Association of the home environment with cardiovascular and metabolic biomarkers in youth.

OBJECTIVE: To examine the relationship between the home environment and biomarkers associated with the cardiovascular and metabolic risks in adolescents. METHODS: Three hundred fifty-eight adolescents (185 males and 173 females) living in the Twin Cities Metropolitan Area, Minnesota, between the ages of 10-17 years agreed to participate. Data were collected from August 2006 through March 2008. A fasting blood sample was drawn and assayed for insulin, glucose and lipids. Resting blood pressure, percent body fat (PBF) and body mass index were also measured. The home environment was assessed using a self-report of physical activity (PA) and media inventory (PAMI) completed by the parents. Density of PA and media equipment was calculated by summing the number of items present in the home and dividing by the total number of locations in the home. PA and screen media density were modeled as independent variables. RESULTS: Our results found that the density of PA equipment was negatively associated with insulin levels, low-density lipoprotein (LDL), total cholesterol, insulin resistance, and PBF. Media density was positively associated with insulin, LDL, total cholesterol, and PBF. CONCLUSIONS: The results of this study suggest that the home environment is associated with metabolic and cardiovascular health in adolescents.

Bringing "play" to life: the use of experiential marketing in the VERB campaign.

Given the abundance of advertising and media that children and adolescents are exposed to today, it is increasingly important to incorporate nontraditional channels and venues in strategies designed to reach them. One such channel that the CDC's VERB campaign employed was experiential marketing, which is defined here as a live event or experience that gives the target audience the opportunity to see a product and experience it for themselves. Experiential marketing and the tactics that the VERB campaign used to reach children aged 9-13 years (tweens) with health messages about physical activity are described, including a discussion about how other public health campaigns might use experiential marketing and other commercial marketing techniques to reach the public with public health messages.

Overview of formative, process, and outcome evaluation methods used in the VERB campaign.

Evaluation was an integral part of the VERB campaign. This paper describes the array of evaluation methods used to support the development, implementation, and assessment of campaign activities. The evaluation of VERB consisted of formative, process, and outcome evaluations and involved both qualitative and quantitative methods. Formative evaluation allowed staff to test ideas for messages and to gauge their appropriateness for the intended audiences. Process evaluation allowed staff to test and monitor the fidelity of the campaign's implementation to objectives and to make changes while the campaign was under way. Outcome evaluation allowed staff to determine the campaign's effects on the target audience. Because a comprehensive approach was used, which included formative and process evaluation, the VERB team's ability to interpret the results of the outcome evaluation was enhanced.

Testing a hierarchy-of-effects model: pathways from awareness to outcomes in the VERB campaign 2002-2003.

BACKGROUND: The McGuire hierarchy-of-effects (HOE) model, used extensively in mass-media interventions to describe the mechanisms for understanding effects, has not been tested in physical activity campaigns. DESIGN: Data collected at baseline (2002) and follow-up (2003) surveys in the VERB evaluation were used in structural equation modeling to test pathways and hierarchies of campaign effects. SETTING/PARTICIPANTS: Population-based cohort of youth aged 9-13 years (N=2364) for whom complete baseline and follow-up data were available. MAIN OUTCOME MEASURES: Awareness of the VERB campaign, understanding of the VERB message, attitude toward being active, outcome expectations, and physical activity participation. RESULTS: Among youth aged 9-13 years (tweens) in the study cohort, significant paths were identified between awareness and understanding (0.72, p<0.001) and between understanding and being physically active (0.11, p<0.05). At baseline there was a high prevalence of positive attitudes and outcome expectations, and these were not influenced by change in understanding or awareness. Among inactive tweens only, the same paths were identified except that, in this subgroup, attitude was related to physical activity (0.13, p<0.05), and awareness was more strongly related to physical activity than it was for the whole sample (0.14, p<0.01). CONCLUSIONS: These findings provided limited support for the HOE model and suggest that increased awareness and understanding were the key proximal effects that led to behavior change. A distinct sequence of effects, which bypassed attitudes and outcome expectations, was found for these U.S. young people. The findings could inform the design of future campaigns to address youth physical activity.

The validation of a home food inventory.

BACKGROUND: Home food inventories provide an efficient method for assessing home food availability; however, few are validated. The present study's aim was to develop and validate a home food inventory that is easily completed by research participants in their homes and includes a comprehensive range of both healthful and less healthful foods that are associated with obesity. METHODS: A home food inventory (HFI) was developed and tested with two samples. Sample 1 included 51 adult participants and six trained research staff who independently completed the HFI in participants' homes. Sample 2 included 342 families in which parents completed the HFI and the Diet History Questionnaire (DHQ) and students completed three 24-hour dietary recall interviews. HFI items assessed 13 major food categories as well as two categories assessing ready-access to foods in the kitchen and the refrigerator. An obesogenic household food availability score was also created. To assess criterion validity, participants' and research staffs' assessment of home food availability were compared (staff = gold standard). Criterion validity was evaluated with kappa, sensitivity, and specificity. Construct validity was assessed with correlations of five HFI major food category scores with servings of the same foods and associated nutrients from the DHQ and dietary recalls. RESULTS: Kappa statistics for all 13 major food categories and the two ready-access categories ranged from 0.61 to 0.83, indicating substantial agreement. Sensitivity ranged from 0.69 to 0.89, and specificity ranged from 0.86 to 0.95. Spearman correlations between staff and participant major food category scores ranged from 0.71 to 0.97. Correlations between the HFI scores and food group servings and nutrients on the DHQ (parents) were all significant (p < .05) while about half of associations between the HFI and dietary recall interviews (adolescents) were significant (p < .05). The obesogenic home food availability score was significantly associated (p < .05) with energy intake of both parents and adolescents. CONCLUSION: This new home food inventory is valid, participant-friendly, and may be useful for community-based behavioral nutrition and obesity prevention research. The inventory builds on previous measures by including a wide range of healthful and less healthful foods rather than foods targeted for a specific intervention.

Evaluation of a national physical activity intervention for children: VERB campaign, 2002-2004.

BACKGROUND: Amid concern for the consequences of physical inactivity among children, the Centers for Disease Control and Prevention started a campaign using commercial marketing methods to promote physical activity to children. DESIGN: Longitudinal study using a telephone survey to assess physical activity behaviors and attitudes at baseline and for 2 years of follow-up. Relationships of campaign awareness to behavioral and psychosocial effects were analyzed with use of propensity scoring. PARTICIPANTS: Nationally representative cohort of 2257 parent-child dyads. INTERVENTION: Marketing campaign (VERB) directed to all U.S. children aged 9 to 13 years. Components included general market and ethnic-specific advertisements on television and radio, in print, and through promotions in communities, schools, and on the Internet. Advertising ran nationally at consistent levels from June 2002 through June 2004. MAIN OUTCOME MEASURES: Psychosocial measures and self-reports of free-time and organized physical activity during nonschool hours in the week before the interview and on the day before the interview. RESULTS: After 2 years, a dose-response effect was detected in the study population. The more children who reported seeing VERB messages, the more physical activity they reported and the more positive their attitudes were about the benefits of being physically active. Children aware of VERB reported engaging in significantly more physical activity than children unaware of VERB. These results were considerably stronger than the effects after Year 1, which were only for physical activity among subpopulations. CONCLUSIONS: The VERB campaign continued to positively influence children's attitudes about physical activity and their physical activity behaviors and expanded the effects to more children. With adequate and sustained investment, health marketing shows promise to affect the attitudes and behavior of children.

Reliability and validity of questions on the youth media campaign longitudinal survey.

PURPOSE: The study evaluated the reliability and validity of the physical activity questions in the Youth Media Campaign Longitudinal Survey (YMCLS), a nationally representative survey of 9- to 13-yr-old youth. METHODS: The participants were 192 youth aged 9-13 yr (93 males and 99 females) in grades 4-8 from eight schools in a large, ethnically diverse school district. Participants completed two YMCLS phone interviews, which were administered 1 wk apart by trained interviewers. Reliability was examined by comparing data from two administrations of the survey. Validity was examined by comparing YMCLS measures from the second administration with temporally matched measures from an accelerometer and a detailed activity log. RESULTS: Reliability coefficients were high for estimates of organized activity (intraclass correlation coefficient (ICC)=0.78) and moderate for estimates of free-time activity (ICC=0.60) and total weekly activity (ICC=0.60). Estimates of total weekly activity sessions were significantly correlated with the accelerometer (r=0.24) and the activity log (r=0.46). Estimates of activity time and activity sessions on the previous day were also significantly correlated with the accelerometer (r=0.53 and 0.37, respectively) and the activity log (r=0.37 and 0.47, respectively). Correlations between the YMCLS and the activity log were higher for organized activity (r=0.72) than for free-time activity (r=0.46). Reliability and validity coefficients were similar for boys and girls, but older youth (11-13 yr) had higher coefficients than younger students (9-10 yr). CONCLUSION: The YMCLS has acceptable reliability and validity for estimating habitual physical activity in youth aged 9-13 yr.

Validity of a modified CHAMPS physical activity questionnaire among African-Americans.

PURPOSE: Valid methods for assessing physical activity (PA) patterns are essential for accurate evaluation of intervention programs and population surveillance. Numerous self-report PA instruments have been validated in white adults; however, few studies have reported validity in African-Americans. METHODS: Data are from the Healthy Body/Healthy Spirit Trial, a study to increase fruit and vegetable intake and physical activity among adults in 17 black churches. Participants completed a modified version of the CHAMPS activity recall as well as components of the Yale Physical Activity Survey and the Paffenberger Activity Questionnaire. The modified CHAMPS was scored to yield four indices: moderate to vigorous physical activities (MET value > or = 3.0), vigorous activities (MET value > or = 5.0), "Sports and Recreational Activities," and all activities. Estimated V(O2) maximum was obtained by submaximal treadmill test in 138 participants, 109 females and 29 males. RESULTS: With the exception of moderate to vigorous activities, the modified CHAMPS indices were significantly correlated with estimated maximum VO(2). Highest correlations were observed for the index of vigorous and sports-related activities, 0.19 and 0.32, respectively. Activity measures were generally uncorrelated with blood pressure, body mass index, or total cholesterol. For the CHAMPS indices, correlations with VO(2max) and other physiologic variables were generally higher for males than females as well as those with income < 30,000 US Dollars and for those participants who did not complete college. CONCLUSION: Responses from the modified CHAMPS were moderately correlated with estimated VO(2max), with higher correlations for vigorous activity and recreational sports indices. The instrument may be useful for assessing physical activity among African-Americans. Stronger correlations for individuals with lower income and educational attainment was an unexpected finding that merits further examination.

The VERB campaign logic model: a tool for planning and evaluation.

The VERB campaign uses a logic model as a tool to share information, to facilitate program planning, and to provide direction for evaluation. Behavior change and communication theories are incorporated to help hypothesize how behavior change might occur. Evaluation of the campaign follows the process of the logic model. The elements of the logic model are described and further explanation "pops up" as the reader rolls over the graphic of the logic model.

VERB - a social marketing campaign to increase physical activity among youth.

The VERB campaign is a multiethnic media campaign with a goal to increase and maintain physical activity among tweens, or children aged nine to 13 years. Parents, especially mothers aged 29 to 46, and other sources of influence on tweens (e.g., teachers, youth program leaders) are the secondary audiences of the VERB initiative. VERB applies sophisticated commercial marketing techniques to address the public health problem of sedentary lifestyles of American children, using the social marketing principles of product, price, place, and promotion. In this paper, we describe how these four principles were applied to formulate the strategies and tactics of the VERB campaign, and we provide examples of the multimedia materials (e.g., posters, print advertising, television, radio spots) that were created.

Influence of limit-setting and participation in physical activity on youth screen time.

OBJECTIVES: To examine the associations of demographics, rules associated with television-viewing, and physical activity with daily screen time (including television, non-school-related computer use, and video games) in children and adolescents. METHODS: We analyzed data from a telephone survey of 7415 youth aged 9 to 15 years from the Youth Media Campaign Longitudinal Survey. We used logistic regression models to calculate odds of exceeding recommended screen-time limits (>120 minutes/day) according to demographics, rules, and physical activity. RESULTS: Odds that children would exceed recommended screen-time limits were positively associated with age and black race/ethnicity and negatively associated with income level. Children and adolescents who reported that they really agreed that their parents had rules about time spent watching television and playing video games were less likely to exceed recommended limits than those who strongly disagreed that their parents had rules. Similarly, when parents reported always or very often having limits on television watching (versus rarely or never) and when parents correctly identified the recommended limits, children were less likely to exceed recommended limits. Children whose parents reported consistent limits and who themselves reported consistent rules about time spent watching television had the lowest prevalence of exceeding recommended limits. Odds that children would exceed recommended limits decreased as physical activity in the previous week increased. CONCLUSIONS: Parental rules regarding screen time and participation in physical activity play a role in the amount of screen time among children and adolescents. Programs that encourage limit-setting by parents and promote physical activity may reduce screen time among youth.

Evaluating a model of youth physical activity.

OBJECTIVE: To explore the relationship between social influences, self-efficacy, enjoyment, and barriers and physical activity. METHODS: Structural equation modeling examined relationships between parent and peer support, parent physical activity, individual perceptions, and objectively measured physical activity using accelerometers among a sample of youth aged 10-17 years (N = 720). RESULTS: Peer support, parent physical activity, and perceived barriers were directly related to youth activity. The proposed model accounted for 14.7% of the variance in physical activity. CONCLUSIONS: The results demonstrate a need to further explore additional individual, social, and environmental factors that may influence youth's regular participation in physical activity.

Inventory versus checklist approach to assess middle school à la carte food availability.

BACKGROUND: The purpose of this research is to evaluate 2 methods of assessing foods available on school à la carte lines for schools' ability to assess the proportion of foods that are healthful options. METHODS: This observational study used data collected at 38 middle schools, October 2006-May 2007. An inventory method was used to collect detailed information of items available on each school's à la carte line, followed by a simplified checklist form. Using the detailed inventory method, the proportion of items meeting the Institute of Medicine's (IOM) nutrition standards for foods available at each school was calculated. From the checklists, we calculated the proportion of categories representing more healthful foods. Schools were independently ranked according to the percentage of items meeting the IOM criteria, (inventory data) and the percentage of food categories considered "healthy" (checklist data). Wilcoxon rank sum test was used to compare school rankings. RESULTS: The inventory and checklist approaches showed a good level of agreement when both methods were independently used to rank the level of healthy foods available on à la carte (Wilcoxon rank sum = 32.5, p = .62). CONCLUSION: For purposes of ranking schools along a continuum of "healthfulness of foods on à la carte lines," especially when resources are limited, a checklist approach appears to be satisfactory. This method may also be useful to school stakeholders needing an inexpensive à la carte assessment tool.

Correlates of physical activity in a national sample of children aged 9-13 years.

BACKGROUND: Physical activity (PA) is critical for children's normal growth and development. The purpose of this study was to assess potential correlates of physical activity in a US national sample of youth aged 9-13 years. METHODS: A nationally representative telephone survey of parent-child pairs was conducted from April through June 2002. The questions assessed organized and free-time physical activity behavior and psychosocial and environmental variables that are potentially related to youth physical activity. RESULTS: Children's positive outcome expectations or beliefs about the benefits of participating in physical activity and parent's beliefs that participating in physical activity is important were related to participation in both organized and free-time physical activity. Children's perception of parental support and parent's reports of direct support were strongly related to organized physical activity. Feeling safe, having lots of places to be active, and parental participation with their child were strongly related to free-time physical activity. CONCLUSIONS: Messages and interventions aiming to increase children and adolescent's participation in organized and free-time physical activity should continue to focus on promoting the benefits that are associated with being active, the importance of parental support, and the provision of safe and enjoyable opportunities to be active.

Reducing children's television-viewing time: a qualitative study of parents and their children.

OBJECTIVES: The American Academy of Pediatrics recommends that children over age 2 years spend < or = 2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children. METHODS: The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old. RESULTS: Most of the children reported spending approximately 3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics. CONCLUSIONS: Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.

Effects of a mass media campaign to increase physical activity among children: year-1 results of the VERB campaign.

OBJECTIVE: To determine the effects of a mass media campaign on the levels of physical activity among children 9 to 13 years of age. DESIGN: A prospective, longitudinal, quasi-experimental design was used. A baseline survey was conducted in April to June 2002, before the launch of VERB advertising. Random-digit-dialing methods were used to survey a nationally representative sample of children and parents. The follow-up survey was repeated with the same cohort of children and parents in April to June 2003. Propensity scoring was used to determine the campaign's effects on awareness and physical activity behaviors. SETTING: United States. PARTICIPANTS: A total of 3120 parent-child dyads. Intervention. The VERB campaign is a multiethnic campaign that combines paid advertisements with school and community promotions and Internet activities to encourage children 9 to 13 years of age to be physically active every day. Launched in 2002 by the Centers for Disease Control and Prevention, VERB uses commercial marketing methods to advertise being physically active as cool, fun, and a chance to have a good time with friends. Using the VERB brand, paid advertising ran nationally from June 2002 through June 2003, targeting 9- to 13-year-old youths. MAIN OUTCOME MEASURES: Children's awareness of the campaign and self-reported estimates of free-time and organized physical activity sessions during nonschool hours in the week before the interview. RESULTS: After 1 year, 74% of children surveyed were aware of the VERB campaign. Levels of reported sessions of free-time physical activity increased for subgroups of children 9 to 13 years of age. A pattern of effects across 2 measures was observed for younger children (9-10 years of age), girls, children whose parents had less than a high school education, children from urban areas that were densely populated, and children who were low active at baseline. These subgroups engaged in more median weekly sessions of free-time physical activity than did children who were unaware of VERB and, as the children's level of VERB awareness was incrementally higher, the children engaged in incrementally more free-time physical activity sessions. The average 9- to 10-year-old youth engaged in 34% more free-time physical activity sessions per week than did 9- to 10-year-old youths who were unaware of the campaign. A pattern of effects for organized activity was found only for children classified as low active at baseline. CONCLUSIONS: The VERB campaign achieved high levels of awareness in 1 year. Higher levels of physical activity were reported for subgroups of US children. Promoting physical activity with child-focused commercial advertising shows promise.