=NR)
Proxy efficacy-parents (a=NR)
Group norm (a=NR) (+)
Dietary behaviors scales (a=0.81)
Fat intake -FFQ (0.86)
F& V intake -24 hour
dietary recall (r=0.54)
Attitude (a=0.72-0.94) (+ girls)
Soft drinks & highSubjective norms (a=0.79-0.89) (+boys) calorie snack
Perceived control (a=0.80-0.91)
consumption -FFQ (NR)
Habit (a=0.82-0.96) (- boys)
Psychosocial Variables
Summary of Interventions Examining Potential Mediators of Dietary Behavior Change in Youth (Cerin, 2009)
Table 2
1584 (Age 10.0)
1676 (Age 8.7)
771 (Age 10.0)
Reynolds (2004)
Reynolds (2002)
Tak (2009)
NR
SCT
SCT
Theories
Project appreciation (a=NR)(+)
Availability (a=0.69)
Eating meals together (a=NR)
Knowledge (a=0.23)(+)
Positive outcome expectancy (a=0.67) (+)
Parent consumption (a=NR)(+)
Self-efficacy (a=0.86)
Family norms (a=0.62)(-)
Peer norms (a=0.79)
Teacher norms (a=0.84)(+)
Knowledge (a=NR) (+)
Parental consumption (a=NR)
Availability (a=0.80)
Psychosocial Variables
F & V intake-FFQ
(a=0.70)
F & V intake -24 hour
recall (NR)
F& V intake- 24 hour
recall (NR)
Outcome
Variable
(Reliability)
A indicates Cronbach a =0.05; r, test-retest reliability coefficient; DPT, Dual-process Theory; HBM, health Belief Model; HST, Habit
strength Theory; NR, not reported; SCT, Social Cognitive Theory; TPB, Theory of Planned Behavior; TTM, Transtheoretical Model;
F &V, fruits and vegetables; (+), significant positive intervention effect on potential mediators; (-), significant negative intervention
effect on potential mediators.
Sample
Author (Year)
Summary of Interventions Examining Potential Mediators of Dietary Behavior Change in Youth (Cerin, 2009)
Table 2 (Continue)
(o
that reported a statistically significant net intervention effect (Table 3). It was concluded
that among those intervention addressing childhood obesity, only few assessed the effects
of psychosocial variables on children's behavior outcomes.
Dissemination
While effectiveness of school-based health education programs in improving
students' knowledge, attitudes, and behavior has been demonstrated, Basch (1984) called
for discovery of efficient ways to disseminate and implement health and nutrition
education programs. Basch (1984) stated that since no matter how positive the outcomes
might be for a given program in research condition, its impact would be determined by
the extent to which it actually was disseminated and maintained in the classroom.
Nevertheless, twenty-five years after Basch's call for discovery, few dissemination
projects have been conducted.
Anderson & Portnoy (1989) stated that dissemination effort can be measured
through both the impact and efficiency of a program. The impact of a program is a
function of 1) its capacity to consistently improve health enhancing behaviors
(effectiveness), 2) the number of sites at which the program is used, plus the number of
time that the program is used at those sites during a given period, plus the total number of
people exposed to the program at the sites (dissemination), and 3) the time during which
the program is used the way it was designed (fidelity). With improvement in any of the
variables, the impact of a program will increase. The efficiency of a program can be
evaluated through a program's impact at a given site during the length of its use, divided
by the expenditures required to implement and maintain the program (Anderson and
11
Effect on level of adiposity of the
lower limbs
No effect on mean BMI in
kindergarten to 3rd grade. Significant
intervention effect in 4th-7th grades
Self-concept
Cognitive competence
Asocial acceptance
Physical competences
30 (Age 9)
383 (Age unknown)
201 (Age 14-17)
Falk et al.(2002)
Healthy Buddies (2007)
New Moves (2003)
Weight control behaviors
Self-acceptance
Athletic competence
Self-worth
Media internalization
No effect on mean BMI
No effect on mean BMI
Global self-worth
Dietary restraint
Satisfaction with body image
634 (Age 7-11)
APPLES (2001)
General self-worth
Body image perception
Findings
Psychosocial
Variables
No. of Subjects (Age)
Intervention (Year)
Summary of School-Based Interventions of Overweight on Psychosocial Outcome Variables of Children (van Wijnen, 2009)
Table
No. of Subjects (Age)
480 (Age 10-14)
225 (Ag 8.9)
549 (Age 9.3)
Intervention (Year)
Planet Health (1999)
Robinson et al.{1999)
SPARK (1993)
Findings
Favorable effect on BMI among girls
Favorable effect on BMI, waist
circumference, and waist-hip ratio
No effect on mean BMI
Psychosocial Variables
Weight control behaviors
Peer-rated aggression
Observed physical aggression
Observed verbal aggression
Perceptions of scary world
Aggressive behavior
Delinquent behavior
Self-perception
Summary of School-Based Interventions of Overweight on Psychosocial Weil-Being of Children (van Wijnen, 2009)
Table 3 (Continue)
Portnoy, 1989).
Several studies have evaluated the dissemination of school-based health
promotion programs: The Smart Choices project (Parcel et al., 1989); a health study by
Steckler et al. (1992); Nutrition for Life (Olson et al., 1993); 5-a day (Harvey-Berino et
al., 1998), CATCH study (Hoelscher et al., 2004); Exercise Your Option (Romero et al.,
2006). In the Smart Choices Project (Parcel et al., 1989), a four-stage diffusion of
innovation model including dissemination, adoption, implementation and maintenance
was used to understand diffusion of the Smart Choice tobacco curriculum in schools in
Taxes. The results showed that leadership workshops organized through an existing
community-based network provided an effective and efficient mechanism for
disseminating tobacco prevention program. However, the majority of school districts
developed their own teaching programs which might not contain important elements of
successfully evaluated programs. Thus, the results indicated the need of a supportive
climate as well as strategies to encourage the dissemination of tobacco-use prevention
programs.
In the study by Steckler (1992) et al., the five year tobacco prevention curriculum
was disseminated to junior high schools in North Carolina to prevent tobacco use. Six
questionnaires were designed to measure the extent to which health promotion program
such as organizational climate, awareness-concern, level of use, level of success, and
level of institutionalization were successfully disseminated. This study was the first to
attempt to use instruments like these to measure sequentially the stages of the diffusion
process.
In the Nutrition for Life study (Olson et al, 1993), the dissemination and
implementation of nutrition teaching in New York State secondary schools was examined.
The results showed that overall, 50% of junior high school and 33% of senior high school
teachers received the program and three-quarters of these teachers used it. At both levels,
home economics teachers were more likely to receive and use the program than health
teachers. Peer-led teacher training workshops organized through an existing communitybased network provide an effective and efficient mechanism for disseminating nutrition
teaching programs.
In the Show the Way to 5-a-Day study (Harvey-Berino et al., 1998), the main goal
was to increase consumption of fruits and vegetables among elementary school children.
The primary educational method used to achieve this goal was providing modeling and
opportunities to practice fruit and vegetable consumption. A nutrition guide, based on the
principles of social cognitive theory and the input from elementary school teachers was
developed to help young children increase fruit and vegetable consumption in this
nutrition program. In order to determine the importance of teacher training from the state
department of health, and the factors distinguishing teachers who adopted the program
from those who did not, the systematic, statewide dissemination of this program was
evaluated. The results showed that 50% of these respondents reported implementing it. In
addition, using the program was positively influenced by teacher training.
The Child and Adolescent Trial for Cardiovascular Heath (CATCH) is a schoolbased health education study aimed at decreasing cardiovascular risk factors in children
(Perry et al., 1990; Luepker et al., 1996). The program was designed to be a multicomponent, multi-year coordinated school health program (Centers for Disease Control
Coordinated School Health Program, 2002) that includes classroom curriculum to
decrease fat, saturated fat and sodium in the diet, a complementary family component,
physical education (PE) curriculum, a school foodservice program (CATCH Eat Smart),
and tobacco-free school policy recommendations.
In the evaluation of the dissemination of the CATCH program in Texas
(Hoelscher et al., 2004) to decrease fat, saturated fat and sodium in the diet, and increase
physical activity, the results showed that continued training and the involvement of other
school staff, such as classroom teachers, coaches, school nurses, and counselors, were
important for successful dissemination. In addition, enhancement of the student, parent,
and community components of the program may increase acceptance of foods lower in
fat and sodium for school meals.
To address the gap of disseminating intervention programs efficiently on a large
scale to prevent childhood obesity in literature, the "Exercise Your Option" (EYO)
program, including a nutrition and physical activity curriculum, was delivered to middleschool students across California. Over the past 5 years, 51% of all middle-school
students in California were exposed to the program; and the potential for moderate to
high public health impact among California middle-school students was demonstrated
(Romero et al., 2006).
Today, the gap between health promotion interventions and its subsequent
dissemination in school setting is not well documented. In 1996, the World Health
Organization (WHO) Global School Health Initiative published a report on barriers to
implementing or improving school health programs. One of the most common barriers
was that schools did not perceive such programs to be a priority. In addition, tremendous
competition for teachers' time, lack of awareness about available resources and school
health program results, and failure to realize that teacher retraining should occur on a
continual basis were identified (Auld et al., 1998). Furthermore, the accepted, validated
instruments to measure dissemination of school health programs particularly important
often were also lacking.
Lead Teacher Model
Many school districts have initiated professional development programs by
beginning with a small group of teachers, called lead teachers, who have demonstrated
interest and expertise in inquiry centered science teaching (National Academy of
Sciences, 1997). Lead teachers can serve several roles: conducting professional
development activities for other teachers; holding workshop at faculty meetings; assisting
with materials support issues and responding to questions that other teachers have about
the program; and providing leadership and work with administrators to expand or modify
selected modules (National Academy of Sciences, 1997).
In 2004, the United Federation of Teacher (UFT) and the Department of
Education launched a yearlong pilot project that would create approximately three dozen
"lead teacher" positions in District 9 in the Bronx, New York. The "lead teacher"
program was an innovative attempt to provide mentoring and guidance to newer teachers
in the schools. In each school, two lead teachers shared a classroom. Each teacher spent
half of their time teaching, and the other half providing support and training to other
teachers in the school through classroom visits; facilitating teacher planning and study
50
groups; meeting and planning with their colleagues and the school administration; and
making their classroom into a model one from which other teachers can learn their
practices (Grantmakers for Education, 2005).
Although the lead teacher model has been used in some school districts in the
States, some teachers have encountered challenges in their efforts to implement new
curriculums. For example, in Huntsville, Alabama, teachers did not want to view a fellow
teacher as supervisor. In addition, some lead teachers find themselves so busy with their
own classroom responsibilities that they do not have time to work with other teachers.
Furthermore, coordinating various components of the lead teacher tasks to provide
sufficient support to teacher and to assist them to change their practices is also
challenging. It has been suggested that for lead teachers to lead effectively, they require
ongoing support and opportunities to experiment with new skills and strategies over time.
In addition, lead teachers should remain as classroom teachers, and not administrators
since it is very important to maintain that ongoing connection to the classroom (Spielberg
& Foulk, 2006).
Professional Trainings & Teaching Materials
Teacher is a critical classroom component that influences whether or not
intervention occurs and its ultimate success. Research evidence has indicated that often
the best way for teachers to become motivated and involved in curriculum is by
participating in professional development programs (Fishman et al., 2003). In
professional development, teachers can gain content knowledge of a curriculum topic and
better understand the rationale behind the modules. In addition, changes in the beliefs and
51
attitudes of teachers that lead to the acquisition of new skills, new concepts, and new
process related to the work of teaching often occur after professional development
(Cohall et al., 2007). The most important measure of whether professional development
is "working" is whether teacher enactment yields evidence of improved student learning
and performance (Fishman et al., 2003).
Because teachers are viewed as central to the implementation process, teacher
training, motivation, lack of materials and motivation, and teachers' feelings of comfort
and preparedness have impact on the likelihood that a teacher will conduct
health/nutrition education (Auld 1999). Thus, when teachers are provided with the
necessary training and materials, have a chance to study the concepts and skills included
in the modules, and feel motivated and comfortable or teaching the probability that they
will engage themselves enthusiastically in the new curriculum (National Academy of
Sciences, 1997).
The curriculum materials designed to promote teacher learning as well as student
learning are called "educative curriculum materials" (Ball & Cohen, 1996). Such
curriculum material serve as cognitive tools to help to increase teachers' knowledge in
specific instructional decision making but also help them develop more general
knowledge that they can apply flexibly in new situations (Davis & Krajcik, 2005). Davis
and Krajcik (2005) point out that educative curriculum material can be used as a guidance
to assist teachers in teaching science topics in several aspects: engaging students with
topic-specific scientific phenomena and providing rationales for why the experiences are
scientifically and pedagogically appropriate; using scientific instructional representations
and adapting and using those representations; anticipating and understanding students'
52
ideas about science and engaging students in questions; engaging students with collecting
and analyzing data and helping them understand why the use of evidence is important in
scientific inquiry; engaging students in designing investigation and providing ideas for
appropriate design and suggestions; and engaging students in making explanations based
on evidence, and developing subject matter knowledge (Davis & Krajcik, 2005).
53
Chapter III
METHODS
An Implementation of the Choice, Control & Change (C3) Curriculum
It is well documented that the impact of any health promotion program depends
on multiplicative function of its effectiveness, dissemination and maintenance (Anderson,
1989). To have the greatest public health impact, it is necessary to widely disseminate the
Choice, Control & Change (C3) curriculum in other sites than the initial site (New York
City), and further evaluate the effectiveness of dissemination when the curriculum is fully
implemented in less tightly controlled and supervised conditions than the original study.
This current study focused on the implementation effort at Parkside Middle School, a
public school in Michigan using a lead teacher model to assess how the C3 curriculum
influenced students' behaviors in terms of diet and physical, psychosocial variables
associated with behaviors, and knowledge related to nutrition and science.
School Context
An implementation study of the C3 curriculum at Parkside Middle School was
important for the research team to evaluate the effectiveness of the curriculum and the
utility of combining behavior change theory with educational approaches in preventing
childhood obesity in a broader education community. The Middle School at Parkside
started as a high school in 1963. In 1982, it became a junior high with grades 7, 8 and 9
until 1994 when the transition to middle school was made. The middle school offers
students enormous physical space to engage in many school and extracurricular activities.
For example, several new facilities were built at this school for various team activities
including a domed field house for a gymnasium, and a soccer field for boys and girls
teams at both the middle school and Jackson High School. Since both education and
physical activity are regarded as important at Parkside, the students have the opportunity
to elect various classes including "Encore" music classes, and join teams for various
activities such as choir, orchestra, swimming, gym, art, and life skills. In addition, the
school also became a NASA Explorer School in 2006 and had a three-year learning
opportunity for educators and students to become involved in NASA research and
discoveries.
Study Design
A pre-post intervention-control design was used for this current study. All
students participating in the study at Parkside Middle School served as their own
controls. They received the 4 week usual science curriculum including cell biology and
genetics taught by six science teachers in the school, and then received the 4 week C3
curriculum taught by the same teachers.
To monitor how the participants changed over time, all students took an
assessment called the BiteStep surveys 3 times. This survey was administered 1 month
before the start of the intervention C3 curriculum and this was considered as the T1
measure for the study. The survey was administered a second time right before the C3
curriculum and this was considered as the T2 measure for the study. Finally, the survey
was administered right after the completion of the C3 curriculum and this was considered
55
as the T3 measure for the study. The differences between results of T1 and T2 measures
were control condition outcomes, and the differences between results of the T2 and T3
measures were intervention condition outcomes. The outcomes of the study were the
differences between control and intervention outcomes.
In addition to BiteStep survey, a second survey Student Survey was administered
at the end of the study to assess students' demographic and contextual factors, goal
setting, and perceived amount of behavior change related specific goals (Figure 1).
Study Population
The participants of the study consisted of all 750 7th and 8th grades students (30
classes) at Parkside Middle School. Since Parkside was the only middle school in town,
consequently the entire student population was a homogeneous sample for the study and
served as their own control and intervention groups, which provided high internal
consistency of subjects between two groups.
Intervention and Delivery
Before the C3 curriculum was implemented at Parkside Middle School, a
summative student outcome evaluation was conducted in 10 middle schools in East
Harlem, Washington Heights, and Bronx in New York City to assess its effectiveness.
Based on the observation of the implementation coordinators during the outcome
evaluation, a revised C3 curriculum containing 5 units of 19 lessons was used for the
current study. The curriculum was taught by 6 science teachers for approximately 4
weeks at Parkside Middle School. All 6 teachers attended a full day professional
56
Figure 1. Study Design
57
development session prior to the start of the curriculum. Each teacher was responsible for
5 classes of 7th and 8th grade student approximately 25 students per class.
Choice, Control & Change (C3) Curriculum
The C3 curriculum was designed with a main question in each unit to help student
to make healthful food and activity choices and to create healthful personal food
environment (Contento & Koch, 2007). At the beginning of the curriculum, a student
workbook was given to each student to help them learn about each lesson and work with
the questions and activities embedded in each unit (Table 4).
Unit 1 "Questioning Our Choices" (Matter of Choice; What we like; Our food
environment; Research in the community) introduces the curriculum by asking students
to think about what choices they have when they eat and being physically active.
Through this unit, they will learn that humans biologically prefer foods that are high in
fat and sugar, and the current food options in fast food places, neighborhood, and school.
The QuESTA (Questioning, experimenting, searching, Theorizing, and Applying to Life)
Learning Cycle is also introduced to student in this unit. The unit ends with a project for
students to learn about what influences their food and activity choices.
Unit 2 "Bodies in Motion" (Making the case; Inside Calvin; Burning up; Balancing
act; and My body) introduces and explores the concepts about the body and energy by
asking students to think about how they can get the right amount of energy for their body
to function well. Through this unit, students learn about digestion, circulation, and
metabolism of nutrients in all cells, and how body cells convert the chemical energy from
food into body energy. The concepts of dynamic equilibrium and how to maintain a
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Table 11
Lesson
Lesson 1:
Matter of
Choice
Lesson 2:
What We
Like
Lesson 3:
Our Food
Environme
nt
Lesson 4:
Research in the
Community
•You can give the students time to do this project in class or explain it in class and then have
the students do it as homework.
•Every unit in C3 ends with a culminating project. Students will display all projects from
Units 1-4 in Unit 5; please save these projects.
• Studying my own questions can help me
learn science and develop my skills in
how to do science.
•Learning more about the food and activity
options in my environment will help
appreciate why it is important to try to
make healthful choices and begin to build
confidence that I can make healthful
choices.
•The measuring of the sand and play dough (to represent fat and sugar) usually has a dramatic
effect, be sure all the students get to view the final cups and plates from this activity.
•Allow all the students to think about the five different activities before they build theories
about our food environment.
•Make time for the class to discuss the experiment before they answer the last 2 questions on
"building theories about taste."
•The students will probably be excited about the taste experiment and want to guess what
each powder is.
•Use the Unit Question to help students see connections between the different parts of the
lesson
•Introduce the Module Question as the question that will drive all of the C3 lessons. Explain
that answering the Module Question in this lesson is to see what they know now, in order to
track how much they learn.
Tips for Teachers
•As scientists we can speculate about our
food environment and how it tends to
have lots of foods that are high in fat/or
sugar readily available.
•All humans are born with a preference for
foods that are sweet and fatty. It is normal
(indeed, inborn!) to like high sugar and/or
fat foods such as soda and other sweet
drinks, chips, fries, burgers, and cookies.
•We will use various strategies to begin to
understand what influences our food and
activity choices.
• Scientists use different strategies to
answer questions.
Key Points for Students to Take Away
How can we use scientific evidence to make healthful food and activity choices?
Choice, Control & Change (C3) Curriculum
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Lesson 5:
Making the
Case
Lesson 6:
Inside Calvin
Lesson 7:
Burning Up
Lesson 8:
Balancing Act
Lesson 9:
My Body
•Being in "energy balance" will make it
possible for your body to do what you
want it to do.
•"Energy in" comes from food. "Energy
out" comes from physical activity AND
body processes that our bodies do all the
time, automatically.
•You can spend as much or as little time on the project in class and as homework as
appropriate for you class. Remember to save the projects for display in lesson 19.
•The Bite and Write activity sheet should be done the before lesson 10.
•The review of unit 2 ("looking backwards and forwards" p i l l ) will help students organize
their thoughts for the project.
•To prevent confusion, remind students (using the Dynamic Equilibrium student reading and
diagram) that "energy out" is energy used by the body, not waste products eliminated from
the digestive system.
•Demonstrate how to use the energy in & energy out cups before you give them to students, to
minimize spilled sand!
•If our bodies are in a balanced state, we
are using up about the same amount of
energy than what we are getting from
food. Every person has different energy
needs in order to stay in balance.
•The process of burning the peanut is
similar to metabolism because it converts
the chemical stored energy in the peanut
into thermal (heat) energy.
•Having the students develop an understanding of the concept of metabolism, and showing
that there is energy stored in foods, is much more important than the specific
definition/calculation of calories.
•If students aren't familiar with cells yet, they just need to know that cells are small and make
up the different parts of their bodies.
•Follow the Human Body Simulation procedure. Be sure to complete part I before introducing
the blood vessels and cells.
•Make connections between the choices that Calvin is making and what they learned about
their environment in Unit 1.
•Emphasize that Calvin isn't able to do what he wants to do and feels unhealthy, instead of
focusing on his weight, or see his weight gain as a contributor to his health issues, not the
problem itself.
•New Unit Question! Please post and review this question!
•A "calorie" is a unit to measure energy (it
is N O T fat or cholesterol, etc).
•The food we eat is broken down by our
digestive system so that our bodies can
use the energy and nutrients. The
nutrients move from your small intestine
to every part of your body.
•Learning about how the body works is
scientific evidence that will help me take
care of myself.
• Understanding the consequences (quality
of life and health) of less healthful food
and activity choices can help us
appreciate why healthful choices are
important.
Unit
Unit 3: Moving Toward Health
How can we use personal data to make healthfulfood and activity choices?
Unit 4: Body
Science
Why are
healthfulfood
and activity
choices
importantfor
our bodies?
Lesson
Lesson 10:
Energy In
Lesson 11:
Energy Out
Lesson 12:
Selecting Food Goals
Lesson 13:
How to Add
Steps
Lesson 14:
Keeping It
Pumping
Activity
•New unit question please post and review!
•Regular physical activity helps our hearts
stay healthy.
•The healthier our hearts are, the more
comfortable we are doing strenuous
exercise (like playing sports).
•Remember to save the students' projects, to display all projects in lesson 19.
•Adding more activities with higher steps
counts per minute can add more activity
to our day.
•You may choose to shorten the recovery time after exercise, OR read the Physical
for a Healthy Heart student reading during this time.
•You may want to make a class graph that displays all the data and from fewest steps per
minute to the most steps per minute.
•Remind them to record in their How To Tracker every time they try their goal and tell them
you will be reviewing their How To Tracker at every lesson from now on.
•Emphasize to students that the HOW TO Tracker activity sheet is another tool for measuring
and keeping scientific data on their "energy in."
•Use the Scientific Evidence for C3 Goals student reading to reinforce to the students why the
C3 goals are important. Please ask students to choose one of the goals about reducing
(sweetened beverages, packaged snacks, fast food places) as these will have a bigger impact
on health. They also are more challenging and thus more exciting to collect data on how it is
going.
•Doing the How To Add Steps homework is important because they need these data for the
unit culminating project in lesson 13.
•If students are getting inaccurate step counts for the 100-step test, it is often because they are
wearing the pedometer on a pocket, etc. instead of the waistband.
•Use the "pedometer talking points" as a guide.
•Emphasize to students that the Step and Write activity sheet is a tool for measuring and
keeping scientific data on their "energy out"
•The 24-hour food intake activity may seem very similar to the bite and write assignment.
Explain that this is a way of analyzing the data they collected.
•New unit question, please post and review!
Tips for Teachers
•Different activities have different average
step counts per minute.
•The process of setting goals and working
on them is where C3 gets its name.
•The guidelines in MyPyramid are based
on scientific research on how to stay
healthy and the C3 goals are based on the
same scientific evidence.
•A pedometer is a scientific tool, it is
important to use it correctly in order to
have it generate accurate data. (This is the
purpose of the 100-step test, and
calibration in general.)
•Physical activity is an important part of
maintaining a balance between energy in
and energy out.
•Once we have our data we need to work
with our data to analyze it and make
sense of it.
•Keeping records of the food we eat is a
way of gathering scientific data.
Scientists try to make sure the data they
collect is complete and accurate.
Key Points for Students to Take Away
How can I maintain my skills
as a competent eater and
mover?
Unit 5: Maintaining
Competence
Lesson 15:
Keeping the
Flow
•Getting the point that it takes longer and is harder to remove more sand (sugar) than less
sand and that it gets even harder when you do it with a fork is more important than getting
every last big of sand out of the bowl.
•Typically sugar can easily move from the
blood into the cells. But, if we have extra
sugar very often, and we are often in a
state of positive energy balance, our body
can get less efficient at removing the
sugar from the blood (insulin resistance).
•New Unit Question! Please post and review this question!
•Scientific evidence can help you make
healthful food and activity choices, and
now you know how to do it.
•One of the most important parts of doing
scientific investigations and research is
sharing it so that everyone can benefit
from it!
Source: Contento & Koch (2007)
•You will need to prepare for this lesson (with the students) several days beforehand.
•The group exercise ("synthesize scientific evidence," p. 225) will help students remember
everything they learned to answer the module question.
•The Scientific Evidence for C3 Goals student reading from lesson 12 can help the students
decide what information they want to convey to others in their project.
•Healthy food and activity choices can
keep us from developing type 2 diabetes.
•The Interviewing My Family activity sheet needs to be completed before lesson 16.
•To make sure students can see the difference in blood flow, have them pay attention to how
long it takes to pour all the "blood" through each tube, or how much they can pour through
in the ten seconds.
•Healthful food and activity can help keep
our blood vessels from getting clogged.
•Extra fat in the food you eat, especially
when we are in positive energy balance,
can build up in our blood vessels, making
them clogged.
•Now that we have learned about the C3
goals and the scientific evidence for the
C3 goals it is important to find interesting
and motivational ways to share what we
learned with others in our community.
People can have an influence on their
environment, not just the other way
around!
Lesson 16:
Fighting Diabetes
Lesson 18:
Bringing
it All
Together
Lesson 19:
Sharing
the Health
Lesson 17:
Telling Others Why
to Do It
62
balance between energy intake and energy expenditure are also introduced to students in
this unit. To help students relate personally to the materials, a case study of a boy Calvin
who has high blood pressure, high blood sugar, and is at risk for type 2 diabetes is
introduced. The unit ends with a project for student to create self-portraits that illustrate
what they want their bodies to do and to demonstrate their understanding of the body.
Unit 3 "Moving toward Health" (Energy in; Energy out; Selecting food goals; How
to add steps) asks students to examine their own eating and activity behaviors and to
make healthful food and activity choices using their personal data. Besides a common
goal of 10, 000 steps a day measure with a pedometer, students will be asked to work
toward a specific C3 food and activity goal (eating more fruits and vegetables, drinking
more water, eating fewer packaged snacks, eating less frequently at fast food restaurants,
and drinking fewer sweetened beverages) throughout the rest of the curriculum. The unit
ends with a project for students to collect data on the average steps per minute for various
activities with their pedometers, so they can add other activities to increase their physical
activity.
Unit 4 "Body Science" (Keeping it pumping; Keeping the flow; Fighting diabetes;
Telling others why to do it) introduces students to the science behind the C3 goals and
ask them why healthy food and activity choices are important for their bodies. Through
experiments, students will learn about how healthy food choices and regular physical
activities can keep their hearts healthy, and decrease the risk of heart disease, type 2
diabetes, strokes, and other diseases. The unit ends with a project for students to create
public service announcements to teach the public about the scientific evidence for the C3
goals.
Unit 5 "Maintaining Competence" (Bringing it all together; Sharing the health)
provides students with the knowledge and skills, and ask them how they can maintain a
healthy lifestyle and become a competent eater and movers. Students revisit the scientific
evidence that supports the C3 goals and evaluate their progress toward achieving their
goals to make healthful food and activity choices. Students also display their projects and
share healthy food to celebrate what they have accomplished during C3 curriculum.
Professional Development
To ensure the C3 curriculum was implemented as planned, a professional
development session was arranged for all 6 science teachers to attend, and substitute
teachers were arranged to teach their classes during their absence. A 6 hour professional
development session was held once at Michigan State University led by Dr. Koch, the
program director, Dr. Barton, and her doctoral student. At the beginning of the session,
each teacher received a teacher handbook for teaching guidance, and the C3 curriculum
overview addressing tips for teaching each lessons and key points for students to take
away. The purposes of the session were to help teachers learn about the lessons and
questions in each unit, and provide hand-on opportunities for them to be familiar with the
activities embedded in each unit. At the end of the session, the teachers shared ideas
about how they would implement the lessons with their students.
Lead Teacher Model
To ensure that the teachers implemented the curriculum according to the protocol,
one teacher, the science department chair, was designated as lead teacher to support the
64
remaining teachers and work closely with the research team. It was the role of the lead
teacher to conduct a daily meeting to review the teachers' curriculum progress and
facilitate problem solving in the classroom, enhance teachers' motivation to teach the
curriculum, communicate between teachers and research staff, keep track of teaching
materials, and prepare overall curriculum reports. Throughout the curriculum, Dr. Barton
and her doctoral student checked in with the lead teacher and observed teachers' progress
occasionally. In addition, Dr. Koch and her search staff also visited the school once to
observe the progress of the curriculum and answered questions for the teachers.
Theoretical Framework
The theoretical framework of this study was based on the constructs from Social
Cognitive Theory and Self Determination Theory to explain variables that affect
intervention outcomes.
Social Cognitive Theory
The Social Cognitive Theory (SCT) proposed by Bandura (1986) explains behavior
in terms of a triadic and reciprocal interaction of the personal factors, environment and
behavior. Within this perspective, one's behavior is constantly under reciprocal influence
from cognitive (and other personal factors such as motivation) and environmental
influences. However, this reciprocal interaction doesn't imply that all influences are of
equal strength. The interaction between the three factors will differ based on the
individual, the particular behavior being examined, and the specific situation in which the
behavior occurs (Bandura, 1986) (Figure 2). The constructs of self-efficacy referring to
65
specific aspect of personal agency, outcome expectations referring to expectation for
specific physical and social outcomes or self-evaluative reaction, and goals that a person
set for himself or herself to reach certain desired outcomes are core features of socialcognitive theory. In this study, when the theory is applied to a behavioral intervention
perspective, students' eating and physical practices (behavioral factors) are influenced by
how they are affected by the inquired-based nutrition and science curriculum (cognitive
factors). Environmental factors will not be addressed in this study.
Figure 2. Social Cognitive Theory (Bandura, 1986)
Behavior
(Cognitive, affective, and biological events)
Self- Determination Theory (SDT)
Self- determination theory (SDT), as proposed by Deci and Ryan (2000), assumes
that people are active organisms with innate abilities toward psychological growth and
development to deal with ongoing challenges, and to integrate their experiences into a
coherent sense of self. However, this natural human operation requires support from the
social environment in order to function effectively. It is suggested the interaction between
the active organism and the social context is the basis for SDT's predictions about
behaviors.
66
The self-determination theory proposes that there are three basic needs that drive
behavior: autonomy; competence; and relatedness. Need for autonomy refers to the need
to actively participate in determining one's own behavior. It includes the need to
experience one's actions as result of autonomous choice without external interference.
Need for competence refers to the need to experience oneself as capable and competent in
controlling the environment and being able to reliably predict outcomes. Need for
relatedness refers to the need to care for and to be related to others. It includes the need to
experience authentic relatedness from others and to experience satisfaction in
participation and involvement with the social world (Deci & Ryan, 2000). The degree to
which these needs are met determines if a behavior is intrinsically or extrinsically
motivated. Intrinsic motivation refers to initiating an activity for its own sake because it
is interesting and satisfying in itself, as opposed to doing an activity to obtain an external
goal (extrinsic motivation) (Deci & Ryan, 2000). The sequence between autonomy,
perceived competence, relatedness and health behavior has been termed the SDT process
model of health behavior change (Williams, McGregor, Sharp, Kouides, Levesque, &
Ryan, 2006).
C3 Curriculum Theoretical framework
Through the concepts of mediators of behavior change from Self Determination
Theory and Social Cognitive Theory, a theoretical framework was created to address
behaviors, psychosocial variables, and knowledge targeted in C3 curriculum (Figure 3).
The hypothesis was that the C3 curriculum would have positive influence on students'
behaviors as primary outcomes of the study, and psychosocial variables and knowledge
Figure 3. Choice, Control & Change (C3) Theoretical Framework
Psychosocial Variables
(Secondary outcomes)
Social Cognitive Theory
1. Self-efficacy
2. Outcome expectations
- Physical aspect
Knowledge
(Secondary outcomes)
Behavior Outcomes
(Primary outcomes)
1. Packaged snacks
2. Sweet drinks
3. Fast food
4. Physical activity
5. Sedentary behaviors
External Variables
Demographics
1. Gender
2. Race/ethnicity
Contextual factors
1. School group activities
2. After school activities
3. Weight control behaviors
4. Availability at home
- Packaged snacks
- Sweet drinks
68
as secondary outcomes. To understand how external variables might affect students'
behaviors, demographic factors including gender and race, and contextual factors such
as physical activities in school and after school, weight control behaviors, and
availability of packaged snacks and sweet drinks at home were also examined in the
study.
Measures
Four categories of measures were collected in this study to evaluate the
effectiveness of the C3 curriculum.
The first category of measures assessed behaviors (primary outcomes) and
psychosocial variables and knowledge (secondary outcomes) of students. Behaviors
measured were sweetened beverages consumption, packaged snack consumption, fast
food consumption, physical activity, and sedentary behaviors. Psychosocial variables
related to targeted behaviors included self-efficacy, outcome expectations (physical and
social aspects), autonomy, and competency. Knowledge referred to nutrition and science
knowledge acquired by students through the C3 curriculum. These outcomes measures
were collected through the BiteStep Survey (Appendix A).
The second category of measures assessed students' food- related behavior goals to
increase fruit and vegetables intake, and decrease packaged snacks, sweet drinks, and fast
food intake; and their perceived amount of change related to specific goals. The third
category of measures was to assess students' demographics including gender and
race/ethnicity, and contextual factors such as physical activities in school and after school,
weight control behaviors, and availability of packaged snacks and sweet drinks at home.
69
These measures were collected through the Student Survey (Appendix B) at the end of the
study.
The fourth category of measures was to understand the lead teacher's teaching
background and training, and to assess her role in facilitating implementation of the C3
curriculum, and challenges she faced as a lead teacher.
Instruments
Two instruments, the BiteStep Survey and the Student Survey were developed for
collecting various types of data to evaluate the dissemination efforts of the C3 curriculum
at Parkside Middle School.
A self-reported instrument BiteStep survey was designed to capture students'
changes in eating and physical activity behaviors, psychosocial variables, and nutrition
and science knowledge. This survey was modified from three instruments (Eat Walk
(Appendix C), Tell Me about You (Appendix D), Understanding Science (Appendix E))
used in the original study to evaluate student outcomes.
Eat walk survey. EatWalk is a survey consisting of 47 items related to frequency
and serving size of food and beverages consumed, and frequency and intensity of
physical activities over the past week. Four categories of food consumption such as fruit
and vegetables, sweetened beverages, snacks, and fast food categories are included in the
food section; and three categories of physical activity such as walking and taking stairs,
screen time, and participating in sports are included in the activity section. The purpose
of the instrument is to capture usual food and beverage consumption and physical activity
information from individuals.
70
Tell me about you survey. The Tell Me About You survey is a survey consisting
of 124 Likert type items, which focuses on the psychosocial variables such as beliefs
about outcomes, perceived barriers, self-efficacy, competence and autonomy in physical
activity and food consumption categories measured in the Eat Walk survey.
Understanding science survey. The third survey, Understanding Science,
consists of 20 multiple choice questions, designed to measure students' cognitive
understanding in science and nutrition knowledge.
The length of the three instruments together (total of 191 questions) required
approximately 90 minutes, the equivalent of 2 class periods for students to complete. The
three instruments were long for some students to accurately and thoughtfully complete in
the designated time frame. Also, teachers and school administrators were concerned that
too many class periods were devoted to assessment. Thus, the instruments were revised in
order to measure the effectiveness of the C3 curriculum for future dissemination. Based
on the observation of the implementation coordinators for the intervention in New York
City schools and the study outcomes, a shorter version of those instruments (Eat Walk,
Tell Me About you, and Understanding Science) was developed. The 68 Likert- type
items of BiteStep instrument was designed to be administered in one class period.
Measures of BiteStep Survey
Four categories of data were measured through the BiteStep Survey. For example,
questions addressing frequency and quantity of consumption were classified as the
behavior category; questions addressing theory-based variables associated to specific
behaviors were classified as the psychosocial variables category; questions addressing
71
information related to nutrition and science were classified as the knowledge category,
and question addressing weight loss was classified as the weight control behavior
category. The domain specifications and items of each category were addressed as
follows:
Eating, physical activity, and sedentary behaviors. Each one of the five
behaviors (packaged snacks consumption, sweet drinks consumption, fast food
consumption, physical activity, and sedentary behaviors) was considered a domain. For
example, Q8, 10, 11, and 12 were used to assess packaged snacks behaviors; Q 21, 22, 24,
and 25 were to assess sweet drink behaviors; Q35 and 38 were to assess fast food
behaviors; Q45, 46 were to assess physical activity; and Q47 and 48 were to assess
sedentary behaviors (Table 5).
Table 5
Measures of Eating, Physical Activity, and Sedentary Behaviors
Behaviors
Questions
Examples
Packaged snacks
Q8, 10, 11, 12
What size of packaged snack do you usually buy?
Sweet drinks
Q21, 22, 24, 25 How many times did you drink a sweet drink yesterday?
Fast food
Q35, 38
How many times did you eat at a fast food place in the
past week?
Physical activity
Q45, 46,
How often do you choose to walk or take stairs when
you don't have to?
Sedentary
Q47, 48
How many hours did you watch TV or movies
yesterday?
Psychosocial variables. Psychosocial variables derived from social cognitive
theory (self-efficacy and outcome expectations), and variables derived from selfdetermination theory (autonomy and competency) were assessed in the survey. Based on
the results of factor analysis with the baseline data (Tl), several questions were grouped
together as a scale to assess each one of the psychosocial variables (Appendix F). For
example, several questions were grouped as self- efficacy scales for different behaviors:
Q17, 18, and 19 were the self -efficacy scale for packaged snacks consumption; Q 31, 32,
and 33 were the self- efficacy scale for sweetened beverages consumption; Q 41, 42, and
43 were the self-efficacy scale for fast food consumption; and Q 53, 54, and 55 were the
self-efficacy scale for physical activities (Table 6).
In addition to self- efficacy, other psychosocial variables were also assessed by
grouping questions together to address the same construct. For example, to measure
outcome expectations, Q13b, 26b, and 37b were a scale for physical aspect of outcome
expectations across all eating behaviors; and Q13c, 13d, 26c, 26d, 37c, 37d formed a
scale for social aspect of outcome expectations across all eating behaviors. For autonomy,
Q15, 16, 29, 30, 39, and 40 formed a scale across all eating behaviors. For competency,
Q 20, 34, 44, and 56 formed a scale across all eating and physical activity behaviors
(Table 7).
Knowledge. This category included 9 multiple-choice questions (Q 60-Q68)
related to science and nutrition information addressed in the curriculum. Students were
asked to choose one correct answer among 4 multiple answers (Table 8).
Measures
Q17, 18, 19
Q31, 32, 33
Q41, 42, 43
Q53, 54, 55
Variables
Packaged snacks self-efficacy
Sweet drinks self-efficacy
Fast food self-efficacy
Physical activity self-efficacy
11
Walking or taking stairs when I don't really have to is a challenge that...
If I wanted to eat at fast food places less than three times a week...
If I tried to drink one small sweet drink or less a day...
Eating no more than one small packaged snack a day is a challenge that...
Examples
Self- Efficacy Scales for Eating and Physical Activity Behaviors
Table
11
Q15, 16, 29, 30, 39, 40
3. Autonomy
(Eating behaviors)
Q20, 34, 44, 56
4. Competency
(Eating and physical activity
behaviors)
Q13c, 13d, 26c, 26d, 37c, 37d When you choose to eat packaged snacks, how important is your friends eating
them?
2. Outcome expectations
(Social aspect for
eating behaviors)
I can make a specific plan for how to eat one small packaged snacks or less
a day.
If I could eat whatever I wanted, I would drink fewer sweet drinks than I do
now.
When you choose whether or not to eat packaged snacks, how important is
its impact on your health?
Q13b, 26b, 37b
1. Outcome expectations
(Physical aspect for
eating behaviors)
Examples
Measures
Variables
Psychosocial Variables for Eating and Physical Activity Behaviors
Table
11
Examples
What is the best way to achieve dynamic equilibrium in your body?
Which system responds to delivering more oxygen to the cells when running?
What is most likely to happen to the cardiovascular system when eats a lot of fatty food
for many years?
A person with diabetes may have which of the following conditions?
What is true about "super" sizes of packaged snacks or fast food?
Sweetened beverages are...
Generally, fast foods tend to be high in which of the following?
Doing aerobic activities such as biking or running everyday will likely cause...
What is a strategy to make more healthful choices in fast food places?
Measures
Q60
Q61
Q62
Q63
Q64
Q65
Q66
Q67
Q68
Variables
1. Dynamic equilibrium
2. Circulatory system
3. Cardiovascular system
4. Diabetes
5. Super size
6. Sweetened beverages
7. Fast food
8. Aerobic activities
9. Fast food
Science and Nutrition Knowledge
Table
76
The Student Survey
To learn about characteristics of participating students, their demographic
factors, contextual factors, behavior change goals, and perceived amount of change
were collected in the Student Survey. Students' sex and race/ethnicity were classified as
the demographic factors, and their school and afiterschool activities were contextual
factors. Four food-related choices such as fruit and vegetables consumption, packaged
snacks consumption, sweet drinks consumption, and fast food consumption were C3
curriculum goals for students to select from. A five- point scale question ranging from 1
"did not change at all" to 5 " already meeting C3 behavior goal" was used to capture
their perceived amount of behavior change related to specific goal.
How the study outcome measures used to address the research questions are
summarized in Table 9.
Data Analysis
Data were entered and analyzed with SPSS version 15.0 for Windows. The aims
of the study are to answer 6 research questions:
1. What are the impacts of the C3 curriculum on eating behaviors (packaged
snacks, sweet drinks, fast food), physical activity (intensive sports and exercise,
walking and taking stairs), and sedentary behaviors (TV/movies watching,
computer/video games playing)?
Mean and standard deviations were calculated for each category asked in the
eating (packaged snacks, sweet drinks, and fast food) behaviors, physical activity, and
sedentary behaviors. Repeated measures ANOVA were performed to assess students'
behavioral change over time (T1 to T3), in the control condition (T1 vs. T2),
-Self-efficacy 17-19, 31-33, 41-43, 53-55
-Physical aspect of outcome expectations
13b, 26b, 37b,
-Social aspect of outcome expectations
13c, 13d, 26c, 26d, 37c, 37d
-Autonomy Q15, 16, 29, 30, 39, 40
-Competence Q20, 34, 44, 56
-Knowledge Q 60-68
a. Psychosocial variables (self-efficacy, physical and social
b. Science and nutrition knowledge?
aspects of outcome expectations, autonomy, competency).
Bitestep Survey:
-Behavior goals Q3a
-Perceived amount of change
related specific goals Q31b, 32b,
33b, 34b
Student Survey:
-Eating behaviors Q8, 10-12,21-22,
24-25, 35, 38
-Physical activity Q45, 46
-Sedentary behaviors Q47, 48
BiteStep Survey:
Measures
3. What are the impacts of the C3 curriculum on
change related to specific goals?
by students, and their perceived amount of behavior
snacks, sweet drinks, and fast food consumption) selected
fruit and vegetables consumption, decreasing packaged
2. What are the food-related behaviors goals (increasing
(TV/movies watching, computer/video games playing)?
exercise, walking and taking stairs), and physical activity
food consumption), physical activity (intensive sports and
eating behaviors (packaged snack, sweet drinks, and fast
1. What are the impacts of the C3 curriculum on
Research Questions
Summary of Study Data
Table 11
Scales
Items
Items
Data
Types of
ANOVA
Measures
Repeated
Descriptive
ANOVA
Measures
Repeated
Analysis
original study?
and study outcomes differ between the current study and the
6. How do study design, study sample, study evaluation,
implementation of the C3 curriculum?
5. What is the role of the lead teacher in facilitating the
contextual factors?
amount of change associated with demographics and
4b. How are self-selected behavior goals and perceived
of sweet drinks and packaged snacks at home)?
and after school, weight control behaviors, and availability
students, and their contextual factors (activities at school
4a. What are demographics (gender, race/ethnicity) of
Research Questions
Understanding Science
(nutrition and science knowledge)
Tell Me about You
(psychosocial variables)
EatWalk survey
(behaviors)
BiteStep Survey
(behaviors; psychosocial variables,
knowledge )
Interview
-Availability of packaged snacks and
sweet drinks at home Q14, 28
-Weight control behaviors Q58
Bitestep Survey:
-Demographics (gender, race/ethnicity)
-Contextual factors Qla, lb, Id
(school and after school activities)
-Behavior goals and perceived
amount of change 3a, 3 lb, 32b,
33b, 34b
Student Survey:
Measures
Content
analysis
Descriptive
questions
Items
Chi square tests
Descriptive;
Analysis
Open-ended
Items
Data
Types of
79
and in the intervention condition comparing to the control condition (T1 and T2 vs. V3);
and to assess whether the behavioral change was related to gender or race/ethnicity.
2. What are the food-related behaviors goals (increasing fruit and vegetables
intake, decreasing packaged snacks intake, decreasing sweet drinks intake, decreasing
fast food intake) selected by students, and their perceived amount of behavior change
related to specific goals?
Descriptive statistics were used to assess students' C3 food-related behavior goals
and their perceived amount of behavior change.
3. What are the impacts of the C3 curriculum on psychosocial variables (selfefficacy, physical and social aspects of outcome expectations, autonomy, competence),
and science and nutrition knowledge?
Mean and standard deviations were calculated for each psychosocial variable and
knowledge scale. Repeated measures ANOVA were performed to assess change of
psychosocial variables and knowledge over time (T1 to T3), in the control condition (T1
vs. T2), and in the intervention condition comparing (T1 and T2 vs. T3); and to assess
whether the change of variables and knowledge were related to gender or race/ethnicity.
4a. What are the demographics of students (gender, race), and their contextual
factors (activities at school and after school, weight control behaviors, and availability of
sweet drinks and packaged snacks at home)?
4b. How are behavior goals and self-perceived amount of changes associated with
demographics and contextual factors?
Descriptive statistics were used to assess study participants' demographics and
contextual factors. Chi square tests were performed to examine how food behavior goal
and perceived amount of behavior change of students were associated with their
demographics and contextual factors.
5. What is the role of lead teacher in facilitating the implementing the C3
curriculum?
A phone interview with the lead teacher was conducted at the end of the C3
curriculum to understand her role in facilitating implementation of the C3 curriculum.
6. How do study design, study sample, study evaluation, and study outcome
differ between the current study and the original study?
Descriptive statistics were used to describe the differences of study design, study
sample, study evaluation, and study outcomes between two studies.
81
Chapter IV
RESULTS
This chapter will present the findings of the six research questions asked in the
study. The results of this study are based on the BiteStep Survey and the Student Survey
given to the 750 students in Parkside Middle School, and an interview with the lead
teacher. The BiteStep Survey was administered to students three times — pre and post the
control condition, and post the intervention condition ~ to assess the effects of the C3
curriculum in changing food and activity behaviors, psychosocial variables and
knowledge. The Student Survey was administered to students one time at the end of the
intervention to determine their demographic and contextual factors, the food related
behavior goals they had selected during the C3 curriculum, and their perceived amount of
behavior change in relation to specific goals. A phone interview was conducted at the end
of the study to understand the lead teacher's role in facilitating implementation of the
curriculum.
The BiteStep Survey was first pilot-tested with a group of 25 students to improve
the clarity of the wording, and drop questions with ceiling effects. The Cronbach's alpha
for self-efficacy scales of four behaviors (packaged snacks, sweet drinks, fast food, and
physical activity), psychosocial variables scales (outcome expectation (physical and
social aspects), autonomy, competency), and knowledge scale, based on the baseline data
(Tl) were found to be over 0.70, (Appendix G) suggesting good internal consistency of
items in the scales.
82
The data were analyzed using the Statistical Package for the Social Sciences
(SPSS), Version 15.0. Some students were eliminated from data analysis as they did not
complete the BiteStep Survey three times, as required for inclusion in the analysis.
Demographics of Study Sample
Among 750 students participated in the study, 80 students who missed either one
of the two surveys due to absence from the class were excluded from the data analysis.
Demographic data of the 670 students are present in Table 10. There were a slightly
fewer boys (49.3%) than girls, and about half of the participants were white.
Table 10
Demographics of Study Population
N
%
Boys
330
49.3
Girls
340
50.7
Black
190
28.4
White
332
49.6
38
5.6
110
16.4
Gender
Race/Ethnicity
Hispanic
Multiracial/Others
83
Primary Behavior Outcomes
The primary outcome measures of the study were students' changes in eating and
physical activity behaviors in the C3 curriculum intervention condition. These changes
were measured using the BiteStep survey. Because the students served as their own
controls, the behavioral data were collected 3 times for all participants: pre-control
condition (Tl), post-control condition which was also the pre-intervention condition (T2),
and then after the C3 intervention condition (T3). Fourteen questions related to packaged
snacks consumption, sweet drinks consumption, fast food consumption, physical activity,
and sedentary behaviors were analyzed individually because they were meant to measure
different constructs. Means and standard deviations were calculated for these behaviors
measured 3 times (Tl, T2, and T3).
Repeated measures ANOVA (analysis of variance) were used to assess the extent
to which behaviors changed over time (Tl to T3), in the control condition (Tl vs. T2),
and in the intervention condition (Tl and T2 vs. T3); and to determine whether behavior
changes were related to gender or race/ethnicity.
Within-Subjects Tests
Packaged snacks. In order to understand students' packaged snacks consumption
behaviors, four questions were asked in the survey: frequency of consumption, frequency
of eating fruit or vegetable instead of packaged snacks, and frequency and size of
packaged snacks purchased. The frequency of consumption behaviors were scored on a
four-point scale ranging from 0 ("0 times"), 1 ("1 time"), 2 ("2 times"), to 3 ("3 or more
times"). The frequency of purchase was scored on a five-point scale ranging from 1
("never buy them or only once in a while"), 2 ("about once a week), 3 ("several times a
week"), 4 ("almost every day") to 5 ("two or more times a day"). The size of purchase
was scored on a four-point scale ranging from 1 ("never buy them"), 2 ("small size"), 3
("medium size") to 4 ("large size").
For frequency of packaged snacks consumption per day, the behavior change over
time was non-significant (Table 11). The within-subjects contrast test was non-significant
for T2 vs. Tl, and borderline significant for T3 vs. Tl and T2, F (1, 498) =3.713,/? =
0.055, partial r|2= 0.007, indicating that decreased packaged snack consumption in the
intervention condition was borderline significant after comparing to the non-significant
decrease in the control condition.
There were no significant changes overtime, in the control condition, or in the
intervention condition in buying packaged snacks, or size of packaged snacks purchased
(Table 11).
There was a significant change over time for eating fruit and vegetables instead of
packaged snacks (p =0.000) (Table 11). However, the within-subjects contrast test was
significant for T2 vs. Tl, F (1, 478) = 12.143,p < 0.05, partial r|2= .025, and nonsignificant for T3 vs. Tl and T2, indicating that increased fruit and vegetables
consumption instead of packaged snacks in the intervention condition was non-significant
after comparing to the significant decrease in the control condition.
1.34(1.05)
1.96(1.04)
1.45 (1.09)
Buying packaged snacks/
week (Scale 1-5)
Eating fruit or vegetables
instead of packaged snacks/
day (Scale 0-3)
Tl Mean
(SD)
Eating packaged snacks/day
(Scale 0-3)
Packaged Snacks
Variables
1.24(1.07)
2.00(1.05)
1.25(1.02)
T2 Mean
(SD)
Repeated ANOVA Tests for Packaged Snacks Behaviors
Table 11
1.35 (1.05)
1.92 (1.03)
1.18(0.95)
T3 Mean
(SD)
Over time
Control
Intervention
Over time
Control
Intervention
Over time
Control
Intervention
WithinSubjects
Tests
(2, 956)
(1,478)
(1,478)
(2, 986)
(1,493)
(1,493)
(2, 996)
(1,498)
(1,498)
df
0.000
0.001
0.076
0.967
0.975
0.804
0.034
0.001
0.062
7.846
12.143
3.168
0.063
0.173
0.055*
Sig
(2-tailed)
2.778
1.864
3.713
F
Ul
00
2.58 (0.93)
Tl Mean
(SD)
2.56(0.95)
T2 Mean
(SD)
2.50(0.95)
T3 Mean
(SD)
Overtime
Control
Intervention
WithinSubjects
Tests
(2,1002)
(1,501)
(1,501)
df
0.710
0.748
0.674
F
0.492
0.387
0.412
Sig
(2-tailed)
* - Borderline significant with the p value between 0.05 and 0.06;
Tl - pretest for control science curriculum; T2- Posttest for control science curriculum and pre-test for C3 curriculum; T3- Posttest for
C3 curriculum;
Four point scale 0-3 (0, 1, 2, 3 or more times) for frequency of consumption; Five point scale 1-5 (never buy, once a week, several
times a week, almost every day, two or more times a day) for frequency of purchase; Four point scale 1-4 (never buy them, small,
medium, large size) for sizes of purchase; df- degree of freedom;
Over time test- within-subjects test for behavior change over time (Tl to T3); Control test- within-subjects contrast test for behavior
change in control condition (T2 vs. Tl); Intervention test- within-subjects contrast test for behavior change in intervention condition
(T3 vs. Tl and T2)
Size of packaged snacks
purchased (Scale 1-4)
Packaged Snacks
Variables
Repeated ANOVA Tests for Packaged Snacks Behaviors
Table 11 (Continue)
oo
87
Sweet drinks. In order to understand students' sweet drink consumption
behaviors, four questions were asked in the survey: frequency of sweet drinks
consumption, frequency of diet beverages consumption, and frequency and size of sweet
drinks purchased were asked in the survey. The frequency of consumption was scored on
a four-point scale ranging from 0 ("0 times"), 1 ("1 time"), 2 ("2 times"), to 3 ("3 or more
times"). The frequency of purchase was scored on a five-point scale ranging from 1
("never buy them or only once in a while"), 2 ("about once a week), 3 ("several times a
week"), 4 ("almost every day") to 5 ("two or more times a day"). The size of purchase
was scored on a four-point scale ranging from 1 ("never buy them"), 2 ("small size"), 3
("medium size") to 4 ("large size).
For frequency of drinking sweet drinks per day, the behavior change over time
was significant (p =0.022) (Table 12). The within-subjects contrast test was nonsignificant for T2 vs. Tl, and significant for T3 vs. Tl and T2, F (1, 499) =6.258,p <
0.05, partial r|2= 0.012, indicating that decreased sweet drinks consumption in the
intervention condition was significant after comparing to the non-significant decrease in
the control condition.
For frequency of drinking diet drinks per day, the behavior change over time was
significant (p =0.029) (Table 12). The within-subjects contrast test was significant for T2
vs. Tl, F (1, 496) = 6.819,p < 0.05, partial r|2=0.014, but non-significant for T3 vs. Tl
and T2, which indicated that increased diet drink consumption in the intervention
condition was non-significant after comparing to the significant decrease in the control
condition. No significant changes over time, or in the control or intervention condition
were found in buying sweet drinks, or size of sweet drinks purchased behaviors.
1.73 (1.08)
0.53 (0.92)
2.07(1.07)
Drinking diet beverages
drinks/day
(Scale 0-3)
Buying sweet drinks/week
(Scale 1-5)
Tl Mean
(SD)
Drinking sweet drinks/day
(Scale 0-3)
Sweet Drinks
Variables
Repeated ANOVA Tests for Sweet Drinks Behaviors
Table 11
1.50(1.04)
0.49 (0.88)
2.06(1.10)
0.41 (0.81)
2.11 (1.07)
T3 Mean
(SD)
1.63 (1.06)
T2 Mean
(SD)
Over time
Control
Intervention
Over time
Control
Intervention
Over time
Control
Intervention
WithinSubjects
Tests
(2, 998)
(1,499)
(1,499)
(2, 992)
(1,496)
(1,496)
(2, 998)
(1,499)
(1,499)
df
0.422
0.290
0.537
3.557
6.819
0.770
3.818
1.501
6.258
F
0.656
0.590
0.464
0.029
0.009
0.381
0.022
0.221
0.013
Sig
(2-tailed)
00
00
2.48 (0.91)
Tl Mean
(SD)
2.47 (0.92)
T2 Mean
(SD)
2.44 (0.98)
T3 Mean
(SD)
Over time
Control
Intervention
WithinSubjects
Tests
(2,992)
(1,496)
(1,496)
df
0.859
0.256
1.332
0.424
0.613
0.249
Sig
(2-tailed)
Tl - pretest for control science curriculum; T2- posttest for control science curriculum and pretest for C3 curriculum; T3- posttest for
C3 curriculum;
Four point scale 0-3 (0, 1, 2, 3 or more times) for frequency of consumption; Five point scale 1-5 (never buy, once a week, several
times a week, almost every day, two or more times a day) for frequency of purchase; Four point scale 1-4 (never buy, small, medium,
and large) for sizes of purchase; df- degree of freedom;
Over time test- within-subjects test for behavior change over time (Tl to T3); Control test- within-subjects contrast test for behavior
change in control condition (T2 vs. Tl) Intervention test - within-subjects contrast test for behavior change in intervention condition
(T3 vs. Tl and T2)
Size of sweet drinks
purchased
(Scale 1-4)
Sweet Drinks
Variables
Repeated ANOVA Tests for Sweet Drinks Behaviors
Table 12 (Continue)
o
00
90
Fast food. In order to understand students' fast food consumption behaviors, two
questions were asked in the survey: frequency of fast food consumption and frequency of
eating fast food with family. The frequency of consumption and eating with family were
scored on a five-point scale ranging from 0 ("0 times"), 1 ("1-2 time"), 2 ("3 times"), 3
("4-5 times") to 4 (6 or more times).
For frequency of fast food consumption per week, the behavior change over time
was significant (p = 0.005) (Table 13). The within-subjects contrast test was significant
for T2 vs. Tl, F (1, 492) = 6.937,p < 0.05, partial r|2=0.014, and borderline significant
for T3 vs. Tl and T2, F (1, 492) = 3.772,p = 0.053, partial r]2=0.008, indicating that
decreased fast food consumption in the intervention condition was borderline significant
after comparing to the significant decrease in the control condition.
There were no significant changes over time, or in the control or intervention
condition in frequency of eating fast food with family (Table 13).
Physical activity. In order to understand students' physical activity, two
questions were asked in the survey: frequency of walking and taking stairs was scored on
a point scale ranging from 1 (only walking or taking stairs when I really have to), 2 (once
in a while), 3 (some days) to 4 (just about every day); and frequency of intensive physical
activities a week was scored on a five point scale ranging from 0 ("0 days"), 1 ("1-2
days"), 2 ("3-4 days"), 3 ("5-6 days"), to 4 (7 days") (Table 14).
For frequency of walking or taking stairs, the behavior change over time was
significant (p= 0.05). The within-subjects contrast test was significant for T2 vs. Tl, F (1,
482) = 5.420,p = 0.020, partial r|2=0.011, and non-significant for T3 vs. T2 and Tl,
indicating that increased frequency of walking and taking stairs in the intervention
1.81 (0.97)
1.76 (0.93)
1.71 (0.84)
Eating fast food with
Family/week (0-4)
(2, 984)
(1,492)
(1,492)
(2, 970)
(1,485)
(1,485)
Over time
Control
Intervention
df
Over time
Control
Intervention
WithinSubjects
Tests
0.005
0.009
0.053*
0.739
0.968
0.490
0.302
0.002
0.447
Sig
(2Jailed)
5.304
6.937
3.772
F
*- Borderline significant with the p value between 0.05 and 0.06;
Tl - pretest for control science curriculum; T2- posttest for control science curriculum and pre-test for C3 curriculum; T3- posttest for
C3 curriculum;
Five point scale 0-4 (0, 1-2, 3, 4-5, 6 times or more) for frequency of consumption; df- degree of freedom;
Over time test - within-subjects tests for behavior change over time (Tl to T3);
Control test- within-subjects contrast test for behavior change in control condition (T2 vs. Tl);
Intervention test- within-subjects contrast test for behavior change in intervention condition (T3 vs. Tl and T2)
0.85 (0.86)
T3 Mean
(SD)
0.94 (0.87)
T2 Mean
(SD)
1.04(0.88)
Tl Mean
(SD)
Eating fast food/week
(Scale 0-4)
Fast Food
Variables
Repeated ANOVA Tests for Fast Food Behaviors
Table 13
vo
92
condition was non-significant after comparing to the significant increase in the control
condition.
For frequency of intensive physical activity per week, the behavior change over
time was significant (p < 0.05). The within-subjects contrast test was significant for T2 vs.
Tl, F (1,482) = 17.424,p < 0.05, partial r|2=0.035, and non-significant for T3 vs. T2 and
Tl, indicating that decreased intensive physical activity in the intervention condition was
non-significant after comparing to the significant increase in the control condition (Table
14).
Sedentary behaviors. In order to understand students' sedentary behaviors, two
questions were asked in the survey: amount of time spent on watching TV/movie and
playing computer/video games were scored on a four point scale ranging from 0 ("0
hours"), 1 ("1 hour"), 2 ("2 hours"), 3 ("3 hours or more").
For amount of time spent watching TV/movies per day, the behavior change over
time was significant (p < 0.05). The within-subjects contrast test was significant for T2 vs.
Tl, F (1,475) = 22.220,p < 0.05, partial n2=0.045, and also significant for T3 vs. T2 and
Tl, F (1,475) = 18.791,p < 0.05, partial r|2=0.038, indicating that the decreased
TV/movie watching in the intervention condition were significant after comparing to the
significant decrease in the control condition.
For amount of time spent playing computer/video games per day, the behavior
change over time was significant (p < 0.05) (Table 14). The within-subjects contrast test
was significant for T2 vs. Tl, F (1, 475) = 38.576,p < 0.05, partial r|2=0.075, and also
significant for T3 vs. Tl and T2, F (1, 475) = 29.998, p < 0.05, partial ti2=0.059,
Number of hours watching
TV or movies/day
(Scale 0-3)
1.96(1.02)
2.07(1.26)
Number of days play
Intensive sports or
Exercise/week
(Scale 0-4)
Sedentary Behaviors
2.60(1.05)
Tl Mean
(SD)
Frequency of walking
& taking stairs
(Scale 1-4)
Physical Activity
Variables
1.59(1.05)
2.39(1.30)
2.70(1.04)
T2 Mean
(SD)
1.52(1.03)
2.36(1.27)
2.71 (1.10)
T3 Mean
(SD)
Repeated ANOVA Tests for Physical Activity and Sedentary Behaviors
Table 11
Overtime
Control
Intervention
Over time
Control
Intervention
Over time
Control
Intervention
WithinSubjects
Tests
(2,950)
(1,475)
(1,475)
(2, 964)
(1,482)
(1,482)
(2, 964)
(1,482)
(1,482)
df
20.531
22.220
18.791
9.262
17.424
2.516
3.012
5.420
1.178
0.000
0.000
0.000
0.000
0.000
0.113
0.050
0.020
0.278
Sig.
(2-tailed)
u>
1.44(1.20)
Tl Mean
(SD)
1.04(1.10)
T2 Mean
(SD)
0.96(1.03)
T3 Mean
(SD)
Overtime
Control
Intervention
WithinSubjects
Tests
(2,950)
(1,475)
(1,475)
df
34.628
38.576
29.998
F
0.000
0.000
0.000
Sig.
(2-tailed)
Tl - pretest for control science curriculum; T2- posttest for control science curriculum and pretest for C3 condition; T3- posttest for C3
curriculum;
Four point scale 1-4 (only really have to, once a while, some days, just about every day) for frequency of walking and taking stairs;
Five point scale 0-4 (0, 1-2, 3-4, 5-6, 7) for days of intensive physical activity a week; Four-point scale 0-3 (0, 1, 2, 3 or more ) for
hours a day spent on TV/movies watching and computer/video games playing;
df- degree of freedom;
Over time test - within-subjects test for behavior change over time (Tl to T3); Control test- within-subjects contrast test for behavior
change in control condition (T2 vs. Tl); Intervention test - within-subjects contrast test for behavior change in intervention condition
(T3 vs. Tl and T2)
Number of hours playing
Computer or video games
(Scale 0-3)
Sedentary Behaviors
Variables
Repeated ANOVA Tests for Physical Activity and Sedentary Behaviors
Table 14 (Continue)
95
indicating that the decreased computer/video games playing in the intervention condition
was significant after comparing to the significant decrease in the control condition.
The behavioral changes in the intervention condition are presented in the
following table.
Table 15
Summary of Behavioral Changes in the Intervention Condition Compared to Control
Condition
Behaviors
Packaged Snacks
Frequency of eating packaged snacks a day
Frequency of buying packaged snacks a week
Frequency of eating fruit or vegetables instead of packaged snacks a day
Size of packaged snacks purchased
Changes in intervention
condition
v*
—
—
—
Sweet Drinks
Frequency of drinking sweet drinks a day
Frequency of drinking diet beverages a day
Frequency of buying sweet drinks a week
Size of sweet drinks purchased
—
—
—
Fast Food
Frequency of eating fast food a week
Frequency of eating fast food with family a week
v*
—
Physical Activity
Frequency of walking and taking stairs
Frequency of intensive physical activity a week
—
—
Sedentary Behaviors
Hours of TV/movies watching a day
V
Hours of computer/video games playing a day
Note, v = Significant changes, y * = Borderline Significant, _ = Non-significant changes
96
Between-Subjects Tests
For those three behaviors (sweet drinks consumption, TV/movies watching, and
computer/video games playing) that showed significant changes, and two behaviors
(packaged snacks consumption, and fast food consumption) that showed borderline
significant changes in the intervention condition, there was a significant interaction
between race and frequency of fast food consumption (p < 0.001), indicating that race
had a significant effect over time on the frequency of fast food consumption. Further, the
between-subjects contrast tests showed that race had a significant effect on fast food
consumption in the control condition, F (3, 492) = 5.520,p = 0.001, partial r|2=0.033,
and a non-significant effect on the behavior in the intervention condition (Table 16).
C3 Food-Related Behavior Goals and Perceived Amount of Behavior Change
Food-Related Behavior Goals Selected by Students
In the middle of the C3 curriculum implementation all participating students were
asked to select a food- related behavior change goal among the four behaviors (increasing
fruit and vegetables consumption, decreasing sweet drinks, packaged snacks, and fast
food consumption) to work on throughout the curriculum, and these data were collected
through the Student Survey. Overall, increasing fruit and vegetables was selected by the
largest percentage of students regardless their gender or race/ethnicity (Table 17).
1.04 (0.88)
Frequency of fast food consumption
(Scale 0-4)
T3 Mean
(SD)
0.85 (0.86)
T2 Mean
(SD)
0.94 (0.87)
Over time
Control
Intervention
BetweenSubjects
Tests
(6, 984)
(3,492)
(3,492)
df
3.263
5.520
1.147
F
0.004
0.001
0.330
Sig
(2-ailed)
Five point scale 0-4 (0, 1-2, 3, 4-5, 6 times or more) for frequency of consumption; df- degree of freedom; Over time test - betweensubjects tests for effect of race on behavior change over time (Tl to T3) on behavior; Control test- between-subjects contrast test for
effect of race on behavior change in control condition (T2 vs. Tl); Intervention test- between-subjects contrasts test for effect of race
on behavior change in intervention condition
Tl Mean
(SD)
Behaviors
Between-Subjects Test for Fast Food Consumption by Race
Table 11
73
45
55
Decrease sweet drink
Decrease packaged snacks
Decrease fast food
168
69
38
57
Increase fruits and vegetables
Decrease sweet drink
Decrease packaged snacks
Decrease fast food
Girls
151
17.2%
11.4%
20.8%
50.6%
17.0%
13.9%
22.5%
46.6%
20
8
18
52
17
15
11
42
n
n
%
Black
Total
Increase fruits and vegetables
Boys
Consumption
C3 Food-Related Behavior Change Goals Selected by Students
Table 11
20.4%
8.2%
18.4%
53.1%
20.0%
17.6%
12.9%
49.4%
%
25
19
36
74
26
27
50
70
n
White
16.2%
12.3%
23.4%
48.1%
15.0%
15.6%
28.9%
40.5%
%
0
4
2
10
6
2
3
11
n
0.0%
25.0%
12.5%
62.5%
27.3%
9.1%
13.6%
50.0%
%
Hispanic
12
7
13
32
6
1
9
28
n
18.8%
10.9%
20.3%
50.0%
13.6%
2.3%
20.5%
63.6%
%
Multiracial
Others
oo
99
Self-Perceived Amount of Change
Students were asked to rate how much their behaviors related to goals selected
had changed as a result of the C3 curriculum. Amount of behavior change was scored on
a four-point scale ranging from 1 ("did not change at all"), 2 ("changed a little"), 3
("changed a medium amount"), to 4 ("changed a lot"). The largest percentage of students
(70% to 83%) reported that they had either "changed a little," "changed a medium
amount," or "changed a lot" in their behaviors related to specific goals (Table 18).
Secondary Psychosocial Variables and Knowledge Outcomes
The secondary outcome measures of the study were students' changes in
psychosocial variables and science and nutrition knowledge in the study. These data were
collected through the BiteStep survey. Because the students served as their own controls,
the psychosocial variables and knowledge data were collected 3 times for all participants:
pre-control condition (Tl), post-control condition which was also the pre-intervention
condition (T2), and then after the C3 intervention condition (T3).
The questions designed to measure the same construct were grouped into a scale.
Different scales were created to assess eight psychosocial variables (self-efficacy for
packaged snacks, sweet drinks, fast food, and physical activity (walking and taking stairs);
physical and social aspects of outcome expectations; autonomy; and competency), and
science and nutrition knowledge. Means and standard deviations were calculated for
those scales measured 3 times (Tl, T2, and T3).
96
146
148
148
Decrease Sweet Drink
Decrease Packaged Snacks
Decrease Fast Food
29.2%
25.8%
24.9%
16.9%
29.4%
38.2%
29.8%
23.3%
167
224
171
118
104
127
121
173
20.5%
22.2%
20.7%
30.5%
%
n
%
n
n
%
Change
a medium
Changed
a little
Did not
change
Increase Fruits and Vegetables
Food-related behavior
change goal
Perceived Amount of Behavior Change by Students
Table 11
137
127
95
132
n
%
27.0%
22.2%
16.2%
23.2%
Changed
a lot
101
Repeated measures ANOVA were to assess the extent to which the variables
changed over time (Tl to T3), in the control condition (Tl vs. T2), and in the intervention
condition comparing to the control condition (Tl and T2 vs. T3); and to determine
whether variable changes were related to gender or race/ethnicity.
Within-Subjects Tests
All psychosocial variables questions were scored on a four-point scale ranging
from 1 ("There is no way I could do this...") to 4 ("I could do this every day"). A higher
score meant a higher degree of psychosocial variable for desirable behaviors. All science
and nutrition questions were scored on a two-point scale including "0" for wrong answers,
and "1" for right answers.
Self-efficacy. In terms of self-efficacy for packaged snacks behavior, the change
over time was significant (p= 0.028) (Table 19). The within-subjects contrast test was
non-significant for T2 vs. Tl, F (1, 489) = 0.002,p= 0.965, partial r|2=0.000, and
significant for T3 vs. Tl and T2, F (1, 489) = 6.125,p < 0.05, partial r|2=0.014,
indicating that increased self-efficacy in the intervention condition was significant after
comparing to the non-significant increase in the control condition.
There were no significant changes over time or for the control or intervention
condition in self-efficacy for sweet drinks behavior or physical activity (walking and
taking stairs) (Table 19).
In terms of self-efficacy for fast food behavior, the change over time was
significant (p= 0.025) (Table 19). The within-subjects contrasts test was significant for
T2 vs. Tl, F (1, 483) = 7.465,;? < 0.05, partial r|2=0.013, and non-significant for T3 vs.
2.87 (0.87)
2.92 (0.87)
3.20 (0.83)
3.07 (0.73)
Sweet Drinks
(Scale 1-4)
Fast Food
(Scale 1-4)
Physical Activity
(Scale 1-4)
Over time
Control
Intervention
Over time
Control
Intervention
3.30 (0.83)
3.14(0.77)
Over time
Control
Intervention
Over time
Control
Intervention
3.14(0.81)
2.97 (0.88)
WithinSubjects
Tests
T3 Mean (SD)
(2, 954)
(1,477)
(1,477)
(2, 966)
(1,483)
(1,483)
(2, 968)
(1,484)
(1,484)
(2, 978)
(1,489)
(1,489)
df
1.447
2.048
0.961
3.701
7.465
0.915
2.063
0.824
3.348
3.582
0.002
6.725
F
0.236
0.153
0.327
0.025
0.007
0.339
0.128
0.364
0.068
0.028
0.965
0.010
Sig
(2-tailed)
Tl - pre-test for control condition; T2- post-test for control condition and pre-test for intervention condition; T3- post-test for
intervention condition;
Scale (1-4) - higher score represents higher degree of self-efficacy;
Over time- within-subjects test for self-efficacy change over time (Tl to T3); Control - within-subjects contrast test for self-efficacy
changed in control condition (T2 vs. Tl); Intervention- within-subjects contrast test for self-efficacy changed in intervention condition
(T3 vs. Tl and T2)
3.10(0.76)
3.28 (0.81)
3.03 (0.79)
3.01 (0.76)
Packaged Snacks
(Scale 1-4)
T2 Mean (SD)
Tl Mean (SD)
Self-Efficacy
Repeated Measures ANOVA for Self-Efficacy
Table 11
103
Tl and T2, F (1, 483) = 0.915,p= 0.339, partial r)2=0.080 (Table 19), indicating that
increased self-efficacy in the intervention condition was non-significant compared to the
significant increase in the control condition.
Other psychosocial variables. There were no significant changes over time or
for the control or intervention condition in either social aspect of outcome expectations,
autonomy, or competency (Table 20).
For physical aspect of outcome expectations, the change over time was significant
(p= 0.009). The within-subjects contrasts test was non-significant for T2 vs. Tl, and
significant for T3 vs. Tl and T2, F (1, 495) = 5.771,/? < 0.05, partial r|2=0.012,
indicating that increased physical aspect of outcome expectations in the intervention
condition was significant after comparing to the non-significant decrease in the control
condition.
Knowledge. There were no significant changes over time or for the control or
intervention condition in overall knowledge (Table 21). Repeated measures ANOVA
were also performed for individual nine questions. There was a significant change in the
intervention condition for the question asking about "dynamic equilibrium in the body",
and a borderline significant change (p=0.05) in the intervention condition for the question
asking about "cardiovascular system."
Between-Subjects Tests
Among three variables (self-efficacy in packaged snacks consumption, physical
aspect of outcome expectations, and knowledge in dynamic equilibrium) that showed
significant change, and one (knowledge in cardiovascular system) that showed borderline
11
2.57 (0.84)
2.89 (0.89)
2.46 (0.60)
2.76 (0.92)
Outcome Expectations
(Physical aspect)
(Scale 1-4)
Outcome Expectations
(Social aspect)
(Scale 1-4)
Autonomy
(Scale 1-4)
Competency
(Scale 1-4)
2.76 (0.94)
2.44 (0.61)
Over time
Control
Intervention
Over time
Control
Intervention
2.48 (0.61)
2.82 (0.98)
Over time
Control
Intervention
2.93 (0.98)
3.01 (0.90)
Over time
Control
Intervention
2.60 (0.92)
2.52 (0.86)
WithinSubjects
Tests
T3Mean(SD)
T2Mean(SD)
(2, 1000)
(1,500)
(1,500)
(2, 1002)
(1,501)
(1,501)
(2, 988)
(1,494)
(1,494)
(2, 990)
(1,495)
(1,495)
df
0.250
0.020
0.456
0.779
0.887
0.500
0.088
0.140
0.106
0.101
0.038
0.567
2.302
4.347
0.437
2.436
2.188
2.618
0.009
0.060
0.017
Sig
(2-tailed)
4.728
3.450
5.771
F
Tl - pre-test for control condition; T2- post-test for control condition and pre-test for intervention condition; T3- post-test for
intervention condition; 4 point scale (1-4) - higher score represents higher degree of psychosocial variable; Over time test - withinsubjects test for variable change over time (Tl to T3); Control test - within-subjects contrast test for variable change in control
condition (T2 vs. Tl); Intervention test- within-subjects contrast test for variable change in intervention condition (T3 vs. Tl and T2)
TlMean(SD)
Psychosocial Variables
Repeated Measures ANOVA for Psychosocial Variables
Table
0.68 (0.25)
0.69 (0.24)
0.44 (0.497)
0.54 (0.499)
0.80 (0.403)
0.42 (0.494)
Knowledge
(Q60-68)
(0, 1)
Q60
(0, 1)
Q61
(0,1)
Q62
(0, 1)
Q63
(0,1)
0.83 (0.378)
0.46 (0.499)
0.41 (0.493)
0.55 (0.498)
0.57 (0.520)
0.70 (0.26)
T3 Mean
(SD)
0.79 (0.405)
0.58 (0.493)
0.44 (0.497)
T2 Mean
(SD)
Tl Mean
(SD)
Variables
Repeated Measures ANOVA for Knowledge
Table 11
Over time
Control
Intervention
Over time
Control
Intervention
Over time
Control
Intervention
Over time
Control
Intervention
Over time
Control
Intervention
WithinSubjects
Tests
(2, 930)
(1,465)
(1,465)
(2, 930)
0,465)
(1,534)
(2,918)
(1,459)
(1,459)
(2, 934)
(1,467)
(1,467)
(2, 956)
(1,478)
(1,478)
df
0.876
0.049
1.686
0.876
0.049
3.697
0.612
1.100
0.105
6.085
0.615
10.596
1.866
0.570
2.949
F
0.417
0.826
0.195
0.417
0.826
0.055*
0.542
0.295
0.746
0.002
0.433
0.001
0.155
0.451
0.087
Significance
(2 tailed)
Over time
Control
Intervention
0.82 (0.380)
0.82 (0.386)
0.86 (0.350)
Q68
(0, 1)
(2, 902)
0,451)
(1,451)
Over time
Control
Intervention
0.76 (0.426)
0.80 (0.404)
0.81 (0.394)
Q67
(0, 1)
(2, 922)
(1,461)
(1,461)
Over time
Control
Intervention
0.89 (0.314)
0.89 (0.317)
0.90 (0.298)
Q66
(0, 1)
Over time
Control
Intervention
0.77 (0.422)
0.76 (0.430)
0.79 (0.410)
Q65
(0,1)
3.209
4.893
1.652
0.840
0.023
1.473
1.069
0.067
2.137
1.496
2.814
0.104
0.747
0.792
0.703
F
0.041
0.027
0.199
0.432
0.881
0.225
0.344
0.795
0.144
0.224
0.094
0.748
0.474
0.374
0.402
Significance
(2 tailed)
Tl- pretest for control condition; T2- posttest for control condition and pretest for intervention condition; T3- posttest for intervention condition;
2 point scale- 0 for incorrect answers and 1 for correct answers; Over time test- test for knowledge change over time (Tl to T3); Control test - test
for knowledge change in control condition (Tl vs. T2); Intervention- knowledge change in intervention condition (T3 vs. Tl and T2)
(2, 898)
(1,449)
(1,449)
(2, 920)
(1,460)
0,460)
(2, 920)
(1,460)
(1,460)
Over time
Control
Intervention
0.67 (0.471)
0.69 (0.463)
Q64
(0,1)
0.67 (0.471)
df
WithinSubjects
Tests
T2 Mean
(SD)
Tl Mean
(SD)
Questions
T3 Mean
(SD)
Repeated Measures ANOVA for Knowledge
Table 21 (Continue)
107
significant change in the intervention condition, there was no significant effect of gender
or race on variables over time, in the control condition, and in the intervention condition.
A summary of psychosocial variables and knowledge changes in the intervention
condition are presented in Table 22.
Table 22
Summary of Psychosocial Variables and Knowledge Changes in the Intervention
Condition Compared to Control Condition
Changes in Intervention
Variables
Condition
Self-Efficacy
Self-efficacy for packaged snacks consumption
Self-efficacy for sweet drinks consumption
Self-efficacy for fast food consumption
Self-efficacy for physical activity
V
—
—
—
Other Psychosocial Variables
Physical aspect of outcome expectations
Social aspect of outcome expectations
Autonomy
—
—
Competency
—
Knowledge
Note. V = Significant changes,
V
—
= Non-significant changes
108
Demographics and Contextual factors of Study Participants
Contextual Factors of Study Sample
Contextual factors such as frequency of physical activities, sedentary behaviors,
weight control behaviors, and availability of foods played influential roles in children's
eating choices and amount of behavior change were assessed in the current study.
Specifically, data on group physical activities students participated in school and after
school, amount of time spent on TV or movies watching, amount of time spent on
computer or videos playing, whether students were trying to lose weight in the present,
and availability of packaged snacks and sweet drinks at home were collected and
analyzed.
School group activities. In order to learn more how active children were in
Parkside, the amount of time they spent on activities both in school and after school were
investigated through one question in the Student Survey. All students had the
opportunities to participate in several school group activities such as chorus, orchestra,
swimming, gym, band, and others in Parkside Middle school. Every student was entitled
to select one or more group activities that fit into their school schedules. Among the study
population, almost half of students (49.7%) participated in gym regardless of their sex or
race/ethnicity, followed by the band chosen by 15.3% of students (Table 23).
Hours spent on school group activity per week were scored on a five-point scale
ranging from 1 ("less than 2 hours") to 5 ("more than 5 hours). According the selfreported hours spent on those activities per week, the largest percentage of students
(27.4%) overall spent less than 2 hours. The largest percentage of boys (31.3%) spent
102
26
64
74
Band
Chorus and Gym
Swimming and Gym
Others
17
Swimming
322
17
Orchestra
Gym
36
11
8
9
11.1%
9.6%
3.9%
15.3%
29
35
7
43
49.7% 187
2.5%
2.5%
5.4%
3.3%
2.4%
2.7%
%
6
9
27
n
8.8%
10.6%
2.1%
13.1%
45
29
19
59
1.8%
2.7%
8.0%
%
1
4
5
n
13.3%
8.6%
5.6%
17.4%
22
17
6
16
0.5%
2.1%
2.6%
%
11
10
23
n
11.6%
8.9%
3.2%
8.4%
32
23
18
68
3.3%
3.0%
6.9%
%
9.7%
6.9%
5.4%
20.5%
44.1%
White
62.6% 146
Black
42.8% 119
Girls
56.8% 145
n
n
%
Boys
Total
Chorus
Group Activities in School
Variable
Contextual Characteristic of Study Population-School Group Activities
Table 23
5
4
0
2
23
1
1
2
n
13.2%
10.5%
.0%
5.3%
60.5%
2.6%
2.6%
5.3%
%
Hispanic
15
20
2
16
44
4
2
6
n
%
13.8%
18.3%
1.8%
14.7%
40.4%
3.7%
1.8%
5.5%
Others
Multiracial/
110
5 hours or more as compared to girls (30.7%), who spent 2 hours or less on activities
(Table 24). The largest of percentage of students spent 2 hours or less regardless their
race/ethnicity (Black 31.4%; Hispanic 28.9%; 30.8% multiracial). However, more than a
quarter of white students spent more than 5 hours a week on activities.
Sports/Activities after school. Besides team activities in school, the amount of
time that students spent on sports and other activities after school or on weekends was
also examined through one question in the Student Survey. Hours spent on
sports/activities per week were scored on a five-point Liker-type scale ranging from 1
("less than 2 hours") to 5 ("more than 5 hours). According the self-reported hours spent
on activity per week, over 1/4 of students overall spent 5 hours followed by % of them
spent 2 to 3 hours a week on sports/activities (Table 25).
The data were then described by gender to assess differences between boys and
girls. While the largest percentage of boys (38.0%) spent more than 5 hours a week on
sports/activities after school or on weekends, the largest percentage of girl (30.6%) spent
2-3 hours a week on sports/activities after school or on weekends.
The data were further described by race/ethnicity to assess differences between
black, white, Hispanic, and multi-racial students. The results were similar to the overall
results in that the largest percentage of students spent more than 5 hours a week on
sports/activities after school or on weekends followed by 2-3 hours a week regardless of
their race except the largest percentage of black students (27.1%) spent 2-3 hours a week
followed by lA of them spent more than 5 hours a week.
11
178
113
53
133
172
2-3 hours
3-4 hours
4-5 hours
More than 5 hours
73
26
45
78
n
Girls
22.6%
8.0%
13.9%
71
60
27
68
24.1% 100
%
26.5% 101 31.3%
20.5%
8.2%
17.4%
27.4%
n
n
%
Boys
Total
Less than 2 hours
Hours/Week on
School Group Activities
Variable
21.8%
18.4%
8.3%
20.9%
30.7%
%
40
24
22
34
62
n
Black
22.0%
13.2%
12.1%
18.7%
34.1%
%
92
84
21
53
72
n
White
Contextual Characteristic of Study Population - Hours/Week Spent on School Group Activities
Table
28.6%
26.1%
6.5%
16.5%
22.4%
%
18.4%
10.5%
13.2%
28.9%
%
11 28.9%
7
4
5
11
n
Hispanic
29
18
6
21
33
n
27.1%
16.8%
5.6%
19.6%
30.8%
%
Multiracial/
Others
11
132
154
92
75
180
2-3 hours
3-4 hours
4-5 hours
More than 5 hours
40
42
57
57
28.4% 120
11.8%
14.5%
24.3%
20.9%
n
n
%
Boys
Total
Less than 2 hours
After School Activities/
Week
Hours/Week
38.0%
12.7%
13.3%
18.0%
18.0%
%
60
35
50
97
75
n
Girls
18.9%
11.0%
15.8%
30.6%
23.7%
%
44
16
31
48
38
n
Black
24.9%
9.0%
17.5%
27.1%
21.5%
%
97
41
42
75
59
n
White
30.9%
13.1%
13.4%
23.9%
18.8%
%
11
2
7
8
7
n
31.4%
5.7%
20.0%
22.9%
20.0%
%
Hispanic
Contextual Characteristic of Study Population - Hours/Week Spent on Sport/Activities after School or on Weekends
Table
28
16
12
23
28
n
26.2%
15.0%
11.2%
21.5%
26.2%
%
Multiracial/
Others
113
Availability of sweet drinks and packaged snacks at home. To assess
availability of sweet drinks and packaged snacks at home for students, two questions
were asked in the BiteStep survey at the beginning of the study. Availability of packaged
snacks at home was scored on a four-point scale ranging from 1 ("Hardly or not at all"), 2
("Some of the time"), 3 ("most of the time"), to 4 ("All of the time"). Among all students,
the largest percentage of students (45.2%) reported packaged snacks were available at
home some of the time. The data were further described by gender and by race/ethnicity.
The results were consistent with the overall outcomes in that the largest percentage of
students reported that packaged snacks were available at home some of the time
regardless of their gender and race/ethnicity (Table 26).
Availability of sweet drinks at home was also scored on a four-point scale ranging
from 1 ("Hardly or not at all"), 2 ("Some of the time"), 3 ("most of the time"), to 4 ("All
of the time"). Among all students, the largest percentage of students (32.5%) reported
sweet drinks were available at home some of the time regardless sex or race/ethnicity
except "all the time" was reported by 38.2% of Hispanic students (Table 26).
Weight control behaviors. In order to assess weight-control behaviors of
students, 1 question was asked in the BiteStep Survey at the beginning of the study. The
question asked whether students were trying to lose weight in the present, and a value of
1 was given for "yes" and a value of 2 for "no". Means and standard deviations were
calculated for this weight control behaviors question.
For weight control behaviors in the present, more students (58.0%) overall were
not trying to lose weight (Table 27). The largest percentage of boys (69.3%) were not
trying to lose weight compared to the largest percentage of girls (52.7%) were trying
157
Most of the time
76
200
169
170
Hardly or not at all
Some of the time
Most of the time
All of the time
97
280
Some of the time
All of the time
Sweet drinks
86
42
33
46
80
27.6%
27.5%
88
73
32.5% 104
12.4%
15.6%
25.3%
45.2% 136
13.9%
n
n
%
Boys
Total
Hardly or not at all
Packaged snacks
Variables
44
n
Girls
29.5%
31.5%
34.9%
11.1%
15.1%
26.3%
82
96
96
43
51
77
44.7% 144
13.8%
%
Availability of Packaged Snacks and Sweet Drinks at Home
Table 11
25.9%
30.3%
30.3%
13.6%
61.1%
24.4%
45.6%
13.9%
%
51
46
64
16
26
37
95
21
n
%
49
n
White
28.8%
26.0%
36.2%
9.0%
14.5%
20.7%
79
86
93
45
52
82
53.1% 122
11.7%
Black
26.1%
28.4%
30.7%
14.9%
17.0%
26.9%
40.0%
16.1%
%
14.3%
%
13
11
8
2
5
8
38.2%
32.4%
23.5%
5.9%
14.3%
22.9%
17 48.6%
5
n
Hispanic
27
26
35
13
14
30
46
11
n
10.9%
%
26.7%
25.7%
34.7%
12.9%
13.9%
29.7%
45.5%
Others
Multiracial/
256
353
Yes
No
Are you trying to lose weight now?
91
n
30.7% 165
%
Girls
58.0% 205 69.3% 148
42.0%
n
n
%
Boys
Total
71
n
Black
n
%
41.0% 127 42.1%
%
White
47.3% 102 59.0% 175 57.9%
52.7%
%
Contextual Characteristic of Study Population- Weight Control Behaviors
Table 27
%
18 52.9%
16 47.1%
n
Hispanic
58
42
n
58.0%
42.0%
%
Multiracial/
Others
116
to lose weight. The largest percentage of boys (69.3%) were not trying to lose weight
compared to the largest percentage of girls (52.7%) were trying to lose weight. The data
were further described by race/ethnicity. The results were consistent with the overall
outcomes in that more than half of students were not trying to lose weight regardless
race/ethnicity.
Association of Behavior Goals and Self- Perceived Amount of Behavior Change with
Demographics and Contextual Factors
Chi square tests were used to assess whether food- related behavior goals selected
by students and their perceived amount of behavior change (a four point scale ranging
from "did not change," "changed a little," "changed a medium amount," to "changed a
lot") were associated with demographics (gender and race), or any of the contextual
factors (school group activity, sports/activity after school, weight control behaviors, and
availability of packaged snacks and sweet drinks at home) (Appendix H).
Based on chi square tests, selection of food-related behavior goals was found to
be significantly related to one contextual factor- weight control behaviors (yu (3, n=595)
= 7.894,^=0.048) (Table 28).
Some contextual characteristics were found to be significantly associated with
perceived amount of change in food-related behaviors. Perception of having increased the
amount of fruit and vegetables consumed was significantly related to two contextual
factors - hours of sports/activities after school (y 2 (12, n=537) = 21.327,/>=0.046), and
weight control behaviors (%2 (3, n=521) =15.551, p=0.001) (Table 28).
x 2 (3, n=537)
= 7.017,
X2 (12, n=568) X2 (12, n=556)
= 23.194,
= 20.073
p =0.026
p=0.066
X2 (9, n=586)
=20.567,
p = 0.015
X 2 (9, n=573)
= 6.662,
/?=0.672
X2 (9, n=507)
= 14.862,
X2 (3, =586)
= 11.857,
X 2 (3, n=573)
= 10.360,
p=0.016
X2 (3, n=507)
= 6.058,
p=0.109
Decrease consumption of
s w e e t drinks
Decrease consumption of
packaged snacks
Decrease consumption of
fast f o o d
= 11.315,
= 12.519,
p=0.405
X2 (12, n=494) X 2 ( 1 2 , n = 4 8 4 )
= 10.800,
= 12.928,
/;=().546
p=0.374
p=0.502
2
X 2 ( 1 2 , n = 5 5 8 ) X (12,n=543)
Note. *= Borderline significant with a p value between 0.05-0.06
p-0.00S
p=0.095
X 2 (3,n=521)
= 15.551,
p=0.001
X 2 (12,n=553) X 2 (12,n=537)
= 10.417
= 21.327,
p=0.579
p=0.046
X2 (9, n=568)
= 8.267,
p= 0. 507
%2 (3,n=568)
= 4.905
p=0.179
Increased c o n s u m p t i o n o f
fruits a n d v e g e t a b l e s
p=0.258
p=0.280
p=0.671
x 2 (3, n=464)
= 8.055,
ip=0.045
x 2 (3, n=526)
= 23.746,
p=0.000
p=0.01\
C (3, n=595)
= 7.894,
j3=0.048
X2 (12, n=637) X2 (12, n=620)
= 14.325,
= 14.707,
X2 (9, n=656)
= 15.258,
p=0.084
'resent weight
control
Dehaviors
X2 (3, n=656)
= 1.547,
Food-Related Behavior Goals
Hours of
sports/activity
after school
week
Hours of
school team
activities/
week
Race
Gender
14.085,
p=0.119
=
X2(9,n=541)
X2 (9, n=601)
= 16.309,
jO=0.061
Availability of
sweet drinks at
home
Chi-Squire Table for Food-Related Behavior Goals and Self-Perceived Amount of Behavior Change
Independent Variables
Table 11
X2 (9, n=535)
= 8.932,
p =0 .444
p=0.386
X2 (9, n=606)
= 9.596,
Availability
of
packaged
snacks at
home
118
Perception of having decreased the amount of sweet drinks consumed was found
to be significantly related to gender (% (3, =586) = 11.857,p=0.008), race/ethnicity (%
(9, n=586) =20.567,p = 0.015), and hours spent on school group activities (x (12, n=568)
= 23.194,p =0.026) (Table 28).
Perception of having decreased the amount of packaged snacks consumed was
found to be significantly associated with gender (x (3, n=573) = 10.360, p=0.016) and
one contextual factors- weight control behaviors (% (3, n=526) = 23.746,p=0.000)
(Table 28).
Perception of having decreased the amount of fast food consumed was also found
to be significantly associated with one contextual factor -weight control behaviors (% (3,
n=464) = 8.055,^=0.045) (Table 28).
The Implementation of the C3 Curriculum Facilitated by Lead Teacher
An interview with the lead teacher was conducted on the phone in October, 2009. The
purposes of the interview were to understand how implementation of the C3 curriculum
was facilitated by the lead teacher, the support she received and obstacles faced while
working with other teachers, so that this information can be used to assess other schools
to replicate the C3 curriculum with a lead teacher model.
The lead teacher was the Science Department chair of the Parkside Middle School.
While doing post-graduate study, she was introduced by the school Principal to Dr.
Barton to conduct a 2 year pilot study of C3 curriculum. The school principal submitted
the C3 curriculum as a comprehensive, health model to the education board for approval
to teach at school. It was agreed upon that the curriculum would be taught for one year
119
first. With sound evidence of the positive experience of using the curriculum, it could
then be proposed to the school district to continue using the curriculum.
Overall the school was committed to teach the C3 curriculum. A one-day
professional development was conducted to introduce C3 curriculum to six science
teachers. Substitute teachers were arranged by the research team while those six teachers
were in training. Teachers showed interest in teaching the C3 curriculum, and some
because of personal reasons. Particularly, one teacher was a vegetarian who was very
enthusiastic about eating healthfully, and the lead teacher was also very motivated
because of her personal health issues.
During the implementation process, the lead teacher worked closely with other
teachers to ensure the curriculum was taught effectively. First, to support teachers for
teaching the C3 curriculum, a teacher meeting was held every day after school. All
teachers taught the curriculum at the same time. They discussed what happened on the
day and what would be covered the next day, and motivated each other to teach the
curriculum. Second, it was important for each teacher to decide how her students could
learn best. Each teacher tried to bring in their personal stories and experiences. They also
modified ways of teaching the material. Sometimes several activities in one unit were
divided up so that one activity was covered each day. Third, the greatest challenge in
teaching the curriculum often was that teachers had to be motivated enough to learn the
background information to teach and this was not a particular issue for those teachers.
Fourth, the C3 research team provided the supplies needed to teach the sessions and
student workbooks. These were very helpful in motivating the teachers to implement the
curriculum. With the workbooks and the material for experiments in hand, teachers were
able to provide the scientific experiments from which students could learn.
All teachers taught the entire curriculum. However, they skimmed through the last
unit since they spent too much time on the first few units and ran out of the time in the
end. After completing the curriculum, all teachers felt that the last unit was important to
summarize and reinforced everything covered in the previous units for students. Without
spending enough time in the last unit, students were not sure what teachers wanted them
to learn in the long term. They concluded that in the future they could pace themselves
better so as to fully cover the last unit.
Comparisons of the Current Study and the Original Study
A major purpose of the current study was to investigate whether a curriculum
tested under research conditions could be implemented in a different setting with the
provision of supplies, but with very little teaching support beyond the one day initial
professional development.
While there were no significant differences in gender among the students who
participated in the current study and the original study, the participants in the current
study were from one school in Parkside, Michigan and about half of the students were
white (50.3%), whereas the participants in the original study were recruited from 5
different schools in New York City and the majority of the students were Hispanic
(70%). Based on the self-reported answers in the student survey, the students in Parkside
actively participated in at least one school team activity and one sport after school. This
information was not asked in the original study.
121
In the current study, the implementation of the curriculum was facilitated by a
lead teacher with very little assistance from the research team, and no additional
supplementary activities were accompanied to the curriculum. In contrast to the current
study, assistance and supervision were provided by the research team throughout the
ongoing original study to ensure a high fidelity of the curriculum. The curriculum was
also accompanied by supplementary activities including field trips (Table 29).
The study design was the same for both studies: randomized pretest-posttest
intervention and control conditions design. Whereas the same group of students served as
their own control and intervention conditions in the current study, different groups of
students were assigned to the intervention and control group in the original study.
Nineteen lessons of the shortened C3 curriculum were taught by six teachers in a period
of four weeks compared to twenty four lessons were taught by seven teachers in a period
of seven to eight weeks in the original study.
Only a few classroom observations were arranged for the current study whereas
the progress of the curriculum was observed by the research team at least once a week,
and weekly meetings were held by the implementation coordinators with the teachers in
the original study. Both studies used surveys to evaluate the impact of the curriculum on
behavior, psychosocial variables, and knowledge.
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Table 29 (Continue)
Comparison of Current Study and Original Study
Variables
Current Study
Original Study
Location
30 classes in 1 school
in Parkside, Michigan
35 classes in 5
schools in New York City
Sample Size
750
897
50% 7th grade,
50% 8th grade
9% 6th grade, 91% 7th
grade
Gender
49.3% boys, 50.7% girls
51% boys, 49% girls
Race/Ethnicity
28.7% African American
50.3% White
5.7% Hispanic
15.3% Others
25.0% African American
0.0% White
70.0% Hispanic
5.0% Others
Study Design
Pretest-posttest
Pretest-posttest
Theoretical Framework
Social cognitive theory
Self-determination theory
Social cognitive theory
Self-determination theory
Professional Training for
Teachers
1
2
C3 Curriculum Lesson
19 lessons in 4 weeks
24 lessons in 7-8 weeks
Classes Observed
None
At least once a week
Supplementary Activities
None
Field trips
Surveys for Outcome
Measures
BiteStep Survey
Student Survey
Eat Walk Survey
Tell Me about You Survey
Understanding Science
Is Science Me Survey
Student Survey
123
Table 29 (Continue)
Comparison of Current Study and Original Study
Current Study
Original Study
Fruit and Vegetables
N/A
Yes (fruit as snacks)
Packaged Snacks
Yes (borderline)
Yes (frequency and size)
Sweet Drink
Yes (frequency)
Yes (frequency and size)
Fast Food
Yes (borderline)
Yes (size and value meals)
Water
N/A
No
Physical Activity
Yes (leisure time
viewing)
Yes (physical activity,
leisure time viewing)
Intention
N/A
Yes
Self- Efficacy
Yes (packaged snacks)
Yes
Outcome Expectations
(Physical aspect)
Yes
Yes
Outcome Expectation
(Social aspect)
No
N/A
Autonomy
No
Yes
Competence
No
Yes
Perceived Barriers
N/A
Yes (physical activity)
No
Yes
Variables
Significant Changes in
Behaviors
Significant Change in
Psychosocial Variables
Knowledge
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Primary Behavior Outcomes
The behavior outcomes of the current study and the original study (Appendix I)
are compared as follows:
Packaged snacks. In the current study, frequency of consumption was borderline
significantly decreased in frequency (1.18 times a day), and non-significant decrease in
size (1.50 times of small size). This result was somewhat different from the significant
decrease in frequency (2.98 days a week) and size (1.52 times of small size) of packaged
snacks consumption at the end of the original study.
Sweet drinks. In the current study, the frequency of sweet drinks consumption
was significantly decreased to 1.50 times a day, but the number (2.06/week) and size (1.5
times of medium size) of sweet drinks purchased were non-significantly decreased. These
changes were somewhat different from the significant decrease in frequency (about 6.0
times a week) and size (about 16 oz.) of sweet drinks consumption in the original study.
Fast food. In the current study, frequency of fast food consumption among
students was borderline significantly decreased (0.85 times a week), and frequency of fast
food consumption with family was non-significantly increased (1.81 times a week) at the
end of the intervention C3 curriculum. These results were somewhat different from the
non-significant decreased in frequency (1.66 days a week) of consumption, but
significantly decreased in size of regular meal (1.84 times of small size) and frequency of
value meal (rarely) consumed found in the original study.
Physical activity. In the current study, frequency of walking and taking stairs for
exercise was not significantly increased to "some days", in contrast to a significantly
increase to about 3 days a week in the original study. In addition, intensive sports and
125
exercise was non-significantly decreased to 2.36 days a week in the current study, which
differed from significant increased to 2.92 days a week on walking and 2.98 days a week
on taking stairs for exercise in the original study.
Sedentary behaviors. In the current study, the amount of time spent on sedentary
behaviors such as TV/movies watching and computer/video games were significantly
decreased to 1.52 hours (71minutes) and 0.96 hours (58 minutes) a day respectively, and
time on intensive physical activity was non-significantly decreased (2.36 days a week) at
the end of the intervention C3 curriculum. The results in the current study are similar to
those in the original study for leisure screen time (reported as 4.85 days a week).
Secondary Psychosocial Variables and Knowledge Outcomes
The Psychosocial variables and knowledge outcomes of the current study and the
original study (Appendix J) are compared as follows:
Self-efficacy. The current study assessed self-efficacy for various eating and
physical activity behaviors and found that students significantly increased self-efficacy in
relation to packaged snacks consumption only, which was different from the original
study that significant increases in self-efficacy in relation to all eating and walking and
taking stairs behaviors were found in the original study.
Outcome expectations. A significant increase in physical aspect of outcome
expectations were found in the current study compared to significant increases in
outcome expectations for all eating and walking behaviors in the original study.
Autonomy and competence. In the current study, autonomy and competence
were not increased at the end of intervention, which was inconsistent with significant
increases in both variables in the original study.
Knowledge. There was a non-significant change in students' knowledge after the
C3 curriculum in the current study in contrast to the significant improvements in the
original study.
127
Chapter V
DISCUSSION
The purpose of the current study was to examine the effectiveness of the C3
curriculum on students' changes in eating and physical activity behaviors, psychosocial
variables, and knowledge when it was implemented in a new setting using a lead teacher
model with little support from the research team. The C3 curriculum was originally
implemented in New York City and in a city in Michigan in the current study. There are
differences in study design, study sample, evaluation methods, and outcome measures
used in these two studies.
In addition, contextual data such as physical activities in school and after school,
weight control behaviors, and availability of sweet drinks and packaged snacks at home
measured in the current study were not collected in the original study. These contextual
data were helpful to explain the food-related behavior goals students selected, and their
perceived amount of behavior change related to specific goals.
To understand how implementation of the C3 curriculum was facilitated by the
lead teacher in the current study, an interview with the lead teacher was conducted. It was
hoped that learning about the effectiveness of C3 curriculum disseminated in one setting
using a lead teacher would provide information on a possible model for the future
dissemination of the curriculum.
128
Primary Outcome Measures
Few dissemination studies examine the impact of the interventions on student
outcomes. This current study conducted such an examination and found similar, though,
not as robust, outcomes as the original study. Evaluation results demonstrated significant
behavior changes in frequency of sweet drinks consumption, and amount of time on
TV/movies viewing and computer/video games playing, and borderline significant
changes in frequency of packaged snacks and fast food consumption. Even though
increasing fruits and vegetables was one of the behaviors covered in the C3 curriculum
and it was most selected by students as their behavior change goal, this particular
behavior was not assessed in the outcomes measured due to negative results in the
original study and difficulties assessing the actual amount of consumption.
Packaged snacks. Research studies have found that there is a trend toward
increasing intake of high-calorie snacks and this shift in food choices has affected the
nutrient intake of children (Nicklas, Demory-Luce, Yang, Baranowski, Zakeri, &
Berenson, 2004). Further, children often consumed more calories from high-fat or highsalt snacks during a day than consumed at breakfast or lunch (Roblin, 2007). Thus,
decreasing packaged snacks consumption was a targeted behavior in the C3 curriculum.
Both the current study and the original study found a significant decrease in
frequency of consumption, but differed in size, of packaged snacks consumed. The
reduction in frequency of consumption 0.07 times a day in the current study was not as
robust as the original study. However, it was encouraging because this small decrease
adds up to about 0.5 times a week and could contribute to a meaningful decrease in
energy balance over a longer timeframe.
129
The positive changes in the current study could be possibly explained by two
reasons. First, various sizes of packaged snacks were demonstrated in the C3 curriculum,
and hence it was easier for students to keep track of numbers and sizes of packaged
snacks purchased or consumed every day. Second, through a calorimetry experiment in
the C3 curriculum, students analyzed the amount of energy in various snacks, and
through a demonstration they learned about the amount of fat in their favorite snacks.
These activities may have motivated them to decrease their packaged snacks
consumption to reduce calorie and fat intake.
The result of the current study is consistent with some studies conducted to
investigate influences of school-based programs and practices on children's packaged
snacks consumption. The Healthy Snack Project, conducted by Schwartz, Novak, & Fiore
(2009), found that students in the intervention schools with more stringent school
nutrition standards consumed fewer salty snacks, as comparison schools increased
slightly. In addition, intervention schools consumed more "meeting nutrition standards"
snacks, whereas comparison schools stayed the same.
Sweet drinks. As consumption of regular soda has increased and become more of
a social norm, children who drink one regular carbonated drink a day have an average
10% more total energy intake than non-consumers (Harnack, Sang, & Story, 1999). Thus,
decreasing sweetened beverages consumption was an important behavior goal for C3
curriculum.
Both the current study and the original study found a significant decrease in
frequency of sweet drinks consumptions, but differed in impact on size. The reduction in
frequency of consumed in the current study of 0.13 times a day was not as robust as the
130
original study. However, it was encouraging because it is a change that is in the right
direction.
The positive changes in the current study could possibly be explained by two
reasons. First, the metabolic Syndrome X and diabetes related topics discussed in the C3
curriculum might have motivated students to take preventative action such as reducing
their sweet drinks consumption. Further, the amount of sugar in various size cans and
bottles of soft drinks demonstrated in the C3 curriculum was highly visual and motivating.
The result of the current study agrees with the results of several other studies
assessing the effects of intervention programs on children's sweetened beverages
consumption. The Dutch Obesity Intervention in Teenagers program (Singh, Chin, Paw,
Brug, & van Mechelen, 2009) resulted in decreased consumption of sugar-containing
beverages in both boys (-233ml/d) and girls (-271ml/d) at 12 month. In addition, in a
school-based cluster-randomized controlled trial (RCT) aimed at reducing the
consumption of carbonated drinks, decreased consumption by 0.6 glasses (average glass
size 250 ml) over three days was found in the intervention group at the end of the 12
month randomized controlled study (James, Thomas, Cavan, & Kerr, 2004).
Fast food. French, Story, and Jeffery (2001) found an increased frequency of
dining in fast food restaurants was associated with higher intake of total calories, calories
from fat, and daily servings of sweetened soft drinks. Further, Pereira, Kartashov,
Ebbeling, van Horn, Slattery, Jacobs, and Ludwig (2005) found that consuming as few as
two meals per week in a fast food restaurant has been associated with an increased
incidence of adult obesity and insulin resistance. Thus, decreasing fast food consumption
was another targeted behavior in the C3 curriculum.
131
Both the current study and the original study found significant decreases in
frequency of fast food consumption. The frequency in the current study (0.85 times a
week) was half of that in the original study (1.66 days a week) as a result of the
intervention curriculum. This result is encouraging because even a small decrease can
contribute to better energy balance over time.
While there were some positive changes in students' behaviors in the current
study, the frequency of eating fast food with family was not significantly changed. This
was probably because family meals play an important role in children' eating behaviors
and the C3 curriculum does not address this particular component. A study by
Sonnerville, La Pelie, Taveras, Gillman, and Prosser (2009) found that child and family
preferences, difficulty with changing habits, and economic factors were barriers to
adopting obesity prevention recommendations. Thus, effective intervention programs
should consider the context of family priorities and help families make changes.
Physical activity and sedentary behaviors. Research has demonstrated
significant positive improvements in adiposity and physical fitness in children enrolled in
short term physical activity interventions (Sacher, Kolotourou, Chadwick, Cole, Lawson,
Lucas, & Singhal, 2010; Walther et al., 2009; Donnelly et al., 2009). In addition,
sedentary behaviors such as television watching have been related to childhood adiposity
in several epidemiological studies (Anderson, Crespo, Bartlett, & Pratt, 1998). Thus,
increasing physical activity and decreasing sedentary behaviors were targeted behaviors
in the C3 curriculum.
Both the current study and the original study found significant decreases in leisure
screen viewing time, but differed in physical activity. Amount of time spent on intensive
132
sports or exercise, and walking and taking stairs for exercise was not significantly
changed in the current study. These could be possible due to the fact that students were
already walking and taking stairs "some days" (a score of 2.6 on a scale of 1-4), and
participating in intensive sports and exercise about 4-5 days a week (a score of 2.3 on a
scale of 1-4) at baseline suggesting a ceiling effect. Therefore, there was not much room
for improvement.
The hours of TV/movies viewing (from 1.59 to 1.52 hours a day) and
computer/video games playing (from 1.04 to 0.96 hours a day) in the current study as a
result of the intervention curriculum cannot be compared to that found in the original
study, which was reported in terms of days per week. However, it was encouraging
because a small decrease of 0.15 hours in TV and computer a day in the current study
comes to about an hour a week, which could contribute to better energy balance.
The positive changes in the current study in terms of screen time could possibly
be explained by the effectiveness of the C3 curriculum on sedentary behaviors. The lack
of effect on intensive physical activity may be because a majority of students were
already participating in various school and afterschool activities before the C3 curriculum.
Thus, it was possible that students had reached a ceiling effect, making it difficult to
demonstrate further improvement.
Food-Related Behavior Goals and Perceived Amount of Behavior Changes
Research has shown that an increased sense of concern can occur through
conducting self-assessments because they are motivating (Schwartzer & Fuchs, 1995). In
the middle of the C3 curriculum, all students were asked to select a particular food-
related behavior goal based on their analysis of, and reflections on, their own personal
diets and activity patterns, which they would like to work on throughout the curriculum.
Students also created culminating projects at the end of each unit to understand why their
goals were important for actions in their lives. Information on students' selections of a
particular C3 behavior change goal and their ratings of amount of change related to their
goals were collected at the completion of the study.
Among all four behavior goals promoted by the curriculum, increasing fruits and
vegetables was selected by most of the student at Parkside regardless of gender or
race/ethnicity. In terms of perceived amount of behavior change, over 70% of students
reported that they had made some changes related to their specific goals depending on the
behaviors. These perceived changes were in the same direction as the actual changes
based on the self-reported frequency instrument, but were larger in magnitude.
One reason for the discrepancy may be that students' reflections on their changes
were collected after the completion of the C3 curriculum, and therefore their optimistic
bias might be operating as compared to the actual changes collected by survey
instruments, suggesting that the accuracy of perception data is questionable. Further,
because fruit and vegetable consumption data were not collected during the study and
perceived amount of change in physical activity was not asked, a difference between
perceived and actual changes for these two behaviors could not be compared.
134
Secondary Outcome Measures
Psychosocial Variables
The purpose of the current study was also to examine the impacts of the C3
curriculum on psychosocial variables derived from social cognitive theory constructs
including self-efficacy and outcome expectations, and self- determination theory
constructs including autonomy and competency, and knowledge related to eating and
physical activity behaviors of middle school children. Two psychosocial variables
improved at the end of the intervention C3 curriculum: self-efficacy in packaged snacks
consumption and physical aspect of outcome expectations.
Self-efficacy. Self-efficacy is an important predictor of behaviors according to
social cognitive theory (Bandura, 2002), and is also the power to produce change within
one's self, which is important when dealing with dietary change (Prince, 2001).
The current study found a significantly increased self-efficacy only for packaged
snacks consumption only, which was different from the original study, which found
significantly increased in relation to all eating and walking and taking stairs behaviors.
These results in the current study could be possibly explained by the fact that
since processed packaged snacks were mostly consumed in individually wrapped
packages that could be counted easily compared to other foods, the behavioral strategies
taught in the curriculum might have increased students' awareness of their own
consumption and thus self-efficacy to decrease the number of packaged snacks consumed.
Therefore, self-efficacy being a significant variable associated with packaged snacks
consumption in this study seems to be a likely explanation.
Outcome expectations. A significant increase in physical aspect of outcome
135
expectations were found in the current study compared to significant increases in
outcome expectations for all eating and walking and taking stairs behaviors in the
original study, suggesting that the inquiry-based curriculum might have impacts on
outcome expectations about health consequences.
This result in the current study agrees with the study findings by Reynolds,
Yaroch, & Franklin (2002) that positive outcome expectations may be an important
mediator for behavior change in school-based nutrition-intervention programs. A review
of all the credible school-based studies also found that outcome expectations are
predictors of change (Cerin et al., 2009). Thus, positive outcome expectations can be
included in a mediational model and used to design intervention activities (Resnicow,
Davis-Hearn, Smith, Baranowski, Lin, & Baranowski, 1997).
Autonomy. Empirical evidence based on self-determination theory suggests that
both intrinsic motivation and autonomous types of extrinsic motivation are conducive to
engagement and optimal learning in educational contexts; and teachers' support of
students' basic psychological needs for autonomy, competence and relatedness facilitates
students' autonomous self-regulation for learning and academic performance (Niemiec &
Ryan, 2009).
In the current study, autonomy was not increased as significantly increased in the
original study, or as might be predicted by SDT, which suggest that self-regulation,
which was emphasized in the C3 curriculum, would have a positive effect on autonomy
(Ryan & Deci, 2000; Burton et al., 2006; Standage, Duda, & Ntoumanis, 2006; Tsai,
Kunter, Ludtke, Trautwein, & Ryan, 2008). The possible explanation for this result could
be either that the intervention did not have a measurable effect on autonomy or that the
136
questions asked for this variable in the current study did not capture the changes of
students.
Competence. Research has demonstrated that perceived competence and
autonomy in physical education are interrelated and function as a whole for enhancing
physically active behavior (Shen, McCaughtry, & Martin, 2007). The current study found
that students did not increase competence at the end of the intervention C3 curriculum,
suggesting the C3 curriculum was not effective in enhancing students' competence,
which was inconsistent with the significant increase found in the original study.
Competence is conceptualized as an overall sense of being able to have an impact on
one's own behavior. It is in some ways a sum of self-efficacy for all the eating and
activity behaviors. The fact that the current study demonstrated increased self-efficacy
only for packaged snacks consumption made it not surprising that students did not show
improvements in the overall construct of competence.
Knowledge
The most unexpected result in the current study was the non-significant changes
in students' knowledge after the intervention C3 curriculum, in contrast to the significant
improvements in the original study. The analysis results indicated that close to 70% of
students answered 1 question correctly, and over 70% answered 5 out of 9 questions
correctly at baseline and thus there was a ceiling effect.
It is our impression that either nine questions were not sufficient in number to
capture changes in students' knowledge. In addition, the final unit of the curriculum
designed to summarize the previous units and reinforce long term learning was not fully
137
delivered to students, which might have not resulted in further improvement in
knowledge at the end of the study.
Demographics and Contextual Factors of Students
When trying to understand the factors that might influence outcomes of an
intervention, it is important to consider the possible effects of demographics and
contextual variables of the study population. The data indicated that contextual factors of
the current study sample were very similar in many areas with the data from The Youth
Risk Behavior Survey System 2007 (YRBSS), which is a national school-based survey
conducted by the Centers for Disease Control and Prevention (CDC) to monitor priority
health-risk behaviors and the prevalence of obesity among youth.
Contextual Factors
Physical activity. In order to understand how active children were in Parkside,
the amount of time they spent on activities both in school and after school were
investigated in the current study. Based on self- report, the data agreed with the Youth
Risk Behavior Survey System (YRBSS) 2007 findings that the prevalence of
participating in physical activity was higher among boys than girls; and higher among
white than other students, and black students spent less time on those activities compared
to other students.
Many studies have demonstrated the effects of physical activity on promoting
weight loss among children. In addition, Epstein, Wing, & Koeske (1982) found that
increasing energy expenditure by engaging in a wide variety of daily activities was
138
helpful for children to maintain their weight loss. To increase physical activity levels of
students, future interventions could offer activities alternatives to standard physical
education classes to appeal to them, especially girls and black students, so they feel
motivated to participate in activities, and consequently increase their energy expenditure.
Weight control behaviors. In order to understand students' weight control
behaviors such as whether they were trying to lose weight in the present was investigated.
Based on the self-report, the results were consistent with the Youth Risk Behavior Survey
System (YRBSS) 2007 findings that nationwide slightly less than 50% of high school
students were trying to lose weight. Overall, the prevalence of trying to lose weight was
higher among girls than boys, and higher among white than black students.
Research has demonstrated that gender, race, and socioeconomic status are
influential in the perception of ideal body size as well as determining concerns about
weight and weight control practices early in a child socio-cultural development (Adams,
Sargent, Thompson, Richter, Corwin, & Rogan, 2000). It is also well documented that
th
these perceptions in children could start as early as the 4 grade (Thompson, Corwin, &
Sargent, 1997). Further, eating disorders have been shown to be more prevalent among
white women in upper-middle class environment (Nagel & Jones, 1992).
Based on current findings and related literature, topics related to negative weight
control behaviors should be explored and discussed in nutrition programs so students
could learn how to eat healthfully.
Availability. To determine whether the availability of food played a role in
students' consumption, how often packaged snacks and sweet drinks available at home
were investigated in the current study. The findings indicated that the availability of these
two foods did not vary much between gender and races/ethnicity. In addition, the
availability was not found to be associated with students' perceived amount of
consumption.
Research has indicated that the childhood obesity epidemic appears secondary to
changes in modern society resulting in increased availability of energy dense foods
(French et al., 2001). The results found in the current study are not consistent with the
study by Spurrier, Magarey, Golley, Curnow, & Sawyer (2008) that physical attributes of
the home environment such as availability of food groups including snacks high in fat
and sweetened beverages in the home was associated with children's intake of these
foods; and restricting children's access to sweet drinks and high fat/sugar snacks was
associated with children's lower intake of these foods.
With inconsistent findings across studies, more research to examine availability of
food at home and at school will be needed to assess their association with amount of
consumption.
Association of Behavior Goals and Self-Perceived Amount of Changes
with Demographics and Contextual Variables
Goal setting is a strategy that is frequently used to help children make dietary
changes. Four steps of successful goal setting include recognizing a need for change,
establishing a goal for change, monitoring progress toward achieving that goal, and
rewarding oneself for goal attainment (Cullen, Baranowski, & Smith, 2001).
The results of the current study demonstrated that weight control behavior was a
strong predictor for selection of a food-related behavior goal and self-perceived amount
140
of behavioral change. This finding indicated that because many students were worried
about their weight, they appeared to be more motivated to change their behaviors, and
hence researchers can build on their concerns to conduct nutrition education.
Lead Teacher Model
For years, the only way teachers could advance their careers was to move to
administration, either by becoming a principal, assistant principal, or going to central
office (The National Teacher Policy Institute). School districts and teachers union
recognized the need to keep talented teachers in classrooms and schools, and allow
teachers to play leadership roles within their profession research. According to the
Academy for Education Development, lead teachers draw upon their teaching experience
to serve as a leader, mentor and sometimes counselor to teachers overwhelmed by time
pressures or challenging students. Further, research results have shown that teachers are
often more responsive to each other than to an administrator (Soloman, 2000),
While the role of a lead teacher at school is often not well defined, a lead teacher
model was used in this study to implement the C3 curriculum with other teachers. Several
characteristics of the lead teacher were crucial for her to facilitate the process. First, the
lead teacher worked directly with school principal and other teachers to ensure proper
implementation of the C3 curriculum, advocate on behalf of the teachers, and improve
learning of students. Second, the lead teacher had 6 years of teaching experience. She
taught an average of 30 hours of science class per week with 145 students. In the
previous 2 years, she had attended 6 professional development activities or sessions on
science-related issues, indicating that she was truly interested in science education. The
141
lead teacher was also working on her master's degree in education at that time, and
decided to use the evaluation of this curriculum as her thesis. With her extensive teaching
background and experiences, the lead teacher was able to determine sources of frustration,
provide possible solutions for teachers, and make their teaching more comprehensible
and engaging for students. Third, daily meeting with other teachers by the lead teacher
was extremely helpful to provide support and guidance to other teachers. Lastly, with her
motivation and engagement as a leader, the lead teacher was able to identify different
motivators for the teacher to teach the curriculum.
Summary
Overall, using of a lead teacher model with a one-day professional development
and some teaching supplies provided, but little support from the research team in the
current study had demonstrated some similar results as the original study but not as
strong.
Strengths
This study has many strengths. First, this seems to be the only systematic
effectiveness study in the nutrition education literature, where an effective curriculum
was carefully disseminated to a different location using a different support mechanism
and its impact on students outcomes measured. Second, to our knowledge, no other
school-based study has tested theory-based nutrition intervention that is led by a lead
teacher. As such, it also provides a unique contribution to the literature. Third, this study
provided evidence of usefulness of the overarching construct from both social cognitive
theory and self-determination theory of personal agency or autonomous motivation for
142
developing a behavior change curriculum. Fourth, using an inquiry-based science
curriculum in the current study was helpful in providing children opportunities to
investigate and develop understandings of the environment and their behavior as the basis
for a meaningful rationale for why to take action and enhance personal agency. Fifth, by
examining what behavioral goals students selected and perceived amount of behavior
change influenced by various demographics and contextual factors, the data were
extremely helpful for researchers to understand the eating and physical activity choices
that students made. Lastly, by assessing the role of the lead teacher in facilitating the
implementation of the curriculum, and comparing the results of the current study and the
original study, these data were important for future dissemination of the curriculum.
Limitations
There were several limitations in the current study. First, since the same group of
students received both the control and intervention curriculums in the study, the
possibility of independent changes over time could not be excluded, and thus this should
be considered while interpreting outcome measures. Second, self-report was selected as
the method of dietary behaviors and physical activity, psychosocial variable, and
knowledge assessment in this study because of its ease of use with middle school students.
While this is the method used in almost all school-based interventions, this method might
introduce measurement bias. Third, given that the lead teacher and other science teachers
participated in the study voluntarily and they were extremely motivated to teach the C3
curriculum, the results might not be indicative of those obtained from teachers who
would implement the curriculum at other locations. Fourth, since the C3 curriculum was
143
implemented by 6 science teachers who taught the curriculum the first time and the last
unit was not fully covered, the results of this study might not reflect the true impacts of
the C3 curriculum, and the outcomes might have been stronger if the complete
curriculum had been taught. Lastly, the self-perceived amount of change was extremely
valuable for researchers to understand students' attitudes and feelings toward behavior
change. However, this type of data for the change in physical activity was not collected
and thus unavailable for further analysis and interpretation.
Implications for Research
As found in other similar studies, the impacts of the C3 curriculum on behavioral
outcomes were modest in this study. This could be because the association between the
predictors from theory and the behaviors of interest was not very strong (Baranowski et
al., 1997). Therefore, theories need to be better specified and researchers must develop a
greater understanding of the factors that explain and predict behavior (Reynolds et al.,
2002). For example, further research could investigate physical activity, weight control
behaviors, and environmental factors that might explain or predict dietary and physical
activity behaviors. Further, the selection and testing of additional potential predictors
should continue with an emphasis on theory-driven predictors and novel potential
predictors that can increase an understanding of how programs produce intervention
effect (Baranowski et al., 1997).
The results of the current study contribute the on-going efforts by researchers to
build an archive of the predictors of eating and physical activity behavior change in
children for future interventions. In future studies, it will be valuable to perform
144
mediational analysis which was not feasible in the current study; to determine the health
impacts of such an intervention by including physiologic measures such as blood pressure,
serum cholesterols, and BMI of children; to include process evaluation to understand how
interventions are implemented; and to have more dissemination research conducted using
the lead teacher model.
Implications for Practice
An approach using science inquiry process for why to take action and behavioral
theory for how to take action is useful in improving behaviors and psychosocial
mediators. So teachers should use guiding questions and experiments to teach a
curriculum so students can acquire and apply knowledge to life.
Findings in many studies suggested that the constructs from social cognitive
theory and self- determination theory were important mechanisms of behavior changes
(Cerin et al., 2009). For example, in order to enhance self-efficacy, students must be
encouraged to set goals to accomplish desired behaviors and self-reward themselves upon
accomplishing the goal (Sharma, Wagner, & Wilkerson, 2005-2006).
Lastly, findings in the current study suggest that lead teacher model can be used
in facilitating the implementation of a curriculum. Indeed in this case the C3 curriculum
has been institutionalized and is now taught each year. More dissemination projects using
a lead teacher model will be needed in the future to add to the existing research archives
in this area.
145
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_
Class:
School:
_
Teacher:
Today's date:
Circle One:
Name:
Appendix A
Girl
Day
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
5
6
7
8
9
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
2
0
0
0
0
0
0
0
0
1
0
Year
0
For Office Use Only
Month
Boy
Last
First
A B O U T THIS SURVEY
Incorrect
Incorrect
The defined words are bolded each time they appear. Please go back
to the definition if it will help you choose your best answer.
On the top of each page, there are definitions for important words.
Please carefully read these definitions.
o
Correct
o
y
o
»
Please fill in the circles completely with pencil or black pen.
Please think about each question carefully and answer them honestly.
H o w T o U S E THIS SURVEY
There is no right answer for each question. Your answers will be used
so we can better understand middle schoolers.
This survey asks you questions about what you think, know, and do
about food and physical activity.
BITESTEP SURVEY
4.
3.
2.
1.
•
Rarely
Sometimes
Most of the time or always
0
0
0
Sometimes
Rarely
Never
0
0
0
A little healthy
Healthy
Very healthy
0
0
0
Every time I make a choose
Most of the time when I make a choose
Once in a while when I make a choose
Rarely
O
0
0
0
When you make a choice about what to eat or drink, how often do you think
about health?
Not healthy
O
How would you describe your eating habits?
Most of the time or always
O
Do you eat lunch at school?
Never
O
Do you eat breakfast?
7.
6.
5.
I am not sure
Yes (please fill in all that are true) -> 0 Diabetes
(High blood sugar)
0
0
A lot
A little
Not at all
2-3 times
0-1 times
0
4-5 times
O
0
6-7 times
O
How often did you eat a home-cooked meal for dinner in the past week?
0
0
O
How concerned are you that you might one day get diabetes, heart
disease, high blood pressure, or become overweight?
0 Overweight
0 High blood pressure
0 Heart disease
No
O
Do members of your family have diabetes, heart disease, high blood
pressure, or are overweight?
Family is m a d e up of you, your brothers, sisters, parents, grandparents, aunts, uncles, and cousins.
Please think about the following questions carefully. Then fill in your best answer.
EATING HABITS & HEALTH
11.
10.
9.
8.
•
1 time
2 times
3 or more times
0
0
0
I purchase them at my school
I purchase them at convenience store or fast food places
From a relative or friend's home
0
0
0
Two or more times a day
0
1 time
2 times
3 or more times
0
0
0
0 times
O
of a packaged snack?
Yesterday, how many times did you choose to eat a fruit or vegetable instead
Several times a week
Almost everyday
0
About once a week
0
0
I never buy them or only once in a while
O
packaged snacks for yourself to eat?
From my home
How often do you usually buy
1 don't eat packaged snacks
0
snacks where do they come from? (Fill in all circles
packaged snacks?
O
When you eat packaged
that are true for you.)
0 times
O
Yesterday, how many times did you eat
packages.
12.
A
A
large size is bigger than this box
medium size is the same size as this box
small size is smaller than this box
I buy a large size
0
A
I buy a small size
I buy a medium size
0
0
I never buy them or once in a while
O
When you buy packaged snacks for yourself, what size do you usually buy?
(See box below for size information)
Packaged snacks are any snack you buy that comes in a wrapper such as a bag or box. Examples are chips, candies, cookies, and cakes that c o m e in
PACKAGED SNACKS
My family eats them
d.
16.
15.
0
0
0
o
0
0
0
A
little
Most of the time
Some of the time
Hardly or not at all
0
0
0
Same amount of packaged snacks as I do now
Fewer packaged snacks than I do now
0
A little important to me, but I do like eating packaged snacks
Important to me even though it can be difficult
Very important to me, and I make sure not to eat too many packaged snacks
0
0
0
0
0
0
o
Very
much
Not at all important to me because I really like eating packaged snacks
0
0
0
o
Pretty
much
0
small packaged snack or less a day is:
More packaged snacks than I do now
0
0
If I could eat whatever I wanted, I would eat:
All of the time
0
Eating one
o
packaged snacks available in your home?
My friends eat them
c.
How often are
Impact on my health
b.
14.
Taste
Not
at all
When you choose whether or not to eat packaged snacks, how important
are the following factors?
(Please answer all four questions, a-d below)
20.
19.
18.
17.
I might be able to do this once in a while
There is no way I could do this
0
0
I don't want to make such a plan
I might be able to make a plan but I am not so good at following through
I can make a plan and might be able to following through
I am good at making a plan and good at following through
0
0
0
0
small packaged snack or less
I would not know how to make this change
0
I can make a specific plan for how to eat one
a day:
I may know how, but would find it hard to make this change
I know how to make this change
I already eat one small packaged snack or less a day
0
0
0
small packaged snack or less a day:
I could do it most days
0
If I wanted to eat one
I could do this everyday
0
small packaged snack or less a day:
I would never want to take
0
If I tried to eat one
I would think about taking
I would definitely want to take
0
0
small packaged snack a day is a challenge that:
I am already taking
0
Eating no more than one
Packaged snacks are any snack you buy that comes in a wrapper such as a bag or box. Examples are chips, candies, cookies, and cakes that come in packages.
Small packaged snack is any packaged snack that is smaller than the box on the previous page. See picture on previous page for a visual.
a.
13.
•
•
PACKAGED SNACKS
On
O
23.
22.
21.
1 time
2 times
3 or more times
O
0
0
1 time
2 times
3 or more times
0
O
O
I don't drink sweet drinks
From my home
I purchase them at my school
I purchase them at convenience stores or fast food places
From a relative or friend's home
0
0
O
O
drinks where do they come from? (Fill in all circles
diet beverage? Water does not
sweet drink?
O
When you drink sweet
that are true for you.)
0 times
O
Yesterday, how many times did you drink a
count as a diet beverage.
0 times
O
Yesterday, how many times did you drink a
0
I buy a 20-ounce bottle or bigger
I buy a 16-ounce bottle
I buy a 12-ounce can
I never buy them or only once in a while
Impact on my health
My friends drink them
My family drink them
c.
d.
Taste
0
0
0
0
0
0
0
0
0
0
Very
much
0
0
0
0
0
0
Pretty
much
A
little
drinks, how important are
Not
at all
When you choose whether or not to drink sweet
the following factors?
(Please answer all four questions, a-d below)
0
O
0
O
sweet drinks for yourself, what size do you usually buy?
Two or more times a day
0
When you buy
Several times a week
Almost everyday
0
About once a week
0
sweet drinks for yourself to drink?
1 never buy them or only once in a while
O
How often do you usually buy
b.
a.
26.
25.
24.
Diet beverages are beverages that use artificial sweeteners, not sugar, to make them sweet. They usually have the word diet in the title or on the label.
Examples are diet soda, diet ice teas, and diet fruit flavored drinks.
Sweet drinks are sweetened beverages that have sugar added to them to make them sweeter. Examples are soda, sweetened iced teas, and fruit flavored
drinks.
SWEET DRINKS
30.
29.
28.
27.
•
•
2 times
3 or more times
0
0
Most of the time
Some of the time
Hardly or not at all
0
0
0
Not at all important to me because I really like drinking sweet drinks
A little important to me, but I do like drinking sweet drinks
Important to me even though it can be difficult
Very important to me, and I make sure not to drink too many
O
0
0
0
I would not know how to make this change
I may know how, but would find it hard to make this change
1 know how to make this change
I already drink one small sweet drink or less a day
I don't want to make such a plan
I might be able to make a plan but I am not so good at following through
I can make a plan and might be able to following through
I am good at making a plan and good at following through
O
0
0
0
small sweet drink or less a day:
1 can make a specific plan for how to drink one
0
Fewer sweet drinks than I do now
0
small sweet drink or less a day is:
0
O
1 wanted to drink one small sweet drink or less a day:
There is no way I could do this
I might be able to do this once in a while
0
0
I could do this everyday
I could do this most days
0
O
Same amount of sweet drinks as I do now
Drinking one
I would never want to take
1 would think about taking
I would definitely want to take
I am already taking
small sweet drink a day is a challenge that:
1 tried to drink one small sweet drink or less a day:
0
If
If
0
0
0
O
Drinking no more than one
0
34.
33.
32.
31.
More sweet drinks than I do now
sweet
O
If 1 could drink whatever 1 wanted, 1 would drink:
All the time
0
sweet drinks available in your home?
1 time
0
How often are
0 times
O
drink?
Yesterday, how many times did you choose to drink water instead of a
Small sweet drink is a small cup (8 ounces) or a can ( 1 2 ounces).
drinks.
Sweet drinks are beverages that have extra sugar added to t h e m to m a k e them sweeter. Examples are soda sweetened iced teas, and fruit flavored
SWEET DRINKS
In the past week, how many times did you eat at a
With my family
O
O
Taste
Impact on my health
My friends eat at fast food
places
My family eats at fast food
places
b.
c.
d.
0
0
0
0
0
0
A
little
Not
at all
0
0
0
0
0
Very
much
0
Pretty
much
When choosing whether or not to eat at fast food places, how important are
the following factors?
(Please answer all four questions, a-d below)
By myself
With my friends
0
I don't eat fast food
O
When you eat at fast food places, with whom do you usually eat? (Fill in all
circles that are true for you.)
6 or more times
4-5 times
3 times
1-2 times
0 times
fast food place?
a.
37.
36.
35.
40.
39.
38.
Hardly or not at all
1-2 days a week
3 days a week
4-5 days a week
Just about everyday
fast food places with your family?
0
Not at all important to me because 1 really like eating at fast food places
A little important to me, but I do like eating at fast food places
Important to me, even though it can be difficult
Very important to me, and I make sure not to eat too often at fast food places
O
0
O
0
fast food places less than three times a week is:
Same amount at fast food places as 1 do now
Less often at fast food places than 1 do now
0
Eating at
More often at fast food places than I do now
O
If I could eat whatever I wanted, I would eat:
O
0
O
0
0
How often do you eat at
Fast food places are places where you order cooked and ready-to-eat food over-the-counter or at a drive-thru. Fast food chains, take-out pizza places,
and take-out Chinese restaurants are examples.
FAST FOOD PLACES
On
I would definitely want to take
I would think about taking
I would never want to take
0
0
0
0
I could do it most weeks
I might be able to do this once in a while
There is no way I could do this
0
0
0
0
0
O
I could do this every week
I am good at making a plan and good at following through
1 can make a plan and might be able to following through
I might be able to make a plan but I am not so good at following through
1 don't want to make such a plan
fast food places less than three
I would not know how to make this change
I may know how, but would find it hard to make this change
I know how to make this change
I already eat at fast food places less than three times a week
fast food places less three times a week:
44.1 can make a specific plan for how to eat at
times a week:
0
0
0
O
43. If 1 wanted to eat at
O
fast food places less than three times a week:
1 am already taking
fast food places no more than three times a week is a challenge
0
Eating at
that:
Fast food places are places w h e r e you order cooked and ready-to-eat food over-the-counter or at a drive-thru. Fast food chains, take-out pizza places,
and take-out Chinese restaurants are examples.
42. If 1 tried to eat at
41.
•
FAST FOOD PLACES
48.
47.
46.
45.
I choose to walk or take stairs once in a while
I choose to walk several blocks and take stairs some days
I choose to walk several blocks and take stairs just about everyday
0
0
0
1-2 days
3-4 days
5-6 days
7 days
0
0
0
0
3 hours or more
0
0
0 hours
1 hour
2 hours
3 hours or more
O
0
0
0
Yesterday, how many hours did you spend on the computer or playing video
games?
1 hour
2 hours
0
0 hours
O
Yesterday, how many hours did you sit and watch TV or watch video
movies?
0 days
O
During the past week, how many days did you play sports or exercise for at
least 30 minutes at an intensity that made you breathe hard?
I only walk or take stairs when I really have to
O
How often do you choose to walk or take stairs when you don't have to?
Neither
Both computer and video games
Video games only
Computer only
My friends walk or take the
stairs
My family walks or takes the
stairs
c.
d.
52.
0
0
^
0
0
Q
A
little
Not something that is important for me to do
A little important for me to do
Important for me to do even though it can be difficult
Very important for me to do so I make sure I do it
0
0
0
0
Walking or taking stairs when 1 don't have to is:
Same amount as 1 do now
Less than I do now
0
More than I do now
0
0
0
0
0
0
Pretty
much
If I could do whatever I wanted, I would walk or take stairs:
Impact on my health
b.
51.
Enjoy how it makes my body
feel
Not
at all
0
0
0
0
Very
much
When choosing whether or not to walk or take the stairs, how important are
the following factors?
(Please answer all four questions, a-d below)
0
0
O
O
Do you have a computer or video games at your home?
a.
50.
49.
WALKING & TAKING STAIRS
56.
55.
54.
53.
I would definitely want to take
I would think about taking
I would never want to take
0
0
0
I might be able to do this once in a while
I could do it most days
I could do this everyday
0
0
0
I would know exactly what part of my day to add this in
I may know when I could add this in, but it would be hard to make this change
I would not know how to make this change
0
0
0
1 might be able to make a plan but I am not so good at following through
I can make a plan and might be able to following through
I am good at making a plan and good at following through
0
0
0
I don't want to make such a plan
O
1 can make a specific plan for how to add more walking or taking stairs to my
life:
I already make walking for exercise a regular part of my life
0
If 1 wanted to make walking for exercise a regular part of my life:
There is no way 1 could do this
O
1 could make walking for exercise an important and regular part of my life:
I am already taking
0
Walking or taking stairs when 1 don't really have to is a challenge that:
WALKING & TAKING STAIRS
59.
58.
57.
Yes, a few times
No
0
0
0
Weight more
Weight less
Keep your weight stay about the same
O
0
0
Would you like to:
Yes
No
O
Are you trying to lose weight now?
Yes, many times
0
Have you ever tried to lose weight?
Y o u & YOUR WEIGHT
62.
61.
60.
Make sure my energy in is a lot less than my energy out
Make sure my energy in is similar to my energy out
0
0
Nervous
Circulatory
Endocrine
0
0
0
The heart gets stronger and is able to pump out more blood each time it beats
Blood vessels get clogged and blood can't flow through them
Lung cancer is developed
Blood gets thinner and flows faster
0
0
0
0
When a person eats a lot of fatty foods for many years, which of the following
is most likely to happen to his/her cardiovascular system?
Digestive
O
Running is an activity that causes the cells in the muscular system to use
oxygen at a faster rate. Which system responds by delivering more oxygen to
these cells?
Make sure my energy in is a lot greater than my energy out
O
What is the best way to achieve dynamic equilibrium in your body?
66.
65.
64.
63.
High blood sugar
0
They makes it easy to balance our energy in and out
They have a lot more fat and sugar than smaller sizes
Food companies give out free food by "super" sizing their products
0
0
0
Are low in calories
Are high in nutrients
Are high in sugar
0
0
0
Vitamins
Fat
Water
Calcium
O
0
0
0
Generally, fast foods tend to be high in which of the following?
Reduce the risk of cavities
O
Generally, sweetened beverages
They cost a lot more than smaller sizes
O
What is true about "super" sizes of packaged snacks or fast food?
Low blood sugar
High blood pressure
0
0
Low blood pressure
O
A person with diabetes mav have which of the followinq conditions?
The following questions measure your knowledge and understanding of science and nutrition. Each question is followed by three to five response
options. Read each question carefully. Then decide which choice is the best answer.
SCIENCE & NUTRITION
as
SCIENCE & NUTRITION
67.
68.
If I do aerobic activities such as biking or running everyday, it will likely
cause;
O
My lungs to become weaker
0
My heart to pump out less blood each time it beats
0
My heart rate be the same as its resting rate
0
My lungs to become better at taking in oxygen
Which of the following is one strategy to make more healthful choices in fast
food places?
O
Choose smaller sizes
O
Choose food that is advertised the most frequently
0
Choose the best deal
0
Choose the food that is most popular
Source: Contento, Koch, Sauberli, Lee, & Porter (2007)
ON
00
169
Appendix B
Post C3 Curriculum Student Survey
Name:
Date
Gender: Male Female
Race: African American, Asian/Pacific Islander, Hispanic, Native American, White, MultiRacial
Science teacher:
Science class Hour: 1 2 3 4 5 6 7
Please circle or fill in the best answer that describe you
1 a. Which group activity are you in this year at school?
Choir
Band
Swimming
Gym
Other (specify)
lb. How many hours per week do you usually spend on this particular activity?
Less than 2 hours
2-3 hours
3-4 hours 4-5 hours
more than 5 hours
lc. What sports/activities do you participate in after-school or on weekends?
Specify
Id. How many hours per week do you usually spend on this particular activity?
Less than 2 hours
2-3 hours
3-4 hours 4-5 hours
more than 5 hours
le. How many hours per week do you usually spend on homework?
Less than 2 hours
2-3 hours
3-4 hours
4-5 hours
More than 5 hours
2a. How do you commute to school most of the time?
By bus
My parent drives my
Walking
Other (specify)
2b. How long does it usually take for you to go to school?
Less than 10 minutes
10-20 minutes
20-30 minutes
More than 30 minutes
3a. For your behavior change goal, which food-related goal did you choose?
Increase fruits and vegetables
Decrease the amount of sweet drinks
Decrease amount of packages snacks
Decrease eating at fast food restaurants
170
3b. For all four of the C3 food-related goals, please rate how much you feel you changed this
behavior as a result of the C3 curriculum.
Food-related behavior
Did not
change
at all
Changed Change Change Already
a
this a
meeting
a little
this goal
medium lot
before
amount
C3
Increase fruits and vegetables
Decrease the amount of sweet drinks
Decrease amount of packages snacks
Decrease eating at fast food restaurant
Source: Contento, Koch, Sauberli, Lee, & Porter (2007)
THANK YOU!
Class
Teacher
Boy
or
Girl
School,
Date_
Survey
B.
Cook a meal for friends or family
A. Talk on the phone
Activity
0
1
2
3
X
4
5
X
6
H o w m a n y d a y s last w e e k
M a r k a n X in t h e b o x that is the b e s t a n s w e r for you.
Examples
honestly a s y o u c a n .
7
>
as accurately and
0
/less
/ than 15
X
16-30
X
/
31-60/
more than
1 hour
O n a v e r a g e , h o w m a n y m i n u t e s in o n e day
a v e r a g e 1 6 - 3 0 minutes e a c h day.
d a y s last w e e k a n d t a l k e d on
T h i s p e r s o n t a l k e d on t h e p h o n e 6
a b o u t w h e r e you buy food a n d w h a t kind of food y o u buy. P l e a s e think carefully a b o u t w h a t y o u e a t a n d a n s w e r the q u e s t i o n s
W e r e a l i z e that m i d d l e school is a t i m e w h e r e y o u a r e gaining f r e e d o m to buy m o r e of your s n a c k s a n d m e a l s on y o u r o w n . W e w a n t to learn m o r e
Section2: Foods
w e e k y o u d o certain things a n d h o w m u c h t i m e on a v e r a g e y o u s p e n d on t h e s e activities.
W e a r e very interested in finding out m o r e a b o u t w h a t m i d d l e school s t u d e n t s do! T h e q u e s t i o n s in this section a s k y o u h o w m a n y d a y s during t h e
Sectionl: Activities
T h i s s u r v e y a s k s y o u q u e s t i o n s a b o u t y o u r activities a n d t h e f o o d s y o u eat.
Circle o n e :
EatWalk
Name
Appendix C
1 Activity
5.1 took a walk for e x e r c i s e
transportation
4 . I p u r p o s e l y w a l k e d i n s t e a d of t a k i n g
shopping mall...etc)
supermarket, restaurant, friend's house,
3.1 walked outside home and school (i.e.
L
4
5
6
7
- »
3
2 . I w a l k e d in a n d a r o u n d m y s c h o o l c a m p u s
2
-»
1
1 . 1 w a l k e d in a n d a r o u n d m y h o m e
0
H o w m a n y d a y s last w e e k
in the box that is the best answer for you.
Last week, when 1 had the chance,
Walking
Mark an A
Didn't
do
Slow
Medium
speed
Fast
For this activity, rate y o u r w a l k i n g
This section asks about activities you did during the last week. W e ask two questions about each activity.
How many days last week: number of days you did each activity last w e e k .
How many minutes in one day: think about the amount of time you spend for each activity in o n e d a y
Section
0
1
2
3
4
H o w m a n y d a y s last w e e k
5
6
7
—>
0
1-3
4-6
7-9
10+
O n a v e r a q e , h o w m a n y f l i q h t s * in o n e d a y
* F l i g h t s o f s t a i r s — a flight o f s t a i r s is g o i n g u p o n e floor in a building, s u c h a s f r o m t h e first to t h e s e c o n d floor.
9.1 took stairs on purpose to increase physical activity
8.1 took stairs in other places outside home and school
(i.e. subway station, restaurant, department store,
office building, shopping mall...etc)
7. 1 took stairs in and around my school campus
6. 1 took stairs in and around my home
During the past week, when / had the
chance,
Taking stairs*
11.1 sat and watched television
10. I sat and played video games or used the
computer
During the past week,
Activity
1
2
3
4
0
1
2
3
4
How many days last week
0
How many days last week
5
5
6
6
7
7
—>
0-15
15-30
31-60
61-90
>90
0
1
2
3-4
5-6
>7
On averaqe, how many hours per day
0
On averaqe, how many minutes in
one day
s q u a t s , t r i c e p s d i p s o r w e i g h t lifting
doing s u c h a s p u s h - u p s , sit-ups, lunges,
15. I strengthened or toned my muscles, by
a s toe touches, k n e e bending or y o g a
14. I did flexibility/stretching exercises such
m a k e m e breathe hard
13. I participated in sports or dancing that
groceries
h o u s e w o r k , g a r d e n i n g , or c a r r y i n g h e a v y
a s s c o o t e r i n g , bicycling, w a l k i n g pet,
12. I participated in e v e r y d a y activities such
During the past week, when / had the
chance,
Activity
0
1
2
3
4
H o w m a n y d a y s last w e e k
5
6
7
- >
- >
Didn't do
Light
Medium
Heavy
Rate your intensity of y o u r daily activity
-J
<u>
6-10
11-15
many
16-20
blocks
20+
Please wait for further direction.
STOP HERE !
0
1
How
2-3
many
4-5
fliqhts
6+
more about stair climbing. T h i n k a b o u t w h e n y o u a r e p l a c e s w h e r e y o u h a v e a c h o i c e b e t w e e n taking stairs or
17. If given t h e c h o i c e h o w m a n y flights w o u l d y o u t a k e b e f o r e taking a n e l e v a t o r ?
taking a n e l e v a t o r .
T h e next question asks you
train, or c a r
16. If given t h e c h o i c e h o w m a n y blocks w o u l d y o u w a l k b e f o r e taking a bus,
1-5
How
more about walking. T h i n k a b o u t w h a t y o u d o to get from place to place, such a s going to a friend's h o m e , a store,
a s p e c i a l e v e n t or a n y o t h e r place.
T h e next q u e s t i o n a s k s y o u
t h i n k a b o u t t h e a m o u n t of e a c h f o o d y o u e a t in o n e d a y
Breakfast
0
1
2
3
4
5
6
7
- >
- >
0
1/2
1
2
3
more
than 3
O n averaae, how m a n y pieces * per day
of y o u r fist.
b l u e b e r r i e s c o u n t 2 0 a s o n e p i e c e . O n e c u p of c h o p p e d o r s l i c e d fruit s u c h a s m e l o n o r s t r a w b e r r i e s is e q u a l to o n e p i e c e . A c u p is a b o u t t h e s i z e
* P i e c e s o f f r u i t - A n a p p l e , o r a n g e , b a n a n a , or p e a c h o r o t h e r s i m i l a r - s i z e d fruit c o u n t s a s o n e p i e c e . F o r s m a l l fruit s u c h a s g r a p e s o r
21. Snack
20. Dinner
19. Lunch
18.
Eat Fruit
H o w m a n y d a y s last w e e k
Mark an X in the box that is the best answer for you. Count all the fruit you eat whether it is at school, at home, or from a store or restaurant.
W h a t s i z e d o y o u u s u a l l y h a v e : p l e a s e c a r e f u l l y r e a d t h e instruction for e a c h q u e s t i o n
H o w m a n y in o n e d a y :
H o w m a n y d a y s last w e e k : n u m b e r of d a y s y o u a t e e a c h f o o d l a s t w e e k .
T h i s section a s k s a b o u t f o o d s you eat. W e a s k two or three questions a b o u t e a c h food.
Section 2 Food
--Jj
7
- >
6
25. Snack
5
- »
4
24. Dinner
3
- »
2
23. Lunch
1
—>
0
22. Breakfast
DON'T INCLUDE French fries or potato
chips.
Eat Vegetables
H o w m a n y d a y s last w e e k
0
cups
1/4
1/2
3/4
1
2
O n a v e r a g e , h o w m a n y c u p ;>* p e r d a y
>2
* s e e a t t a c h e d s h e e t for a g u i d e on e s t i m a t i n g
Count all the vegetables you eat whether it is at school, at home, or from a store or restaurant. Also include vegetables that are part of
food such as lettuce and tomato on sandwiches or hamburgers.
0
1
2
3
4
5
6
i
7
- >
—>
— >
0
day
1
2
3
>4
h o w m a n y p a c k a g e s per
—»
—»
small
med
Large
usually have?
W h a t size** do y o u
estimating size
b o a r d for a g u i d e o n
o f p r e - p a c k a g e d s n a c k s . T h e s e f o o d s all h a v e "nutrition facts" l a b e l s .
* P r e - p a c k a g e d s n a c k f o o d s — a n y s n a c k t h a t y o u b u y t h a t c o m e s in a p a c k a g e . C h i p s , c a n d y , c o o k i e s , a n d c a k e s a r e e x a m p l e s o f s o m e t y p e s
brownies
cookies, doughnuts, or
f o o d s such as cakes,
28. Sweet pre-packaged snacks
c r a c k e r s , or p o r k rinds
p r e t z e l s , tortilla c h i p s ,
f o o d s * such a s chips,
27. Salty pre-packaged snacks
candy
b a r s , g u m m y c a n d i e s , or h a r d
26. C a n d y such as chocolate
Eat
H o w m a n y d a y s last w e e k
On average,
** u s e the index card
or s e e the poster
of
water
snacks
33. B e t w e e n meals and
3 2 . W i t h your s n a c k
31. Dinner
30. Lunch
29. Breakfast
Glass
Drink
0
1
2
3
H o w m a n y d a y s last w e e k
4
5
6
7
- >
0
1-2
3-4
5-6
7-8
9-12
13+
O n a v e r a g e , h o w m a n y 8 o u n c e ql<a s s e s p e r d a y
35. Non-carbonated
sweetened beverages
such as fruit punch,
sweetened iced tea,
sports drinks, lemonade
or drink mixes
34. Regular soda and other
sweetened carbonated
beverages
Drink
0
1
2
3
4
How many days last week
5
6
7
—»
—>
0
1
2
3
4
5
>6
On averaqe, how many in one
day
- >
more than 20 ounces
20 ounce bottle
12 ounce can
less than 12 ounces
more than 20 ounces
20 ounce bottle
12 ounce can
less than 12 ounces
What size do you
usually have?
1
2
3
4
5
6
7
On
Never
-»
H o w
med
Rarely
Sometimes
do
large
often
p u r c h a s e
a v e r a g e ,
small
Always
you
X-large
O n average, w h a t size d o y o u eat
yourself e a c h day?
Thank you !
3 8 . O n a v e r a g e , h o w m u c h m o n e y d o y o u s p e n d o n f o o d s a n d b e v e r a g e s for
Source: Contento, Koch, Lee, Sauberli (2006)
per day
* * V a l u e m e a l s - a m e a l a t a f a s t f o o d r e s t a u r a n t w h e r e y o u p a y o n e p r i c e for a n e n t i r e m e a l s u c h a s a h a m b u r g e r , s o d a , a n d F r e n c h fries.
examples.
w a i t r e s s e s , a n d b u f f e t s d o not c o u n t a s f a s t f o o d r e s t a u r a n t s . F a s t f o o d c h a i n s , t a k e - o u t p i z z a p l a c e s , a n d t a k e - o u t C h i n e s e r e s t a u r a n t s a r e
* F a s t f o o d r e s t a u r a n t s — P l a c e s w h e r e y o u o r d e r c o o k e d a n d r e a d y to e a t f o o d o v e r - t h e - c o u n t e r or a t a d r i v e - t h r u . R e s t a u r a n t s w i t h w a i t e r s o r
37. V a l u e M e a l s * * at fast food restaurants
36. Eat at fast food restaurants *
0
H o w m a n y d a y s last w e e k
get
y o u r b e s t e s t i m a t e of w h a t s i z e y o u u s u a l l y
Think about the sizes available and m a k e
183
Appendix D
1. Student Name: (Last)
2. Circle one:
, (First).
Boy or Girl
3. Today's Date:
/
/
(mm/dd/yr)
4. Teacher:
5. Class:
6. School:
Instructions
This survey asks you questions about what you think. There is no right answer for each
question and your answer will be used only for us to understand what middle school
students think. Please answer each question honestly.
Definitions of important terms used in this survey:
•
Fast food restaurants: Places where you order cooked and ready to eat food
over-the-counter or at a drive-thru. Fast food chains, take-out pizza places, and
take-out Chinese restaurants are examples
•
Packaged snacks: any snack that you buy that comes in a package. Chips,
candy, cookies, and cakes are examples of some types of packaged snacks.
•
Sweetened beverages: include soda, sweetened iced teas and fruit flavored
drinks.
184
Examples:
This is a stem for question 1, 2, and 3
Please think about the following statements carefully, and then mark the answer that best describes
Strongly
Disagree
Disagree
Uncertai
n
Agree
Strongly
Agree
©
2
3
4
5
2. is the best way to quench my thirst
1
2
®
4
5
3. contributes to developing healthy bones
1
2
3
©
5
I believe that drinking lotjs of milk...
1. is a good substlftite for water
These are response
•
Question number 1 asks if you believe that drinking lots of milk is a good substitute for water.
T h e person, who answered this question, strongly disagreed with the statement, so circled 1.
•
Question number 2 asks if you believe that drinking lots of milk is the best way to quench your
thirst. T h e person, who a n s w e r e d this question, w a s uncertain with the statement, so circled 3.
•
Question number 3 asks if you believe that drinking lots of milk contributes to developing
healthy bones. T h e person, who a n s w e r e d this question, agreed with the statement, so circled 4.
If you h a v e any questions, please raise your hand now. Or, please turn the page and start the survey a s the
instructor tells you to do so.
185
We would like to ask you whether you want to change your eating habits or physical activity.
Will you?
Won't
do it
within
next 6
months
Will try
within
the next
6
months
Plan to
do it in
a
month
or so
Currentl
y doing
it for
past 16
months
Have
been
doing it
for over
past 6
months
1.
drink less soda and other sweetened
beverages
1
2
3
4
5
2.
eat less frequently at fast food
restaurants
1
2
3
4
5
3.
eat fewer packaged snacks
1
2
3
4
5
4.
drink more water
1
2
3
4
5
5.
eat more fruit and vegetables
1
2
3
4
5
6.
do more physical activity
1
2
3
4
5
7.
walk more
1
2
3
4
5
186
Please think about the following statements carefully, and then mark the answer that best describes what you think.
I believe that drinking lots of soda and other
sweetened beverages...
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
1
2
3
4
5
contributes to our developing high blood
pressure
1
2
3
4
5
10.
contributes to our developing diabetes
1
2
3
4
5
11.
contributes to weight gain
1
2
3
4
5
12.
contributes to healthy skin
1
2
3
4
5
13.
is satisfying
1
2
3
4
5
14.
is cool
1
2
3
4
5
15.
is important to me
1
2
3
4
5
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
1
2
3
4
5
8.
9.
is the best way to quench my thirst
1 believe eating frequently at the fast food
restaurant...
16.
provides proper nutrients for my body
17.
contributes to our developing high blood
pressure
1
2
3
4
5
18.
contributes to our developing diabetes
1
2
3
4
5
19.
contributes to healthy skin
1
2
3
4
5
20.
contributes to weight gain
1
2
3
4
5
21.
is cool
1
2
3
4
5
22.
is important to me
1
2
3
4
5
187
1 believe eating lots of packaged snacks...
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
23.
provides proper nutrients for my body
1
2
3
4
5
24.
contributes to our developing high blood
pressure
1
2
3
4
5
25.
contributes to our developing diabetes
1
2
3
4
5
26.
contributes to weight gain
1
2
3
4
5
27.
contributes to healthy skin
1
2
3
4
5
28.
is cool
1
2
3
4
5
29.
is important to me
1
2
3
4
5
1 believe drinking plenty of water...
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
30. is the best way to quench my thirst
1
2
3
4
5
31. contributes to healthy skin
1
2
3
4
5
32. helps reduce our developing cavities
1
2
3
4
5
33. contributes to weight gain
1
2
3
4
5
34. contributes to our developing high blood pressure
1
2
3
4
5
35. is satisfying
1
2
3
4
5
36. is cool
1
2
3
4
5
37. is important to me
1
2
3
4
5
188
1 believe eating lots of fruits and vegetables...
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
38.
provides proper nutrients for my body
1
2
3
4
5
39.
contributes to healthy skin
1
2
3
4
5
40.
contributes to healthy hair
1
2
3
4
5
41.
is good for my bone health
1
2
3
4
5
42.
contributes to weight gain
1
2
3
4
5
1
2
3
4
5
43.
contributes to our developing high blood
pressure
44.
is satisfying
1
2
3
4
5
45.
is cool
1
2
3
4
5
46.
is important to me
1
2
3
4
5
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
I believe walking...
47.
makes my body stronger
1
2
3
4
5
48.
is good for my bone health
1
2
3
4
5
49.
contributes to a stronger heart
1
2
3
4
5
50.
contributes to weight gain
1
2
3
4
5
51.
contributes to our developing high blood
pressure
1
2
3
4
5
52.
is cool
1
2
3
4
5
189
53
is important to me
2
1
4
3
5
Please think about the following statements carefully, and then mark the answer that best describes the hard situation
in achieving healthy eating or physical activity behaviors.
It's difficult to eat healthy or be physically active
because...
Strongly
Disagree
Disagree
Uncertain
Agree
Strongly
Agree
54.
I prefer soda/sweetened beverages than water
1
2
3
4
5
55.
I like to eat at fast food restaurants
1
2
3
4
5
56.
I like to have packaged food for snacks
1
2
3
4
5
57.
I don't like the taste of fruits
1
2
3
4
5
58.
I don't like the taste of vegetables
1
2
3
4
5
59.
I think walking to places is too much trouble
1
2
3
4
5
60.
It is difficult to resist the soda/sweetened beverages
that are available in vending machines and stores
1
2
3
4
5
61.
It is difficult to resist the super-sized food and
beverages that are available
1
2
3
4
5
62.
It is difficult to pass up the cheaper price of the
larger sizes of foods and beverages
1
2
3
4
5
63.
It is difficult to select healthy options are available in
school and stores in my neighborhood
1
2
3
4
5
64.
Walking is too much work when subways and buses
are so convenient to places near by
1
2
3
4
5
65.
It is too tiring to walk the stairs to get to my
destination
1
2
3
4
5
190
These questions are about how sure that you can eat healthfully and be physically active in different situations. Please
imagine you're in the certain situation as each question describes, then answer the question honestly.
66.
How sure are you that you could drink soda or sweetened beverages no more than 8 ounces a day?
(Check one)
Not Sure
A little Sure
Somewhat Sure
Very Sure
How sure are you that you could drink LESS soda or sweetened
beverages...
Not
Sure
A little
Sure
Somewhat
Sure
Very
Sure
67.
when you eat lunch?
1
2
3
4
68.
when you are at school?
1
2
3
4
69.
when you are at home?
1
2
3
4
70.
when you eat meals with your family?
1
2
3
4
71.
when you are with your friends (i.e. after school, weekend)?
1
2
3
4
72.
How sure are you that you could eat at fast food restaurants no more than 3 times a week? (Check
one)
Not Sure
A little Sure
Somewhat Sure
Verv Sure
How sure are you that you could eat LESS OFTEN at the fast
food restaurants...
Not
Su re
A little
Sure
Somewhat
Sure
Very
Sure
73.
when you eat out with your friends?
1
2
3
4
74.
when you pass by fast food restaurants?
1
2
3
4
75.
when you are really hungry?
1
2
3
4
76.
when you are with your family?
1
2
3
4
191
These questions are about how sure that you can eat healthfully and be physically active in different situations. Please
imagine you're in the certain situation as each question describes, then answer the question honestly.
77.
How sure are you that you could eat only one small packaged snack per day?
(Check one)
Not Sure
A little Sure
Somewhat Sure
Verv Sure
How sure are you that you could eat FEWER packaged
snacks...
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
78.
when you eat lunch?
1
2
3
4
79.
when you are at school?
1
2
3
4
80.
when you are at home?
1
2
3
4
81.
when you are with your family?
1
2
3
4
82.
when you are with your friends (i.e. after school,
weekend)?
^
2
3
4
83.
How sure are you that you could drink water more than 8 glasses a day? (Check one]
Not Sure
A little Sure
Somewhat Sure
Verv Sure
How sure are you that you could drink lots of water...
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
3
4
3
4
3
4
3
4
84.
when you eat lunch?
1
2
85.
when you have other choices such as soda or other
sweetened
beverages?
,
_
86.
when you eat meals with your family?
1
2
87.
when you are with your friends (i.e. after school,
weekend)?
.
„
192
These questions are about how sure that you can eat healthfully and be physically active in different situations. Please
imagine you're in the certain situation as each question describes, then answer the question honestly.
88.
How sure are you that you could eat fruit and vegetables at least 4 cups a day? (Check one)
Not Sure
A little Sure
Somewhat Sure
Very Sure
How sure are you that you could eat fruit and vegetables...
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
89.
as your snacks?
1
2
3
4
90.
when you eat lunch?
1
2
3
4
91.
when you are at school?
1
2
3
4
92.
when you are at home?
1
2
3
4
93.
when you eat meals with your family?
1
2
3
4
94.
How sure are you that you could walk at least 10,000 steps per day (about 5 miles)? (Check one)
Not Sure
A little Sure
Somewhat Sure
Very Sure
How sure are you that you could walk instead of taking
subway or bus...
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
95.
When you are with your family?
1
2
3
4
96.
When you are with your friends?
1
2
3
4
97.
When you don't have full of energy?
1
2
3
4
98.
In order to exercise?
1
2
3
4
193
How sure are you that you could take stairs instead of taking an
elevator or escalator
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
1
2
3
4
100. When you are with your friends?
1
2
3
4
101.
When you don't have full of energy?
1
2
3
4
102.
In order to exercise?
1
2
3
4
99.
When you are with your family?
Next questions are about what you do or think. Please circle the answer that best describes about you.
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
1
2
3
4
104. When I have a goal for healthy eating, I can follow it through
pretty well
1
2
3
4
105.
I know how to assess my food intake
1
2
3
4
106.
I enjoy keeping track of my eating patterns
1
2
3
4
107.
I enjoy making healthy food choices
1
2
3
4
108.
I'm very interested in having healthier eating patterns
1
2
3
4
109.
I feel confident in my ability to make healthy food choices
1
2
3
4
110.
I'm capable of making changes in my eating habits to make
them healthier
1
2
3
4
111.
I'm capable of maintaining a healthy eating habits
1
2
3
4
112.
I can take control of my food choices
1
2
3
4
1
2
3
4
Eating
103.
113.
I can set a goal for healthy eating
I can make good decisions about what I eat
194
Physical activity
114.
I can set a goal for being physically active
115. When I have a goal for being physically active, I can follow it
through pretty well
Not Sure
A little
Sure
Somewhat
Sure
Very
Sure
1
2
3
4
1
2
3
4
116.
I know how to assess my physical activity
1
2
3
4
117.
I enjoy keeping track of my own physical activity
1
2
3
4
118.
I enjoy being a physically active person
1
2
3
4
119.
I'm currently doing exercise for pleasure
1
2
3
4
120.
I feel confident in my ability to be physically active
1
2
3
4
121.
I'm capable of making changes in my physical activity habits
to make them healthier
1
2
3
4
122.
I'm capable of maintaining an activity routine
1
2
3
4
123.
I can take control of how much physical activity I get
1
2
3
4
124.
I can make good decisions to be physically more active
1
2
3
4
Source: Contento, Koch, Lee, & Sauberli (2006)
Thank You!
195
Appendix E
Understanding Science
1. Student Name: (Last)
2. Circle one:
Boy
3. Today's Date:
, (First).
or
Girl
/
/
(mm/dd/yr)
4. Teacher:
5. Class:
6. School:
INSTRUCTIONS
The questions on this questionnaire measure your knowledge and understanding of
science and nutrition. The questionnaire consists of 20 multiple-choice questions. You
may use a calculator to answer the questions, if needed. You will have 20 minutes to
answer these questions.
Do not discuss with your peers, and just answer the questions as best you can.
196
DIRECTIONS
There are 20 questions on the test. Each question is followed by three to five response
options. Read each question carefully. Decide which choice is the best answer.
Read the sample question below:
Sample Question
The main function of the human digestive system is to
absorb food into the blood
b. exchange gases in the lungs
c. release energy from the cells
d. carry nutrients to the body
The correct answer is 'to absorb food into the blood', which is choice letter a. Circle the
letter that you think is the best answer.
Answer all of the questions in the same way. Circle only one answer for each question. If
you want to change an answer, be sure to erase or cross out your first mark clearly. Then
circle the answer you want.
You will not need scrap paper. You may use the pages of this test booklet to work out our
answers to the questions.
197
1. Which substance provides humans with their main source of energy?
a.
b.
c.
d.
Food
Carbon dioxide
Water
Chlorophyll
2. What is the correct information about metabolism?
Metabolism... (Check all that apply)
Releases the energy we need to keep all our organs and body systems working
Is the process our cells use to take nutrients and use them to build molecules our
body needs
Changes the chemical energy from food into mechanical energy
Converts the stored chemical energy from food into heat energy to maintain our
body temperature
3. The energy obtained from food is measured in units called
a.
b.
c.
d.
Watts
Calories
Degrees
Pounds
4. What is the best way to achieve dynamic equilibrium in your body?
a. Make sure my energy in is a lot greater than my energy out
b. Make sure my energy in is a lot less than my energy out
c. Make sure my energy in is similar to my energy out
5. What are the purposes of keeping 24-hour food intake records? (Check all that apply)
To compare my own energy intake with my friends
To compare my own energy intake with recommendations
To help me analyze how I usually eat
To help me choose a goal that is specific to my own food and beverage intake
198
Direction: Given two examples of food label, answer the question number 6
Label A.
Label B.
Nutrition Facts
Nutrition Facts
Serving Size l/2cup (98g)
Servings Per Container 4
Serving Size 1 container (227g)
Servings Per Container 1
Amount Per Serving
Amount Per Serving
Calories 250 Calories from Fat 20
%Daily Value*
Total Fat 2.5g
4%
Saturated Fat 1.5g
7%
Cholesterol 15mg
5%
Sodium llOmg
5%
Total Carbohydrate 48g
16%
Dietary fiber Og
Sugar 47g
Protein 8g
Vitamin A 0% Vitamin C 0%
Calcium 30% Iron
0%
*Percent Daily Values are based on
2,000
calorie diet. Your daily values may
be higher or lower depending on
your calorie needs:
Calories 100 Calories from Fat 25
%Daily Value*
Total Fat 2.5g
4%
Saturated Fat 1.5g
7%
Cholesterol 30mg
11%
Sodium 60mg
2%
Total Carbohydrate 26g
9%
Dietary fiber less than lg
4%
Sugar 18g
Protein 8g
Vitamin A 2%
Vitamin C 0%
Calcium 20%
Iron
4%
* Percent Daily Values are based on
2,000
calorie diet. Your daily values may
be higher or lower depending on
your calorie needs:
6. If you eat the whole container, which one has FEWER calories?
a. Label A
b. Label B
c. Same
7. When you use pedometers to collect step count data, it is important to
a.
b.
c.
d.
Compare my performance with my friends'
Be more active than my usual routine
Have high step counts
Calibrate to make sure the pedometer's counting matches mine
8. Running is an activity that causes the cells in the muscular system to use oxygen at a
faster rate. Which system responds by delivering more oxygen to these cells?
a.
b.
c.
d.
Digestive
Nervous
Circulatory
Endocrine
199
9. When a person eats a lot of fatty foods for many years, which of the following is most 1
ikely to happen to his/her cardiovascular system?
a.
b.
c.
d.
The heart gets stronger and is able to pump out more blood each time it beats
Blood vessels get clogged and blood can't flow through them
Lung cancer is developed
Blood gets thinner and flows faster
10. A person with syndrome X may have which of the following conditions?
a.
b.
c.
d.
Low blood insulin
High blood pressure
Low LDL cholesterol
Low blood sugar
11. Humans have an innate preference toward
foods.
a.
b.
c.
d.
tastes and the mouth-feel of
Bitter, dry
Bitter, fatty
Sweet, dry
Sweet, fatty
12. What is true about "super" sizes of packaged snacks or fast food?
a.
b.
c.
d.
They cost a lot more than smaller sizes
They makes it easy to balance our energy in and out
They have a lot more fat and sugar than smaller sizes
Food companies give out free food by "super" sizing their products
13. Results of the invention of packaged foods include which of the following?
a. More time needed to prepare foods as well as increased sugar and increased fat
intake
b. More time needed to prepare foods as well as, decreased sugar and decreased fat
intake
c. Less time needed to prepare foods, as well as, increased sugar and increased fat
intake
d. Less time needed to prepare foods as well as, decreased sugar and decreased fat
intake
200
14. Generally, sweetened beverages
a.
b.
c.
d.
Reduce the risk of cavities
Are low in calories
Are high in nutrients
Are high in sugar
15. Generally, fast foods tend to be high in which of the following?
a.
b.
c.
d.
Vitamins
Fat
Water
Calcium
16. If I do aerobic activity such as biking or running everyday, it will likely cause;
a.
b.
c.
d.
My
My
My
My
lungs to become weaker
heart to pump out less blood each time it beats
heart rate be the same as its resting rate
lungs to become better at taking in oxygen
17. Which of the following is one strategy to make more healthful choices in fast food res
taurants?
a.
b.
c.
d.
Choose smaller sizes
Choose food that is advertised the most frequently
Choose the best deal
Ask for the most popular food among their customers
18. You have learned that vegetables are healthy. You are curious to know how much
vegetables you usually eat. To find this out you could;
a.
b.
c.
d.
Ask your doctor to explain what happens to your body when you eat vegetables
Estimate how many times your family serves vegetables each week
Make a goal to eat more vegetables after school
Write down when and how much vegetables you eat for several days
19. To answer the question "Why do we need to drink lots of water?" you could;
a.
b.
c.
d.
Search for information that is based on scientific experiments
Ask your friends who drink lots of water
Start to drink more water
Survey your family to find out how much water they drink
201
20. What do scientists use to back up their theories about how things work? (Check all
that apply)
Research done by other people
Educated guesses
Data from experiments
The opinions of others
Source: Contento, Koch, & Lee (2006)
Thank You!
202
Appendix F
Factor Analysis for Psychosocial Variables Scales
Rotated Component Matrix(a)
Component
pp_q26c
pp_q13c
pp_q26d
1
.882
2
.004
3
-.003
4
.099
5
-.002
6
.083
7
-.041
8
-.015
9
-.089
.857
.003
.042
-.027
.104
-.038
.028
-.008
.010
.049
.006
.016
.129
.101
.024
-.074
.025
.000
-.075
.025
-.002
-.001
.030
.122
.068
.034
-.018
.085
-.020
.315
.090
.059
.031
.042
pp_q37c
.851
.839
pp_q13d
.786
-.006
pp_q37d
pp_q44
.725
.072
.796
-.084
.121
-.065
.092
-.076
-.017
pp_q20
.056
.034
.763
.150
.138
.116
.093
.037
pp_q34
.039
.747
.177
.383
.076
pp_q56
pp_q40
.023
.052
.097
.725
.442
.091
.382
.061
.065
.164
.064
.086
.021
.413
.023
.004
.008
.122
.403
.772
.385
.044
.739
.187
.036
.655
.130
.458
pp_q30
pp_q15
pp_q29
pp_q39
.232
.282
-.013
.441
.134
.016
.068
.087
.061
.401
.062
.046
.074
.135
.042
.065
.004
.086
.153
.057
.293
.060
.066
-.060
-.067
.047
-.015
.073
.079
.059
.054
.078
.065
.176
.042
.136
.019
.276
.186
.247
.051
-.067
.135
.384
.049
.167
-.120
pp_q16
.074
.221
.287
pp_q51
.058
.051
.438
-.068
.052
pp_q33
.061
.095
.814
pp_q31
pp_q32
.011
.098
.172
.091
.067
.238
.740
.161
.159
.228
.053
.068
.118
.126
.165
.119
.106
-.097
.238
.098
.721
.136
.166
.007
.132
.234
pp_q26b
.140
.848
.821
.083
.019
.104
.154
-.076
.092
.036
.113
.012
pp_q37b
.103
.134
.161
.027
.056
-.007
.113
.149
.008
pp_q13b
.114
.127
.027
.780
.721
-.032
.138
.208
.110
.124
.177
.697
.124
.306
-.049
.026
pp_q43
pp_q41
.085
.152
.814
.017
.036
.154
.180
.191
.092
.119
.168
.021
.028
.041
-.011
-.003
.849
.063
.056
.177
pp_q42
.144
.197
pp_q13a
-.023
pp_q37a
.020
.035
.067
.072
.010
.064
.044
.846
.045
.071
pp_q26a
.018
.030
.059
.076
.054
.032
.843
.063
-.010
pp_q55
-.011
-.037
-.032
.048
.103
.709
.230
.011
.084
.131
.160
.134
.089
pp_q53
.107
.278
.696
.055
pp_q54
.061
.372
.059
.098
.057
-.028
.068
-.117
.646
.137
pp_q52
-.028
.408
.231
-.038
.162
.141
.020
.564
-.089
pp_q18
.061
.176
.140
.191
.073
.088
.748
.058
.051
.021
.146
.086
.208
.266
-.003
pp_q19
.098
.171
.739
.069
.181
.334
.227
.099
.227
.016
.062
.024
.479
Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization,
a Rotation converged in 7 iterations.
PP_q17
203
Appendix G
Cronbach 's Alpha for Psychosocial Variable and Knowledge Scales
Scale
Physical Aspect of Outcome
Expectations
Social Aspect of Outcome Expectations
Competency
Autonomy
Self-efficacy in packaged snacks
consumption
Self-efficacy in sweet drinks
consumption
Self-efficacy in fast food consumption
Self-efficacy in physical activity
Knowledge
Questions grouped to a
scale
Q13b, 26b, 37b
Cronbach's
Alpha
0.842
Q13c, 13d, 26c, 26d, 37c,
37d
Q20, 34, 44, 56
Q15, 16, 29,30,39, 40
Q17, 18, 19
0.907
Q31, 32, 33
0.817
Q41, 42, 43
Q53, 54, 55
Q60-68
0.797
0.648
0.710
0.860
0.776
0.717
Appendix H
Chi Square Tables
Table 30
Food-Related Behavior Goals and Gender Crosstab
Gender
1
1
Total
2
151
168
319
% within a3
47.3%
52.7%
100.0%
% within Gender
46.6%
50.6%
48.6%
% of Total
23.0%
25.6%
48.6%
73
69
142
% within a3
51.4%
48.6%
100.0%
% within Gender
22.5%
20.8%
21.6%
% of Total
11.1%
10.5%
21.6%
45
38
83
% within a3
54.2%
45.8%
100.0%
% within Gender
13.9%
11.4%
12.7%
6.9%
5.8%
12.7%
55
57
112
% within a3
49.1%
50.9%
100.0%
% within Gender
17.0%
17.2%
17.1%
8.4%
8.7%
17.1%
324
332
656
49.4%
50.6%
100.0%
100.0%
100.0%
100.0%
49.4%
50.6%
100.0%
Count
Goals
(a3)
2
3
Count
Count
% of Total
4
Count
% of Total
Total
Count
% within a3
% within Gender
% of Total
Goals: 1- Increase fruits and vegetables intake; 2- Decrease sweet drinks intake
3- Decrease packaged snacks intake; 4- Decrease fast food intake
Gender: 1- Boys; 2- Girls
205
Table 31
Food- Related Behavior Goals and Race Crosstab
Race
1
Goals
1
(a3)
2
Count
144
60
319
% within a3
29.5%
6.6%
45.1%
18.8%
100.0%
% within Race
51.4%
55.3%
44.0%
55.6%
48.6%
% of Total
14.3%
3.2%
22.0%
9.1%
48.6%
29
5
86
22
142
% within a3
20.4%
3.5%
60.6%
15.5%
100.0%
% within Race
15.8%
13.2%
26.3%
20.4%
21.6%
4.4%
.8%
13.1%
3.4%
21.6%
23
6
46
8
83
% within a3
27.7%
7.2%
55.4%
9.6%
100.0%
% within Race
12.6%
15.8%
14.1%
7.4%
12.7%
3.5%
.9%
7.0%
1.2%
12.7%
37
6
51
18
112
% within a3
33.0%
5.4%
45.5%
16.1%
100.0%
% within Race
20.2%
15.8%
15.6%
16.7%
17.1%
5.6%
.9%
7.8%
2.7%
17.1%
183
38
327
108
656
27.9%
5.8%
49.8%
16.5%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
27.9%
5.8%
49.8%
16.5%
100.0%
Count
Count
Count
% of Total
Total
Total
6
21
% of Total
4
5
94
% of Total
3
3
Count
% within a3
% within Race
% of Total
Goals: 1- Increase fruits and vegetables intake; 2- Decrease sweet drinks intake
3- Decrease packaged snacks intake; 4- Decrease fast food intake
Race: 1- African American, 3- Hispanic, 5- White, 6- Multiracial/Others
206
Table 32
Food-Related Behavior Goals and Hours of Activity at School Crosstab
Hours of activity at school (b1)
1
Goals
1
(a3)
2
3
Total
4
Total
5
96
54
22
62
76
310
% within a3
31.0%
17.4%
7.1%
20.0%
24.5%
100.0%
% within b1
55.8%
48.6%
41.5%
46.6%
45.2%
48.7%
% of Total
15.1%
8.5%
3.5%
9.7%
11.9%
48.7%
26
22
19
31
42
140
% within a3
18.6%
15.7%
13.6%
22.1%
30.0%
100.0%
% within b1
15.1%
19.8%
35.8%
23.3%
25.0%
22.0%
% of Total
4.1%
3.5%
3.0%
4.9%
6.6%
22.0%
19
15
6
19
21
80
% within a3
23.8%
18.8%
7.5%
23.8%
26.3%
100.0%
% within b1
11.0%
13.5%
11.3%
14.3%
12.5%
12.6%
3.0%
2.4%
.9%
3.0%
3.3%
12.6%
31
20
6
21
29
107
% within a3
29.0%
18.7%
5.6%
19.6%
27.1%
100.0%
% within b1
18.0%
18.0%
11.3%
15.8%
17.3%
16.8%
% of Total
4.9%
3.1%
.9%
3.3%
4.6%
16.8%
172
111
53
133
168
637
% within a3
27.0%
17.4%
8.3%
20.9%
26.4%
100.0%
% within b1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
27.0%
17.4%
8.3%
20.9%
26.4%
100.0%
Count
Count
Count
% of Total
4
3
2
Count
Count
% of Total
Goals: 1- Increase fruits and vegetables intake; 2- Decrease sweet drinks intake
3- Decrease packaged snacks intake; 4- Decrease fast food intake
Hours of activitiesafterschool (dl): 1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4- 4 to 5 hours; 5- More than 5 hours
207
Table 32
Food- Related Behavior Goals and Hours of Activities after School Crosstab
Hours of activities after school (d1)
1
Goals
1
03)
Count
4
Total
5
47
41
78
300
% within a3
19.3%
25.3%
15.7%
13.7%
26.0%
100.0%
% within d1
46.0%
50.3%
52.2%
55.4%
43.6%
48.4%
9.4%
12.3%
7.6%
6.6%
12.6%
48.4%
26
30
16
16
46
134
% within a3
19.4%
22.4%
11.9%
11.9%
34.3%
100.0%
% within d1
20.6%
19.9%
17.8%
21.6%
25.7%
21.6%
4.2%
4.8%
2.6%
2.6%
7.4%
21.6%
11
18
14
5
28
76
% within a3
14.5%
23.7%
18.4%
6.6%
36.8%
100.0%
% within d1
8.7%
11.9%
15.6%
6.8%
15.6%
12.3%
% of Total
1.8%
2.9%
2.3%
.8%
4.5%
12.3%
31
27
13
12
27
110
% within a3
28.2%
24.5%
11.8%
10.9%
24.5%
100.0%
% within d1
24.6%
17.9%
14.4%
16.2%
15.1%
17.7%
5.0%
4.4%
2.1%
1.9%
4.4%
17.7%
126
151
90
74
179
620
% within a3
20.3%
24.4%
14.5%
11.9%
28.9%
100.0%
% within d1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
20.3%
24.4%
14.5%
11.9%
28.9%
100.0%
Count
Count
Count
% of Total
Total
4
76
% of Total
3
3
58
% of Total
2
2
Count
% of Total
Goals: 1- Increase fruits and vegetables intake; 2- Decrease sweet drinks intake
3- Decrease packaged snacks intake; 4- Decrease fast food intake
Hours of activities after school (dl): 1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4- 4 to 5 hours; 5- More than 5 hours
Table 34
Food- Related Behavior Goals and Weight Control Behaviors Crosstab
Weight control
behaviors (pp_q58)
1
Goals
1
(a3)
2
Count
112
177
289
% within a3
38.8%
61.2%
100.0%
% within pp_q58
44.8%
51.3%
48.6%
% of Total
18.8%
29.7%
48.6%
52
80
132
% within a3
39.4%
60.6%
100.0%
% within pp_q58
20.8%
23.2%
22.2%
8.7%
13.4%
22.2%
42
33
75
% within a3
56.0%
44.0%
100.0%
% within pp_q58
16.8%
9.6%
12.6%
7.1%
5.5%
12.6%
44
55
99
% within a3
44.4%
55.6%
100.0%
% within pp_q58
17.6%
15.9%
16.6%
7.4%
9.2%
16.6%
250
345
595
42.0%
58.0%
100.0%
100.0%
100.0%
100.0%
42.0%
58.0%
100.0%
Count
% of Total
3
Count
% of Total
4
Count
% of Total
Total
Total
2
Count
% within a3
% within pp_q58
% of Total
Goals: 1- Increase fruits and vegetables intake; 2- Decrease sweet drinks intake
3- Decrease packaged snacks intake; 4- Decrease fast food intake
Weight control behaviors: 1- Yes; 2- No
209
Table 35
Food- Related Behavior Goals and Availability of Packaged Snacks at Home Crosstab
Availability of packaged snacks at home (pp_q14)
1
Goals
1
03)
139
76
42
296
% within a3
13.2%
47.0%
25.7%
14.2%
100.0%
% within pp_q14
48.1%
50.4%
49.4%
44.2%
48.8%
6.4%
22.9%
12.5%
6.9%
48.8%
23
60
33
18
134
% within a3
17.2%
44.8%
24.6%
13.4%
100.0%
% within pp_q14
28.4%
21.7%
21.4%
18.9%
22.1%
3.8%
9.9%
5.4%
3.0%
22.1%
8
39
15
13
75
10.7%
52.0%
20.0%
17.3%
100.0%
% within pp_q14
9.9%
14.1%
9.7%
13.7%
12.4%
% of Total
1.3%
6.4%
2.5%
2.1%
12.4%
11
38
30
22
101
% within a3
10.9%
37.6%
29.7%
21.8%
100.0%
% within pp_q14
13.6%
13.8%
19.5%
23.2%
16.7%
1.8%
6.3%
5.0%
3.6%
16.7%
81
276
154
95
606
13.4%
45.5%
25.4%
15.7%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
13.4%
45.5%
25.4%
15.7%
100.0%
Count
% of Total
3
Count
% within a3
4
Count
% of Total
Total
Total
4
3
39
Count
% of Total
2
2
Count
% within a3
% within pp_q14
% of Total
Goals: 1- Increase fruits and vegetables intake
2- Decrease sweet drinks intake
3- Decrease packaged snacks intake
4- Decrease fast food intake
Availability of packaged snacks at home: 1- All of the time; 2- Most of the time;
3- Some of the time; 4- Hardly or not at all
210
Table 36
Food- Related Behavior Goals and Availability of Sweet Drinks at Home Crosstab
Availability of sweet drinks at home (pp_q28)
1
1
Goals
Count
2
3
Total
4
34
106
76
76
292
% within a3
11.6%
36.3%
26.0%
26.0%
100.0%
% within pp_q28
46.6%
53.5%
45.8%
46.3%
48.6%
5.7%
17.6%
12.6%
12.6%
48.6%
24
30
40
39
133
% within a3
18.0%
22.6%
30.1%
29.3%
100.0%
% within pp_q28
32.9%
15.2%
24.1%
23.8%
22.1%
4.0%
5.0%
6.7%
6.5%
22.1%
5
30
24
16
75
% within a3
6.7%
40.0%
32.0%
21.3%
100.0%
% within pp_q28
6.8%
15.2%
14.5%
9.8%
12.5%
.8%
5.0%
4.0%
2.7%
12.5%
10
32
26
33
101
9.9%
31.7%
25.7%
32.7%
100.0%
13.7%
16.2%
15.7%
20.1%
16.8%
1.7%
5.3%
4.3%
5.5%
16.8%
73
198
166
164
601
12.1%
32.9%
27.6%
27.3%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
12.1%
32.9%
27.6%
27.3%
100.0%
(a3)
% of Total
2
Count
% of Total
3
Count
% of Total
4
Count
% within a3
% within pp_q28
% of Total
Total
Count
% within a3
% within pp_q28
% of Total
Goals: 1- Increase fruits and vegetables intake
2- Decrease sweet drinks intake
3- Decrease packaged snacks intake
4- Decrease fast food intake
Availability of sweet drinks at home: 1- All of the time; 2- Most of the time; 3- Some of
the time; 4- Hardly or not at all
211
Table 37
Perceived Amount of Behavior Change in Increasing F. V. consumption and Gender
Crosstab
Gender
1
1
Total
2
56
40
96
% within b31
58.3%
41.7%
100.0%
% within Gender
20.4%
13.7%
16.9%
9.9%
7.0%
16.9%
77
90
167
% within b31
46.1%
53.9%
100.0%
% within Gender
28.0%
30.7%
29.4%
% of Total
13.6%
15.8%
29.4%
78
95
173
% within b31
45.1%
54.9%
100.0%
% within Gender
28.4%
32.4%
30.5%
% of Total
13.7%
16.7%
30.5%
64
68
132
% within b31
48.5%
51.5%
100.0%
% within Gender
23.3%
23.2%
23.2%
% of Total
11.3%
12.0%
23.2%
275
293
568
48.4%
51.6%
100.0%
100.0%
100.0%
100.0%
48.4%
51.6%
100.0%
Count
Inc.
F.V.
% of Total
intake
(b31)
2
3
4
Total
Count
Count
Count
Count
% within b31
% within Gender
% of Total
Amount of change: 1- Did not change at al 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Gender: 1- Boys; 2- Girls
212
Table 31
Perceived Amount of Change in Increasing F. V. Consumption and Race crosstab
Race
1
1
In
Total
6
5
3
26
2
51
17
96
% within b31
27.1%
2.1%
53.1%
17.7%
100.0%
% within Race
17.2%
5.9%
17.6%
18.3%
16.9%
4.6%
.4%
9.0%
3.0%
16.9%
40
11
87
29
167
% within b31
24.0%
6.6%
52.1%
17.4%
100.0%
% within Race
26.5%
32.4%
30.0%
31.2%
29.4%
7.0%
1.9%
15.3%
5.1%
29.4%
47
8
91
27
173
% within b31
27.2%
4.6%
52.6%
15.6%
100.0%
% within Race
31.1%
23.5%
31.4%
29.0%
30.5%
8.3%
1.4%
16.0%
4.8%
30.5%
38
13
61
20
132
% within b31
28.8%
9.8%
46.2%
15.2%
100.0%
% within Race
25.2%
38.2%
21.0%
21.5%
23.2%
6.7%
2.3%
10.7%
3.5%
23.2%
151
34
290
93
568
26.6%
6.0%
51.1%
16.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
26.6%
6.0%
51.1%
16.4%
100.0%
Count
F.V.
intake
% of Total
(b31)
2
Count
% of Total
3
Count
% of Total
4
Count
% of Total
Total
Count
% within b31
% within Race
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Race: 1-AfricanAmerican,3- Hispanic, 5- White, 6- Multiracial/Others
213
Table 32
Perceived Amount of Change in Increasing F. V Consumption and Activities at School
Crosstab
Hours of activities at school (b1)
1
1
Inc.
2
4
3
Total
5
33
13
6
14
29
95
% within b31
34.7%
13.7%
6.3%
14.7%
30.5%
100.0%
% within b1
20.9%
13.7%
12.5%
12.3%
21.0%
17.2%
% of Total
6.0%
2.4%
1.1%
2.5%
5.2%
17.2%
47
26
14
38
34
159
% within b31
29.6%
16.4%
8.8%
23.9%
21.4%
100.0%
% within b1
29.7%
27.4%
29.2%
33.3%
24.6%
28.8%
% of Total
8.5%
4.7%
2.5%
6.9%
6.1%
28.8%
45
30
14
39
40
168
% within b31
26.8%
17.9%
8.3%
23.2%
23.8%
100.0%
% within b1
28.5%
31.6%
29.2%
34.2%
29.0%
30.4%
% of Total
8.1%
5.4%
2.5%
7.1%
7.2%
30.4%
33
26
14
23
35
131
% within b31
25.2%
19.8%
10.7%
17.6%
26.7%
100.0%
% within b1
20.9%
27.4%
29.2%
20.2%
25.4%
23.7%
% of Total
6.0%
4.7%
2.5%
4.2%
6.3%
23.7%
158
95
48
114
138
553
% within b31
28.6%
17.2%
8.7%
20.6%
25.0%
100.0%
% within b1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
% of Total
28.6%
17.2%
8.7%
20.6%
25.0%
100.0%
Count
F.V.
intake
(b31)
2
3
4
Total
Count
Count
Count
Count
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activitiesafterschool(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4 to
214
Table
32
Perceived Amount of Change in Increasing F. V. Consumption and Activities after School
Crosstab
Hours of activities after school (d1)
1
1
Count
2
3
4
Total
5
23
22
7
8
31
91
% within b31
25.3%
24.2%
7.7%
8.8%
34.1%
100.0%
% within d1
18.7%
16.9%
9.1%
12.7%
21.5%
16.9%
% of Total
4.3%
4.1%
1.3%
1.5%
5.8%
16.9%
43
40
21
14
36
154
% within b31
27.9%
26.0%
13.6%
9.1%
23.4%
100.0%
% within d1
35.0%
30.8%
27.3%
22.2%
25.0%
28.7%
8.0%
7.4%
3.9%
2.6%
6.7%
28.7%
35
42
22
27
37
163
% within b31
21.5%
25.8%
13.5%
16.6%
22.7%
100.0%
% within d1
28.5%
32.3%
28.6%
42.9%
25.7%
30.4%
6.5%
7.8%
4.1%
5.0%
6.9%
30.4%
22
26
27
14
40
129
% within b31
17.1%
20.2%
20.9%
10.9%
31.0%
100.0%
% within d1
17.9%
20.0%
35.1%
22.2%
27.8%
24.0%
4.1%
4.8%
5.0%
2.6%
7.4%
24.0%
123
130
77
63
144
537
% within b31
22.9%
24.2%
14.3%
11.7%
26.8%
100.0%
% within d1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
22.9%
24.2%
14.3%
11.7%
26.8%
100.0%
Inc.
F.V.
intake
(b31)
2
Count
% of Total
3
Count
% of Total
4
Count
% of Total
Total
Count
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activities after school(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4
215
Table 41
Perceived Amount of Change in Increasing F. V. Consumption and Weight Control
Behaviors Crosstab
Weight control
behaviors (pp_q58)
1
1
Total
2
37
50
87
% within b31
42.5%
57.5%
100.0%
% within pp_q58
17.3%
16.3%
16.7%
7.1%
9.6%
16.7%
43
109
152
% within b31
28.3%
71.7%
100.0%
% within pp_q58
20.1%
35.5%
29.2%
8.3%
20.9%
29.2%
79
82
161
% within b31
49.1%
50.9%
100.0%
% within pp_q58
36.9%
26.7%
30.9%
% of Total
15.2%
15.7%
30.9%
55
66
121
% within b31
45.5%
54.5%
100.0%
% within pp_q58
25.7%
21.5%
23.2%
% of Total
10.6%
12.7%
23.2%
214
307
521
41.1%
58.9%
100.0%
100.0%
100.0%
100.0%
41.1%
58.9%
100.0%
Count
Inc.
F.V.
% of Total
intake
(b31)
2
Count
% of Total
3
4
Total
Count
Count
Count
% within b31
% within pp_q58
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Weight control behaviors: 1- Yes; 2- No
216
Table 54
Perceived Amount of Change in Decreasing Sweet Drink Consumption and Gender
Crosstab
Gender
1
1
Dec.
sweet
drinks
2
Total
2
88
58
146
% within b32
60.3%
39.7%
100.0%
% within Gender
30,6%
19.5%
24.9%
% of Total
15.0%
9.9%
24.9%
104
120
224
% within b32
46.4%
53.6%
100.0%
% within Gender
36.1%
40.3%
38.2%
% of Total
17.7%
20.5%
38.2%
59
62
121
% within b32
48.8%
51.2%
100.0%
% within Gender
20.5%
20.8%
20.6%
% of Total
10.1%
10.6%
20.6%
37
58
95
% within b32
38.9%
61.1%
100.0%
% within Gender
12.8%
19.5%
16.2%
6.3%
9.9%
16.2%
288
298
586
49.1%
50.9%
100.0%
100.0%
100.0%
100.0%
49.1%
50.9%
100.0%
Count
Count
intake
(b32)
3
4
Count
Count
% of Total
Total
Count
% within b32
% within Gender
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Gender: 1 - boys; 2- girls
217
Table 31
Perceived Amount of Change in Decreasing Sweet Drink Intake and Race Crosstab
Race
1
1
Dec.
Count
41
7
83
15
% within b32
28.1%
4.8%
56.8%
10.3%
% within Race
25.2%
20.6%
28.3%
15.6%
7.0%
1.2%
14.2%
2.6%
76
15
95
38
% within b32
33.9%
6.7%
42.4%
17.0%
% within Race
46.6%
44.1%
32.4%
39.6%
% of Total
13.0%
2.6%
16.2%
6.5%
23
5
64
29
% within b32
19.0%
4.1%
52.9%
24.0%
% within Race
14.1%
14.7%
21.8%
30.2%
3.9%
.9%
10.9%
4.9%
23
7
51
14
% within b32
24.2%
7.4%
53.7%
14.7%
% within Race
14.1%
20.6%
17.4%
14.6%
3.9%
1.2%
8.7%
2.4%
163
34
293
96
27.8%
5.8%
50.0%
16.4%
100.0%
100.0%
100.0%
100.0%
27.8%
5.8%
50.0%
16.4%
sweet
drinks
% of Total
intake
(b32)
2
Count
Count
% of Total
Count
% of Total
Total
Count
% within b32
% within Race
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Race: 1-AfricanAmerican,3- Hispanic, 5- White, 6- Multiracial/Others
218
Table
32
Perceived Amount of Change in Decreasing Sweet Drinks Consumption and Activities at
School Crosstab
Hours of activities at school (b1)
1
1
Dec.
Count
2
3
4
Total
5
38
27
7
39
29
140
% within b32
27.1%
19.3%
5.0%
27.9%
20.7%
100.0%
% within b1
23.9%
27.3%
15.6%
33.6%
19.5%
24.6%
6.7%
4.8%
1.2%
6.9%
5.1%
24.6%
76
38
20
32
54
220
% within b32
34.5%
17.3%
9.1%
14.5%
24.5%
100.0%
% within b1
47.8%
38.4%
44.4%
27.6%
36.2%
38.7%
% of Total
13.4%
6.7%
3.5%
5.6%
9.5%
38.7%
27
16
10
23
40
116
% within b32
23.3%
13.8%
8.6%
19.8%
34.5%
100.0%
% within b1
17.0%
16.2%
22.2%
19.8%
26.8%
20.4%
4.8%
2.8%
1.8%
4.0%
7.0%
20.4%
18
18
8
22
26
92
% within b32
19.6%
19.6%
8.7%
23.9%
28.3%
100.0%
% within b1
11.3%
18.2%
17.8%
19.0%
17.4%
16.2%
3.2%
3.2%
1.4%
3.9%
4.6%
16.2%
159
99
45
116
149
568
% within b32
28.0%
17.4%
7.9%
20.4%
26.2%
100.0%
% within b1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
28.0%
17.4%
7.9%
20.4%
26.2%
100.0%
sweet
drinks
% of Total
intake
(b32)
2
3
Count
Count
% of Total
4
Count
% of Total
Total
Count
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activitiesafterschool(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4 to
219
Table
32
Perceived Amount of Change in Decreasing Sweet Drinks Consumption and Hours of
Activities after School Crosstab
Hours of activities after school (d1)
Total
1
Count
38
34
12
16
38
138
% within b32
27.5%
24.6%
8.7%
11.6%
27.5%
100.0%
% within d1
31.9%
24.6%
15.0%
24.2%
24.8%
24.8%
6.8%
6.1%
2.2%
2.9%
6.8%
24.8%
53
51
31
27
53
215
% within b32
24.7%
23.7%
14.4%
12.6%
24.7%
100.0%
% within d1
44.5%
37.0%
38.8%
40.9%
34.6%
38.7%
9.5%
9.2%
5.6%
4.9%
9.5%
38.7%
15
33
16
14
35
113
% within b32
13.3%
29.2%
14.2%
12.4%
31.0%
100.0%
% within d1
12.6%
23.9%
20.0%
21.2%
22.9%
20.3%
2.7%
5.9%
2.9%
2.5%
6.3%
20.3%
13
20
21
9
27
90
% within b32
14.4%
22.2%
23.3%
10.0%
30.0%
100.0%
% within d1
10.9%
14.5%
26.3%
13.6%
17.6%
16.2%
2.3%
3.6%
3.8%
1.6%
4.9%
16.2%
119
138
80
66
153
556
% within b32
21.4%
24.8%
14.4%
11.9%
27.5%
100.0%
% within d1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
21.4%
24.8%
14.4%
11.9%
27.5%
100.0%
Dec.
sweet
drinks
% of Total
intake
Count
(b32)
% of Total
Count
% of Total
Count
% of Total
Total
Count
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activities after school(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4
220
Table 41
Perceived Amount of Change in Decreasing Sweet Drinks Consumption and Weight
Control Behaviors Crosstab
Weight control
behaviors (pp_q58)
1
Dec.
1
sweet
Total
2
Count
47
89
136
% within b32
34.6%
65.4%
100.0%
% within pp_q58
21.1%
28.3%
25.3%
8.8%
16.6%
25.3%
83
117
200
% within b32
41.5%
58.5%
100.0%
% within pp_q58
37.2%
37.3%
37.2%
% of Total
15.5%
21.8%
37.2%
45
64
109
% within b32
41.3%
58.7%
100.0%
% within pp_q58
20.2%
20.4%
20.3%
8.4%
11.9%
20.3%
48
44
92
% within b32
52.2%
47.8%
100.0%
% within pp_q58
21.5%
14.0%
17.1%
8.9%
8.2%
17.1%
223
314
537
41.5%
58.5%
100.0%
100.0%
100.0%
100.0%
41.5%
58.5%
100.0%
drinks
intake
% of Total
(b32)
2
3
Count
Count
% of Total
4
Count
% of Total
Total
Count
% within b32
% within pp_q58
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Weight control behaviors: 1- Yes; 2- No
221
Table 47
Perceived Amount of Change in Decreasing Sweet Drinks Consumption and Availability
of Sweet Drinks at Home Crosstab
Availability of sweet drinks at home (pp_q28)
Total
1
20
37
33
49
139
% within b32
14.4%
26.6%
23.7%
35.3%
100.0%
% within pp_q28
32.3%
21.0%
22.1%
31.8%
25.7%
3.7%
6.8%
6.1%
9.1%
25.7%
17
73
62
49
201
8.5%
36.3%
30.8%
24.4%
100.0%
27.4%
41.5%
41.6%
31.8%
37.2%
3.1%
13.5%
11.5%
9.1%
37.2%
11
40
26
34
111
9.9%
36.0%
23.4%
30.6%
100.0%
17.7%
22.7%
17.4%
22.1%
20.5%
2.0%
7.4%
4.8%
6.3%
20.5%
14
26
28
22
90
% within b32
15.6%
28.9%
31.1%
24.4%
100.0%
% within pp_q28
22.6%
14.8%
18.8%
14.3%
16.6%
2.6%
4.8%
5.2%
4.1%
16.6%
62
176
149
154
541
11.5%
32.5%
27.5%
28.5%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
11.5%
32.5%
27.5%
28.5%
100.0%
Count
Dec.
sweet
drinks
intake
% of Total
(b32)
Count
% within b32
% within pp_q28
% of Total
Count
% within b32
% within pp_q28
% of Total
Count
% of Total
Total
Count
% within b32
% within pp_q28
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot;
Availability of sweet drinks at home: 1- All of the time; 2- Most of the time; 3- Some of
the time; 4- Hardly or not at all
222
Table 54
Perceived Amount of Change in Decreasing Packaged Snacks Consumption and Gender
Crosstab
Gender
1
1
Dec.
Total
2
81
67
148
% within b33
54.7%
45.3%
100.0%
% within Gender
28.6%
23.1%
25.8%
% of Total
14.1%
11.7%
25.8%
90
81
171
% within b33
52.6%
47.4%
100.0%
% within Gender
31.8%
27.9%
29.8%
% of Total
15.7%
14.1%
29.8%
65
62
127
% within b33
51.2%
48.8%
100.0%
% within Gender
23.0%
21.4%
22.2%
% of Total
11.3%
10.8%
22.2%
47
80
127
% within b33
37.0%
63.0%
100.0%
% within Gender
16.6%
27.6%
22.2%
8.2%
14.0%
22.2%
283
290
573
49.4%
50.6%
100.0%
100.0%
100.0%
100.0%
49.4%
50.6%
100.0%
Count
P.S.
intake
(b33)
2
3
4
Count
Count
Count
% of Total
Total
Count
% within b33
% within Gender
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Gender: 1 - boys; 2- girls
223
Table
31
Perceived Amount of Change in Decreasing Packaged Snacks Consumption and Race
Crosstab
Race
1
Count
Dec.
6
43
6
73
26
% within b33
29.1%
4.1%
49.3%
17.6%
% within Race
26.1%
18.2%
26.0%
27.7%
7.5%
1.0%
12.7%
4.5%
48
10
88
25
% within b33
28.1%
5.8%
51.5%
14.6%
% within Race
29.1%
30.3%
31.3%
26.6%
8.4%
1.7%
15.4%
4.4%
38
5
59
25
% within b33
29.9%
3.9%
46.5%
19.7%
% within Race
23.0%
15.2%
21.0%
26.6%
6.6%
.9%
10.3%
4.4%
36
12
61
18
% within b33
28.3%
9.4%
48.0%
14.2%
% within Race
21.8%
36.4%
21.7%
19.1%
6.3%
2.1%
10.6%
3.1%
165
33
281
94
28.8%
5.8%
49.0%
16.4%
100.0%
100.0%
100.0%
100.0%
28.8%
5.8%
49.0%
16.4%
P.S.
intake
(b33)
% of Total
Count
% of Total
Count
% of Total
Count
% of Total •
Total
Count
% within b33
% within Race
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Race: 1-AfricanAmerican,3- Hispanic, 5- White, 6- Multiracial/Others
224
Table
32
Perceived Amount of Change in Decreasing Packaged Snacks Consumption and
Activities at School crosstab
Activities at school (b1)
1
1
Dec.
Count
2
3
4
Total
5
35
22
8
38
41
144
% within b33
24.3%
15.3%
5.6%
26.4%
28.5%
100.0%
% within b1
22.2%
23.4%
16.7%
33.6%
28.3%
25.8%
6.3%
3.9%
1.4%
6.8%
7.3%
25.8%
50
26
20
30
37
163
% within b33
30.7%
16.0%
12.3%
18.4%
22.7%
100.0%
% within b1
31.6%
27.7%
41.7%
26.5%
25.5%
29.2%
% of Total
9.0%
4.7%
3.6%
5.4%
6.6%
29.2%
39
22
10
22
32
125
% within b33
31.2%
17.6%
8.0%
17.6%
25.6%
100.0%
% within b1
24.7%
23.4%
20.8%
19.5%
22.1%
22.4%
% of Total
7.0%
3.9%
1.8%
3.9%
5.7%
22.4%
34
24
10
23
35
126
% within b33
27.0%
19.0%
7.9%
18.3%
27.8%
100.0%
% within b1
21.5%
25.5%
20.8%
20.4%
24.1%
22.6%
% of Total
6.1%
4.3%
1.8%
4.1%
6.3%
22.6%
158
94
48
113
145
558
% within b33
28.3%
16.8%
8.6%
20.3%
26.0%
100.0%
% within b1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
28.3%
16.8%
8.6%
20.3%
26.0%
100.0%
P.S.
intake
% of Total
(b33)
2
3
4
Total
Count
Count
Count
Count
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activitiesafterschool(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4 to
225
Table
32
Perceived Amount of Change in Decreasing Packaged Snacks Consumption and
Activities after School Crosstab
Activities after school (d1)
1
1
Dec.
Count
2
4
3
Total
5
35
34
13
18
41
141
% within b33
24.8%
24.1%
9.2%
12.8%
29.1%
100.0%
% within d1
29.4%
24.8%
17.6%
27.7%
27.7%
26.0%
% of Total
6.4%
6.3%
2.4%
3.3%
7.6%
26.0%
38
40
19
24
39
160
% within b33
23.8%
25.0%
11.9%
15.0%
24.4%
100.0%
% within d1
31.9%
29.2%
25.7%
36.9%
26.4%
29.5%
7.0%
7.4%
3.5%
4.4%
7.2%
29.5%
27
30
22
9
32
120
% within b33
22.5%
25.0%
18.3%
7.5%
26.7%
100.0%
% within d1
22.7%
21.9%
29.7%
13.8%
21.6%
22.1%
5.0%
5.5%
4.1%
1.7%
5.9%
22.1%
19
33
20
14
36
122
% within b33
15.6%
27.0%
16.4%
11.5%
29.5%
100.0%
% within d1
16.0%
24.1%
27.0%
21.5%
24.3%
22.5%
3.5%
6.1%
3.7%
2.6%
6.6%
22.5%
119
137
74
65
148
543
% within b33
21.9%
25.2%
13.6%
12.0%
27.3%
100.0%
% within d1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
% of Total
21.9%
25.2%
13.6%
12.0%
27.3%
100.0%
P.S.
intake
(b33)
2
Count
% of Total
3
Count
% of Total
4
Count
% of Total
Total
Count
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activities after school(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4
226
Table
41
Perceived Amount of Change in Decreasing Packaged Snacks Consumption and Weight
Control Behaviors Crosstab
Weight control
behaviors (pp_q58)
1
1
Dec.
Total
2
44
97
141
% within b33
31.2%
68.8%
100.0%
% within pp_q58
20.4%
31.3%
26.8%
8.4%
18.4%
26.8%
51
101
152
% within b33
33.6%
66.4%
100.0%
% within pp_q58
23.6%
32.6%
28.9%
9.7%
19.2%
28.9%
52
61
113
% within b33
46.0%
54.0%
100.0%
% within pp_q58
24.1%
19.7%
21.5%
9.9%
11.6%
21.5%
69
51
120
% within b33
57.5%
42.5%
100.0%
% within pp_q58
31.9%
16.5%
22.8%
% of Total
13.1%
9.7%
22.8%
216
310
526
41.1%
58.9%
100.0%
100.0%
100.0%
100.0%
41.1%
58.9%
100.0%
Count
P.S.
intake
% of Total
(b33)
2
Count
% of Total
3
Count
% of Total
4
Total
Count
Count
% within b33
% within pp_q58
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Weight control behaviors: 1-Yes;2- No
227
Table 53
Perceived Amount of Change in Decreasing Packaged Snacks Consumption and
Availability of Packaged Snacks at Home Crosstab
Availability of packaged snacks at home (pp_q14)
Total
1
17
57
42
27
143
% within b33
11.9%
39.9%
29.4%
18.9%
100.0%
% within pp_q14
27.0%
22.8%
30.4%
32.1%
26.7%
3.2%
10.7%
7.9%
5.0%
26.7%
18
68
43
27
156
% within b33
11.5%
43.6%
27.6%
17.3%
100.0%
% within pp_q14
28.6%
27.2%
31.2%
32.1%
29.2%
3.4%
12.7%
8.0%
5.0%
29.2%
12
60
28
15
115
% within b33
10.4%
52.2%
24.3%
13.0%
100.0%
% within pp_q14
19.0%
24.0%
20.3%
17.9%
21.5%
2.2%
11.2%
5.2%
2.8%
21.5%
16
65
25
15
121
% within b33
13.2%
53.7%
20.7%
12.4%
100.0%
% within pp_q14
25.4%
26.0%
18.1%
17.9%
22.6%
3.0%
12.1%
4.7%
2.8%
22.6%
63
250
138
84
535
11.8%
46.7%
25.8%
15.7%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
11.8%
46.7%
25.8%
15.7%
100.0%
Count
Dec.
P.S.
intake
(b33)
% of Total
Count
% of Total
Count
% of Total
Count
% of Total
Total
Count
% within b33
% within pp_q14
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Availability of packaged snacks at home: 1- All of the time; 2- Most of the time; 3- Some
of the time; 4- Hardly or not at all
228
Table 54
Perceived Amount of Change in Decreasing Fast Food Consumption and Gender
Crosstab
Gender
1
Dec.
Count
Total
2
1
82
66
148
% within b34
55.4%
44.6%
100.0%
% within Gender
32.7%
25.8%
29.2%
% of Total
16.2%
13.0%
29.2%
63
55
118
% within b34
53.4%
46.6%
100.0%
% within Gender
25.1%
21.5%
23.3%
% of Total
12.4%
10.8%
23.3%
48
56
104
% within b34
46.2%
53.8%
100.0%
% within Gender
19.1%
21.9%
20.5%
9.5%
11.0%
20.5%
58
79
137
% within b34
42.3%
57.7%
100.0%
% within Gender
23.1%
30.9%
27.0%
% of Total
11.4%
15.6%
27.0%
251
256
507
49.5%
50.5%
100.0%
100.0%
100.0%
100.0%
49.5%
50.5%
100.0%
fast
food
intake
(b34)
2
3
Count
Count
% of Total
4
Total
Count
Count
% within b34
% within Gender
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Gender: 1 - boys; 2- girls
229
Table
31
Perceived Amount of Change in Decreasing Fast Food Consumption and Race Crosstab
Race
1
1
Dec.
3
5
Total
6
37
7
88
16
148
% within b34
25.0%
4.7%
59.5%
10.8%
100.0%
% within Race
26.1%
24.1%
34.8%
19.3%
29.2%
7.3%
1.4%
17.4%
3.2%
29.2%
35
6
56
21
118
% within b34
29.7%
5.1%
47.5%
17.8%
100.0%
% within Race
24.6%
20.7%
22.1%
25.3%
23.3%
6.9%
1.2%
11.0%
4.1%
23.3%
34
3
46
21
104
% within b34
32.7%
2.9%
44.2%
20.2%
100.0%
% within Race
23.9%
10.3%
18.2%
25.3%
20.5%
6.7%
.6%
9.1%
4.1%
20.5%
36
13
63
25
137
% within b34
26.3%
9.5%
46.0%
18.2%
100.0%
% within Race
25.4%
44.8%
24.9%
30.1%
27.0%
7.1%
2.6%
12.4%
4.9%
27.0%
142
29
253
83
507
28.0%
5.7%
49.9%
16.4%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
28.0%
5.7%
49.9%
16.4%
100.0%
Count
fast
food
% of Total
intake
(b34)
2
Count
% of Total
3
Count
% of Total
4
Count
% of Total
Total
Count
% within b34
% within Race
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Race: 1-AfricanAmerican,3- Hispanic, 5- White, 6- Multiracial/Others
230
Table 56
Perceived Amount of Change in Decreasing Fast Food Consumption and Activities at
School Crosstab
Activities at school (b1)
2
1
1
Dec.
4
3
Total
5
32
30
12
30
42
146
% within b34
21.9%
20.5%
8.2%
20.5%
28.8%
100.0%
% within b1
22.4%
36.1%
32.4%
30.0%
32.1%
29.6%
6.5%
6.1%
2.4%
6.1%
8.5%
29.6%
38
21
10
22
24
115
% within b34
33.0%
18.3%
8.7%
19.1%
20.9%
100.0%
% within b1
26.6%
25.3%
27.0%
22.0%
18.3%
23.3%
7.7%
4.3%
2.0%
4.5%
4.9%
23.3%
30
11
4
20
33
98
% within b34
30.6%
11.2%
4.1%
20.4%
33.7%
100.0%
% within b1
21.0%
13.3%
10.8%
20.0%
25.2%
19.8%
6.1%
2.2%
.8%
4.0%
6.7%
19.8%
43
21
11
28
32
135
% within b34
31.9%
15.6%
8.1%
20.7%
23.7%
100.0%
% within b1
30.1%
25.3%
29.7%
28.0%
24.4%
27.3%
8.7%
4.3%
2.2%
5.7%
6.5%
27.3%
143
83
37
100
131
494
% within b34
28.9%
16.8%
7.5%
20.2%
26.5%
100.0%
% within b1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
28.9%
16.8%
7.5%
20.2%
26.5%
100.0%
Count
fast
food
% of Total
intake
(b34)
2
Count
% of Total
3
Count
% of Total
4
Count
% of Total
Total
Count
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activities at school: 1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours; 4- 4 to
5 hours; 5- More than 5 hours
231
Table
32
Perceived Amount of Change in Decreasing Fast Food Consumption and Activities after
School Crosstab
Activities after school (d1)
1
1
Dec.
Count
2
4
3
Total
5
27
36
19
12
46
140
% within b34
19.3%
25.7%
13.6%
8.6%
32.9%
100.0%
% within d1
25.2%
29.8%
28.4%
19.7%
35.9%
28.9%
% of Total
5.6%
7.4%
3.9%
2.5%
9.5%
28.9%
29
25
13
16
29
112
% within b34
25.9%
22.3%
11.6%
14.3%
25.9%
100.0%
% within d1
27.1%
20.7%
19.4%
26.2%
22.7%
23.1%
6.0%
5.2%
2.7%
3.3%
6.0%
23.1%
25
24
13
17
22
101
% within b34
24.8%
23.8%
12.9%
16.8%
21.8%
100.0%
% within d1
23.4%
19.8%
19.4%
27.9%
17.2%
20.9%
5.2%
5.0%
2.7%
3.5%
4.5%
20.9%
26
36
22
16
31
131
% within b34
19.8%
27.5%
16.8%
12.2%
23.7%
100.0%
% within d1
24.3%
29.8%
32.8%
26.2%
24.2%
27.1%
% of Total
5.4%
7.4%
4.5%
3.3%
6.4%
27.1%
107
121
67
61
128
484
% within b34
22.1%
25.0%
13.8%
12.6%
26.4%
100.0%
% within d1
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
% of Total
22.1%
25.0%
13.8%
12.6%
26.4%
100.0%
fast
food
intake
(b34)
2
Count
% of Total
3
Count
% of Total
4
Total
Count
Count
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Hours of activities after school(dl):1- Less than 2 hours, 2- 2 to 3 hours; 3- 3 to 4 hours;
4-
4
232
Table
41
Perceived Amount of Change in Decreasing Fast Food Consumption and Weight Control
Behaviors Crosstab
Weight control
behaviors (pp_q58)
1
Dec.
1
fast
Total
2
Count
53
87
140
% within b34
37.9%
62.1%
100.0%
% within pp_q58
27.3%
32.2%
30.2%
% of Total
11.4%
18.8%
30.2%
39
67
106
% within b34
36.8%
63.2%
100.0%
% within pp_q58
20.1%
24.8%
22.8%
8.4%
14.4%
22.8%
36
56
92
% within b34
39.1%
60.9%
100.0%
% within pp_q58
18.6%
20.7%
19.8%
7.8%
12.1%
19.8%
66
60
126
% within b34
52.4%
47.6%
100.0%
% within pp_q58
34.0%
22.2%
27.2%
% of Total
14.2%
12.9%
27.2%
194
270
464
41.8%
58.2%
100.0%
100.0%
100.0%
100.0%
41.8%
58.2%
100.0%
food
intake
(b34)
2
Count
% of Total
3
Count
% of Total
4
Total
Count
Count
% within b34
% within pp_q58
% of Total
Amount of change: 1- Did not change at all; 2- Changed a little; 3- Changed a medium
amount; 4- Changed a lot
Weight control behaviors: 1- Yes; 2- No
Packaged processed snacks
Sweetened beverages: with snacks
and in between
Sweetened beverages: meals
Water: with snacks and in
between
Water: meals
Vegetables: snacks
Vegetables: meals
Fruit: snacks
Fruit: meals
Food Choices
Scale
3.78 (2.8)
1.98(1.1)
3.25 (2.5)
Pieces per day" (0-4)
Days previous week (0-7)
Size per snack (1-3)
0
Days previous week (0-7)
(0-1)
Size per beverage
b
Days previous week (0-7)
(<M)
1.52 (.5)
2.98 (2.0)
1.57(1.0)
3.17(2.4)
1.63 (.6)
3.60(2.0)
1.84(1.1)
3.99 (2.4)
3.29
8.11
6.78
11.45
18.91
<.001
14.84
3.79 (2.2)
2.85 (2.1)
Days previous week (0-7)
1.75 (1.0)
.880
.02
1.88(1.2)
1.82(1.3)
8-oz glasses (0-4)
1.37 (.9)
.120
2.42
4.02 (2.6)
3.75 (2.5)
Days previous week (0-7)
Size per beverageb
.299
1.08
1.97(1.2)
1.97(1.1)
8-oz glasses (0-4)
.07
.005
.009
.001
<.001
.830
.05
.179
1.8
4.26 (2.4)
.722
.13
.819
4.21 (2.3)
Days previous week (0-7)
.05
.277
Days previous week (0-7)
1.70(2.4)
1.77(2.4)
Cups per day (0M)
1.18
1.01 (1.3)
1.40(1.1)
1.37(1.0)
3
.019
.040
.909
.235
Ph
1.12(1.3)
2.49(2.1)
2.59(2.1)
Days previous week (0-7)
5.55
4.22
.01
1.41
Fh
Cups per day" (0-1)
2.34(1.5)
1.99(1.4)
Pieces per day (CM)
a
2.06(1.2)
3.61 (2.2)
3.51 (2.4)
Control
(n=437)
Days previous week (0-7)
Intervention
(n=460)
Adjusted Post Mean (SD)
Impact of Choice, Control & Change (C3) on Behavioral Outcomes
Appendix I
to
*
1.87(1.5)
4.85 (1.8)
Flights (0-4)
Days previous week (0-7)
5.51 (1.7)
1.53(1.5)
2.28 (2.6)
2.56 (2.6)
1.45 (.9)
2.79(2.1)
1.42 (.9)
1.32 (.9)
2.03 (.8)
1.76(1.8)
21.97
11.97
18.51
4.07
5.35
15.81
.11
6.07
9.65
.00
<.001
.001
<.001
.044
.021
<.001
.745
.014
.002
.973
a=pieces or cups: 0=0, 1=1/2, 2=1, 3=2, 4=>2
b=beverage sizes: 0=0, l=<12oz, 2=12oz can, 3=20oz bottle, 4=>20oz
c=snack sizes: l=smaller than 3/5X5inch index card, 2=about same size as index card, 3=larger than index card
d=fast food item size: l=small, 2=medium, 3=large, 4=extra-large
e=how often make this choice: 0=never, l=rarely, 2=sometimes, 3=always
f=walking speed: 0=don't do this, l=slow, 2=medium, 3=fast
g=flights: 0=0, 1=1,2=2-3, 3=4-5, 4=6+
h=Results based on Analysis of Covariance (ANCOVA) with group (control/intervention) as a fixed factor and pre-test scores as covariate
Leisure screen time
2.98 (2.7)
Days previous week (0-7)
Purposely taking stairs for
exercise
8
2.92 (2.6)
1.62 (.8)
3.34(2.1)
1.46 (.9)
1.13 (.8)
Days previous week (0-7)
Speed (0-3)
f
Days previous week (0-7)
(1-4)
Healthier option
6
Value/combo meal (1^4)
1.84 (.7)
1.66(1.7)
Walking for exercise
Purposely walking instead of
public transportation
Physical Activity
Fast food restaurants
e
Usual item size (1^1)
d
Days previous week (0-7)
u>
Scale
(1-5)'
Barriers
Perceived
(1-5) c
Outcome
Expectations
Intention to
Change (1-5) b
(score range)"
3.89 (.70)
3.29 (.80)
4.05 (.70)
3.38 (.87)
Walking
Eating healthfully
3.58 (1.05)
3.79 (.72)
3.96 (.69)
Eating lots of fruit and vegetables
3.80(1.0)
3.76 (.76)
3.92 (.68)
Drinking plenty of water
Being physically active
3.42 (.63)
3.67 (.66)
3.48 (.67)
Eating lots of packaged snacks
3.69 (.68)
Eating frequently at fast food restaurants
3.65 (1.26)
3.91 (1.20)
Walk more
3.26 (.61)
3.61 (1.26)
3.82(1.13)
Do more physical activity
3.49 (.65)
3.37 (1.32)
3.56(1.24)
Eat more fruit and vegetables
Drinking lots of s sweetened beverages
3.76(1.30)
4.0(1.20)
2.76(1.23)
2.75 (1.29)
Drink more water
3.07(1.27)
Eat less frequently at fast food restaurants
2.70(1.26)
3.03 (1.23)
2.97(1.24)
Drinking less soda and other sweetened
beverages
3.23 (.84)
Control
(n=417)
Eat fewer packaged snacks
3.48 (.84)
Total for the C3 obesity risk reducing behaviors
Intervention
(n=445)
Adjusted Post
Mean (SD)
Fe
e
4.23
0.87
12.15
12.68
11.42
0.040
0.351
0.001
<0.001
0.001
<0.001
<0.001
19.04
23.96
<0.001
0.014
0.012
0.027
0.048
0.002
0.001
0.002
<0.001
P
27.96
6.08
6.36
4.88
3.93
9.36
11.48
9.49
18.48
Impact of Choice, Control & Change (C3) on Potential Theory Mediators of Behavior Change
Appendix J
2.66 (.92)
2.60 (.81)
2.75 (.75)
2.75 (.81)
2.72 (.88)
2.89 (.77)
2.95 (.74)
2.95 (.80)
Eating fruit and vegetables
Walking and taking stairs
Eating
8.03
7.99
2.95 (.82)
2.95 (.88)
2.94 (.82)
3.12 (.72)
3.13 (.77)
3.13 (.74)
Physical activities
Competence
Autonomy
8.63
2.75 (.76)
.005
.005
.003
.001
.001
10.75
12.38
<.001
<.001
.205
.038
.031
.023
<.001
13.56
17.60
1.61
4.34
4.68
5.19
2.95 (.76)
Autonomy
Competence
2.82 (.92)
2.96 (.83)
2.59 (.85)
2.74 (.85)
Eating fewer packaged snacks
Drinking lots of water
2.56 (.79)
2.71 (.78)
Eating less at the fast food restaurants
12.91
Higher scores indicate more desirable beliefs
Intention to change: 1 = won't do it within next 6 months, 2 = will try within the next 6 months, 3 = plan to do it in a month or so, 4 = currently doing it for past 1-6 months, 5 = have been
doing it for over past 6 months
c.
5-point response options: 1 = strongly disagree, 2 = disagree, 3 = uncertain, 4 = agree, 5 = strongly agree
d.
4-pont response options: 1 = not sure, 2 = a little sure, 3 = somewhat sure, 4 = very sure
Results based on Analysis of Covariance (ANCOVA) with group (control/intervention) as a fixed
a.
b.
(1-4) d
Personal agency /
Autonomous
motivation
(1-4)
d
Self-Efficacy
2.51 (.77)
2.72 (.72)
Drinking less sweetened beverages
OJ
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