Academic journal article Childhood Obesity

Mediating Mechanisms of Theory-Based Psychosocial Determinants on Behavioral Changes in a Middle School Obesity Risk Reduction Curriculum Intervention, Choice, Control, and Change

Academic journal article Childhood Obesity

Mediating Mechanisms of Theory-Based Psychosocial Determinants on Behavioral Changes in a Middle School Obesity Risk Reduction Curriculum Intervention, Choice, Control, and Change

Article excerpt

[Author Affiliation]

Heewon Lee Gray. 1 Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.

Isobel R. Contento. 1 Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.

Pamela A. Koch. 1 Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.

Jennifer Di Noia. 2 Department of Sociology, William Paterson University, Wayne, NJ.

Address correspondence to: Heewon Lee Gray, PhD, RD, Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, 525 W. 120th Street, New York, NY 10027, E-mail: hl2001@tc.columbia.edu

Introduction

Given the high rates of overweight and obesity in youth,1 determining and utilizing the most effective behavioral change strategies in obesity prevention programs is critical. Energy-dense, palatable, low-cost easily available foods and large portion sizes, as well as sedentary behaviors and lack of physical activity, contribute to positive energy balance, which may increase risks of overweight and obesity in youth.2,3

Among nutrition intervention studies targeting energy balance-related behaviors (EBRBs) in school-aged children and adolescents,4-7 a limited number of studies have investigated mediation mechanisms of behavior changes.3,5,8-10

According to Baranowski's mediating variable framework,11,12 theory-based mediating variables are substantial components under the assumption that mediators cause the targeted behavior changes in behavioral change interventions. Statistically testing this assumption with mediation analysis allows researchers to determine whether the prevention program changed the mediator, which in turn changed the dependent variable, thereby providing tests of the theoretical basis of the intervention.12,13 Researchers can therefore build a theory of the causal process for behavioral change through mediation analysis and eliminate potential mediators unrelated to the target behavior and their corresponding intervention activities.5,14 Thus, mediating variables with higher predictability provide more effective levers to promote behavior changes, aiding researchers and program developers in the construction of more efficient and effective interventions.9,15-18

Reviews on mediating mechanisms of school-based EBRB interventions have indicated that effective mediators are behavior specific.3,10 For example, knowledge and attitude,19 outcome expectancies, and stages of change20 were significant mediators for fruit and vegetable intake changes in school children and adolescents; attitude and habit strength8 were significant mediators for soft drink intake changes in boys (aged 12-13 years), and self-efficacy,9,21,22 autonomy and intention,23 and enjoyment15 were reported as significant mediators for physical activity behavior change in adolescents. However, a large number of other variables thought to be potential mediators of behavior changes in intervention studies have shown no statistically significant mediation effect.3,10 Collective evidence on significant relationships between theoretical mediators and EBRB outcomes, from diverse studies, especially using longitudinal research designs would strengthen future intervention research.24

The purpose of this study was to determine mediation mechanisms of theory-based psychosocial variables on behavior changes in the Choice, Control, and Change trial. Choice, Control, and Change was a school-based nutrition education intervention to reduce obesity risks in urban minority youth, and it has been reported that it was effective in improving targeted psychosocial determinants based on social cognitive and self-determination theories, as well as EBRB outcomes. …

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