Health equity in action: using community-engaged research to update an intervention promoting a healthy home food environment to Black/African American families.

PURPOSE: Describe the method for conducting community-engaged research to identify needed changes for an existing evidence-based intervention, and prepare it for implementation in a community setting within the Dan L Duncan Comprehensive Cancer Center catchment area in an effort to achieve more equitable outcomes in diet-related disease risk factors. METHODS: The intervention, Family Eats, was developed over 10 years ago. It works directly with parents of Black/African American 9-12 year old children to create a healthy home food environment to support prevention of obesity and related cancers. Data collection with community stakeholders occurred through a series of  Community Advisory Board (CAB) meetings guided by the Delphi Technique, an iterative approach for gaining group consensus on a topic. RESULTS: Key information on needed changes and potential implementation strategies were identified. Perceived level of engagement among CAB members was high overall and in terms of both quantity and quality. CONCLUSION: The Delphi Technique shows promise as a method for conducting community-engaged research that promotes engagement and identifies key information needed to adapt and implement an existing intervention in a community setting.

Promoting Health Equity: Identifying Parent and Child Reactions to a Culturally-Grounded Obesity Prevention Program Specifically Designed for Black Girls Using Community-Engaged Research.

The Butterfly Girls (BFG) Study is a culturally and developmentally appropriate online obesity prevention program for 8-10-year-old Black girls designed with key stakeholders in the Black community. This multi-methods investigation, conducted with parent-child dyads who participated in an outcome evaluation of the intervention, aimed to understand parent and child reactions to the program. We were particularly interested in understanding perceptions regarding its cultural and developmental appropriateness, relevance and acceptability. Program participation and survey data (demographics, parent and child write-in comments on process evaluation surveys) were analyzed. Participation data demonstrated high adherence in treatment and comparison groups. Descriptive statistics were calculated for survey data and highlighted the socioeconomic diversity of the sample. Post intervention surveys included two fill-in-the-blank questions for parents (n = 184 for question 1, n = 65 for question 2) and one for children (n = 32). Comments were analyzed using structured thematic analysis. The majority of the feedback from child participants was complimentary and many found the program relatable. Among the parent responses, the majority found the program to be beneficial in its educational nature and in promoting behavior change. This multi-methods analysis suggests that the BFG program was perceived as beneficial by parents while being culturally and developmentally appropriate and engaging for young Black girls, highlighting the importance of co-collaboration in program development.

How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic?

BACKGROUND: eHealth interventions using active video games (AVGs) offer an alternative method to help children exercise, especially during a pandemic where options are limited. There is limited data on costs associated with developing and implementing such interventions. OBJECTIVES: We quantified the costs of delivering an eHealth RCT intervention among minority children during COVID-19. METHODS: We categorized the total trial cost into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs. RESULTS: The total RCT cost was $1,927,807 (Direct: $1,227,903; Indirect: $699,904) with three visits required for each participant. The average cost per participant completing the RCT (79 participants/237 visits) was $24,403 (Direct: $15,543; Indirect: $8860). Due to no-shows and cancellations (198 visits) and dropouts before study completion (61 visits; 56 participants), 496 visits had to be scheduled to ensure complete data collection on 79 participants. If all 496 visits were from participants completing the three-visit protocol, that would correspond to 165 participants, bringing the average cost per participant down to $11,684 (Direct: $7442; Indirect: $4242). Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted <1% of the entire budget, the indirect effects were much larger and significantly impacted the trial. CONCLUSION: RCTs typically involve significant resources, even more so during a pandemic. Future eHealth intervention investigators should budget and plan accordingly to prepare for unexpected costs such as recruitment challenges to increase flexibility while maximizing the intervention efficacy.

Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review.

BACKGROUND: Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions. OBJECTIVE: The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths. METHODS: A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers. RESULTS: Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health. CONCLUSIONS: To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents. TRIAL REGISTRATION: CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442.

Food Assistance Use Among Food Bank Clients Affected by Type 2 Diabetes.

OBJECTIVE: To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM). DESIGN: Semi-structured in-depth interviews conducted with food bank clients. SETTING: Arizona regional food bank. PARTICIPANTS: Twenty English- and Spanish-speaking food bank clients with T2DM or living with a person with T2DM, aged 45-83 years, majority female, Hispanic, and food insecure. PHENOMENON OF INTEREST: Food bank use and preferences, and how these related to T2DM management. ANALYSIS: A hybrid thematic analysis combining inductive and deductive reasoning. RESULTS: Three organizing themes emerged from the analysis. First, food assistance was influenced by food preferences and the ability to pair with existing household foods. Second, desired support included fresh fruits and vegetables, meat, oats, oil, and herbs; recipes; cooking demonstrations; and social support. Third, factors influencing T2DM management were lack of financial resources, low motivation, insufficient nutrition knowledge, low medication adherence, and multiple comorbidities. Participants also expressed resilience and interest in improving T2DM management. CONCLUSIONS AND IMPLICATIONS: Among a predominantly Hispanic food bank sample, produce and protein-rich foods, nutrition and culinary education, and social support were components of a supportive food bank experience and should be considered when designing food-based interventions for T2DM management for food insecure persons.

The Impact of the COVID-19 Pandemic on Food Distribution at Emergency Food Assistance Organizations in the Southwestern United States: A Qualitative Investigation.

This study aimed to identify changes in food distribution operations at emergency food assistance organizations (EFAOs) during the COVID-19 pandemic. EFAOs across the Houston metro area, TX (human service centers and food pantries) as well as the Houston Food Bank (HFB) participated in the qualitative study. Data were collected via individual semi-structured interviews and focus group (December 2020-February 2021), and coded using semi-structured thematic analysis. Categories were pre-identified based on the interview questions. Direct quotes supported subcategories. Directors from 18 EFAOs were interviewed; 8 HFB leadership staff participated in a focus group. Four major categories of change due to COVID-19 included new safety measures, changes in food distribution process, changes in volunteerism and staffing, and changes in amounts of food distributed. This study helps identify susceptibilities in EFAOs' food distribution chain should be addressed to manage future emergency food insecurity crises more effectively. An understanding of the changes/challenges incurred by EFAOs during the COVID-19 pandemic can inform policymakers to ensure local food distribution organizations are prepared to fill the needs during future a crisis of food insecurity.

Cross-Site Process Evaluation Results for the Early Childhood Education Center Setting: CORD Study.

Background: The Childhood Obesity Research Demonstration project aimed to deliver evidence-based obesity prevention interventions to at-risk families at three demonstration sites. The interventions were delivered in multiple settings, including early childhood education centers (ECECs), public schools, and primary care clinics. An evaluation center conducted cross-site process, impact, and sustainability evaluations. Results of the cross-site process evaluation for the ECECs will be described. Methods: Reach (proportion of the target population who participated), dose delivered (materials and interventions that were distributed), and fidelity (proportion of planned intervention components delivered) were assessed at two levels (researcher-to-provider and provider-to-family levels). Standardized data forms were completed by research team members at each demonstration site with assistance from the evaluation center. Results: The Childhood Obesity Research Demonstration project reached 5174 children and 390 teachers in 58 ECECs. The centers delivered an average of 3.9 hours of training to teachers. A total of 1382 different types of materials were distributed to providers, and from 1.3 to 4.3 hours of technical support were delivered to centers monthly. For fidelity at the researcher-to-provider level, 49.5% (n = 370) of eligible teachers completed all training sessions. Considerable variations across demonstration sites in reach, dose delivered, and fidelity across were observed. Conclusion: The Childhood Obesity Research Demonstration project reached large numbers of children, families, teachers, and ECECs. Maintaining intervention fidelity while reaching large numbers of at-risk individuals proved to be a challenge.

Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis.

Objective: The aim of this study was to investigate which narrative elements of digital game narratives are preferred by the general adolescent population, and to examine associations with gender, socioeconomic status (SES), and gameplay frequency. Further, the study aims to discuss how results can be translated to serious digital games. Materials and Methods: Adolescents were recruited through school to complete a survey on narrative preferences in digital games. The survey included questions on sociodemographic information, frequency of gameplay, and an open-ended question on what could be an appealing narrative for them. Data were analyzed in a mixed-methods approach, using thematic analysis and chi-square analyses to determine narrative preferences and the associations between game narrative elements and player characteristics (gender, SES, and frequency of gameplay). Results: The sample consisted of 446 adolescents (12-15 years old) who described 30 narrative subthemes. Preferences included human characters as protagonists; nonhuman characters only as antagonists; realistic settings, such as public places or cities; and a strong conflict surrounding crime, catastrophe, or war. Girls more often than boys defined characters by their age, included avatars, located the narrative in private places, developed profession-related skills, and included a positive atmosphere. Adolescents of nonacademic education more often than adolescents of academic education defined characters by criminal actions. Infrequent players more often included human characters defined by their age than frequent players. After performing a Bonferroni correction, narrative preferences for several gender differences remained. Conclusion: Different narrative elements related to subgroups of adolescents by gender, SES, and frequency of gameplay. Customization of narratives in serious digital health games should be warranted for boys and girls; yet, further research is needed to specify how to address girls in particular.

Perceived Influences on Farmers' Market Use among Urban, WIC-enrolled Women.

OBJECTIVES: We identified perceived barriers and facilitators to purchasing fruits and vegetables (FV) at farmers' markets, FV shopping practices, and reactions to a planned online lesson to promote farmers' market use among urban, inner-city WIC-enrolled women. METHODS: Thirteen focus groups were conducted with 3-5 participants each (N = 54). RESULTS: Common barriers were structural (transportation issues) and informational (not knowing the locations of markets). Improving access (by increasing the number of area markets, expanding market hours and locations, and increasing transportation options to markets) and raising awareness of the importance of eating healthfully were common facilitators. Information was sought on the locations of farmers who accept FV vouchers provided by WIC, FV sold at farmers' markets, reasons to eat locally grown FV, and FV food safety and preparation skills. Questions were raised about the accessibility of an online lesson; providing information via inperson seminars and handouts also was recommended. Although purchasing FV at supermarkets and corner stores and bodegas was common, concerns were expressed about the freshness, cost, quality, and variety of produce sold at these venues. CONCLUSIONS: Findings aid understanding of factors to consider in designing interventions to promote farmers' market use in this population.

Incorporating Behavioral Techniques into a Serious Videogame for Children.

INTRODUCTION: Little is known about how to design serious videogames for children. The purpose of this article is to describe how behavior change techniques promoting self-regulation were incorporated into a serious videogame to help children consume more fruits and vegetables (FVs) and the extent to which these techniques were used by players. A secondary goal is to contribute to the body of scientific knowledge regarding how to design effective serious videogames for children. MATERIALS AND METHODS: This research examines the gameplay data from an effective 10-episode online serious videogame promoting FV consumption to preadolescent children in the United States (roughly 9-11-year-olds). RESULTS: Children participated in the self-regulation components. Modifications to reduce potential cognitive overload and inform future game design were identified. CONCLUSION: This research provided suggestive evidence that behavior change techniques promoting self-regulation can be successfully integrated into a serious videogame for children without detracting from game appeal. It also emphasizes the importance of formative research to the design of an appealing game where children understand and can successfully perform the behavior change procedures.

Physical Activity Behaviors and Influences Among Chinese-American Children Aged 9-13 Years: A Qualitative Study.

Low physical activity is a major health issue among Chinese Americans. This study explored Chinese-American children's physical activity behaviors and influencing factors. Twenty-five children of Chinese or Taiwanese descent were interviewed to understand their favorite sports or physical activities, physical activity environments, and influences on their physical activity. All were between the ages of 9 and 13. Interviews were transcribed and coded using thematic data analysis procedures. Major themes included: (1) team sports, particularly basketball, were commonly listed as favorite sports or activities; (2) physical activity occurred mostly at school or an after-school setting; and (3) family played a major role in physical activity. Some trends/differences were detected based on age, sex, and socioeconomic status. Interventions to promote physical activity among Chinese-American children should emphasize team sports and encourage physical activity in schools, but also explore ways to involves families outside of school.

Outcome Evaluation of Family Eats.

This article presents the results of a randomized clinical trial evaluating the eight-session Family Eats web-based intervention promoting healthy home food environments for African American families. African American families ( n = 126) with 8- to 12-year-old children completed online baseline questionnaires and were randomized into intervention or control groups. Data collection occurred at baseline, immediately postintervention (Post 1), and 4 months later (Post 2), for parents and children, separately. There were two group by time intervention effects: Control group parents reported a significantly greater frequency of drinking 100% fruit juice at Post 1 compared with intervention group parents. Parent menu planning skills were significantly higher at Post 2 for the intervention group compared with the control group. Significant positive changes overtime were noted for both groups for home fruit/vegetable availability, food preparation practices, and healthy restaurant selection. Intervention group children reported a significant increase in home juice availability at Post 1 compared with the control group; home fruit availability improved for both groups. There was no difference in log on rates by group: 84% and 86% for those who completed Post 1 and Post 2 measurements, respectively. Sixty-four participants completed the evaluation survey: 17 control (50%) and 47 intervention (51%) participants. All participants reported liking the program components; all but one gave it an A or B grade. An Internet-delivered nutrition intervention for families was successful in achieving change in some mediating variables, with good log on rates. Future research with Family Eats should include larger sample sizes, with longer follow-up and a more objective measure of diet.

Culture and Diet Among Chinese American Children Aged 9-13 Years: A Qualitative Study.

OBJECTIVE: To examine Chinese American children's behaviors, food preferences, and cultural influences on their diet. DESIGN: Qualitative individual interviews using constructs from the proposed model of dietary acculturation. SETTING: Community centers and Chinese schools in Houston, TX. PARTICIPANTS: Twenty-five Chinese American children aged 9-13 years. PHENOMENON OF INTEREST: Diet, favorite restaurants, and parents' cooking and grocery shopping habits. ANALYSIS: Content analysis and thematic data analysis to identify code categories and themes. Coders also identified patterns based on demographic and acculturation factors. RESULTS: Overall, participants described their diets and associated behaviors as Asian and non-Asian. Key themes included preference for Asian and non-Asian foods; consumption of non-Asian foods for breakfast and lunch, but Asian foods for dinner; infrequent dining at restaurants; grocery shopping at Asian and non-Asian stores; and familial influences on diet. Acculturated children and children of higher socioeconomic status appeared to prefer and consume a more Westernized/non-Asian diet. CONCLUSIONS AND IMPLICATIONS: Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.

Texting to Increase Adolescent Physical Activity: Feasibility Assessment.

OBJECTIVE: Feasibility trials assess whether a behavior change program warrants a definite trial evaluation. This paper reports the feasibility of an intervention consisting of Self Determination Theory-informed text messages, pedometers, and goal prompts to increase adolescent physical activity. METHODS: A 4-group randomized design with baseline and immediate post-study assessments was used. Groups (pedometer; pedometer + goal prompt; pedometer + goal prompt + theory-informed texts; no-treatment control) were systematically varied to assess the additive effect of intervention components on objectively measured physical activity (ie, ActiGraph). The primary outcome of the 12-week intervention was program feasibility. Changes in average daily step counts and minutes of moderate-to-vigorous physical activity also were examined. Post-intervention research with a subset of participants examined program reactions. RESULTS: Participants (N = 160) were evenly split by sex, mostly 14-15 years old, and of diverse race/ethnicity. Feasibility criteria were met. The attrition rate was less than 2%. Modest increases in average daily step counts and moderate-to-vigorous physical activity were observed in all groups except the control group. Participants reported positive reactions to the intervention. CONCLUSIONS: An intervention consisting of pedometers, theory-informed texts, and goal prompts, is a feasible and acceptable method for promoting physical activity to adolescents.

Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: a randomized controlled trial.

BACKGROUND: Child fruit and vegetable intake is below recommended levels, increasing risk for chronic disease. Interventions to influence fruit and vegetable intake among youth have had mixed effects. Innovative, theory-driven interventions are needed. Goal setting, enhanced by implementation intentions (i.e., plans tightly connected to a behavioral goal), may offer a solution. Action plans state "how" a goal will be achieved, while coping plans identify a potential barrier and corresponding solution. The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode, theoretically-grounded serious videogame promoting fruit and vegetables. This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children. METHODS: A four-group randomized design with three data collection periods (baseline, immediate post-intervention, 3 months post-intervention) was employed. Groups varied on whether children created an implementation intention (none, action, coping, both) as part of goal setting. Participants were 4th and 5th grade children (~9-11 years old) and one parent. An a priori power analysis indicated this would provide >80% power to detect a small effect (Cohen's d = 0.17). Children played a 10-episode online videogame; parents received 10 electronic newsletters and access to a parent-only website. The primary outcome was child fruit and vegetable intake, assessed via three, dietitian-assisted telephone recalls at each data collection period. The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure. Secondary analyses examined intervention effects on fruit and vegetables separately. RESULTS: Four hundred parent/child dyads were recruited. A significant group-by-time interaction for fruit and vegetable intake (p < 0.001) was found in only the Action group, which had significant increases in fruit and vegetable intake at post 1 (p < 0.0001) and post 2 (p < 0.0001). No other significant interactions were observed; however, there were significant time effects for fruit (p < 0.0001). CONCLUSIONS: Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children. Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children. TRIAL REGISTRATION: ClinicalTrials.gov NCT01004094 .

Childhood Obesity Research Demonstration project: cross-site evaluation methods.

INTRODUCTION: The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2-12 years of age. DESIGN/METHODS: The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model. CONCLUSIONS: The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model.

Predicting use of effective vegetable parenting practices with the Model of Goal Directed Behavior.

OBJECTIVE: To model effective vegetable parenting practices using the Model of Goal Directed Vegetable Parenting Practices construct scales. DESIGN: An Internet survey was conducted with parents of pre-school children to assess their agreement with effective vegetable parenting practices and Model of Goal Directed Vegetable Parenting Practices items. Block regression modelling was conducted using the composite score of effective vegetable parenting practices scales as the outcome variable and the Model of Goal Directed Vegetable Parenting Practices constructs as predictors in separate and sequential blocks: demographics, intention, desire (intrinsic motivation), perceived barriers, autonomy, relatedness, self-efficacy, habit, anticipated emotions, perceived behavioural control, attitudes and lastly norms. Backward deletion was employed at the end for any variable not significant at P<0·05. SETTING: Houston, TX, USA. SUBJECTS: Three hundred and seven parents (mostly mothers) of pre-school children. RESULTS: Significant predictors in the final model in order of relationship strength included habit of active child involvement in vegetable selection, habit of positive vegetable communications, respondent not liking vegetables, habit of keeping a positive vegetable environment and perceived behavioural control of having a positive influence on child's vegetable consumption. The final model's adjusted R 2 was 0·486. CONCLUSIONS: This was the first study to test scales from a behavioural model to predict effective vegetable parenting practices. Further research needs to assess these Model of Goal Directed Vegetable Parenting Practices scales for their (i) predictiveness of child consumption of vegetables in longitudinal samples and (ii) utility in guiding design of vegetable parenting practices interventions.

Psychometric assessment of scales for a Model of Goal Directed Vegetable Parenting Practices (MGDVPP).

BACKGROUND: Vegetable intake has been related to lower risk of chronic illnesses in the adult years. The habit of vegetable intake should be established early in life, but many parents of preschoolers report not being able to get their child to eat vegetables. The Model of Goal Directed Behavior (MGDB) has been employed to understand vegetable parenting practices (VPP) to encourage a preschool child's vegetable intake. The Model of Goal Directed Vegetable Parenting Practices (MGDVPP) provides possible determinants and may help explain why parents use effective or ineffective VPP. Scales to measure effective and ineffective vegetable parenting practices have previously been validated. This manuscript presents the psychometric characteristics and factor structures of new scales to measure the constructs in MGDVPP. METHODS: Participants were 307 parents of preschool (i.e. 3 to 5 year old) children, used for both exploratory (EFA) and confirmatory factor analyses (CFA). Data were collected via an internet survey. First, EFA were conducted using the scree plot criterion for factor extraction. Next, CFA assessed the fit of the exploratory derived factors. Then, classical test theory procedures were employed with all scales. Finally, Pearson correlations were calculated between each scale and composite effective and ineffective VPP as a test of scale predictive validity. RESULTS: Twenty-nine subscales (164 items) within 11 scales were extracted. The number of items per subscale ranged from 2 to 13, with three subscales having 10 or more items and 12 subscales having 4 items or less. Cronbach's alphas varied from 0.13 to 0.92, with 17 being 0.70 or higher. Most alphas <0.70 had only three or four items. Twenty-five of the 29 subscales significantly bivariately correlated with the composite effective or ineffective VPP scales. DISCUSSION: This was the initial examination of the factor structure and psychometric assessment of MGDVPP scales. Most of the scales displayed acceptable to desirable psychometric characteristics. Research is warranted to add items to those subscales with small numbers of items, test their validity and reliability, and characterize the model's influence on child vegetable consumption.

Physical activity problem-solving inventory for adolescents: development and initial validation.

Youth encounter physical activity barriers, often called problems. The purpose of problem solving is to generate solutions to overcome the barriers. Enhancing problem-solving ability may enable youth to be more physically active. Therefore, a method for reliably assessing physical activity problem-solving ability is needed. The purpose of this research was to report the development and initial validation of the physical activity problem-solving inventory for adolescents (PAPSIA). Qualitative and quantitative procedures were used. The social problem-solving inventory for adolescents guided the development of the PAPSIA scale. Youth (14- to 17-year-olds) were recruited using standard procedures, such as distributing flyers in the community and to organizations likely to be attended by adolescents. Cognitive interviews were conducted in person. Adolescents completed pen and paper versions of the questionnaire and/or scales assessing social desirability, self-reported physical activity, and physical activity self-efficacy. An expert panel review, cognitive interviews, and a pilot study (n = 129) established content validity. Construct, concurrent, and predictive validity were also established (n = 520 youth). PAPSIA is a promising measure for assessing youth physical activity problem-solving ability. Future research will assess its validity with objectively measured physical activity.