Anti-Sugar-Sweetened Beverage Messages Elicit Reactance: Effects on Attitudes and Policy Preferences

Messages that convey the dangers associated with consumption of sugar-sweetened beverages (SSBs) may be the most effective means of changing attitudes toward consumption and policy preferences. However, there is a risk that this message type also stimulates reactance, a form of resistance to persuasion. A study (N = 618) using messages from the 2012 New York City anti-SSB campaign and a sample of New York City residents showed just such effects. Reactance was heightened by prior message exposure, conservative political orientation and prior consumption of SSBs. The net message effect was still persuasive overall for attitudes, but could be improved by 17% if reactance were eliminated. In contrast, the net message effect on policy preferences was counterpersuasive, due to processes other than reactance. Anti-SSB threat appeals can change attitudes toward one’s own behavior in a more healthful direction, while simultaneously eroding support for more restrictive SSB policies.     

Awareness of Health Outcomes Associated with Insufficient Physical Activity and Associations with Physical Activity Intentions and Behavior

Introduction: Little is known about people’s awareness of the link between insufficient physical activity and increased risk for multiple health outcomes.

Methods: Of 1161 respondents to an online cross-sectional survey of the US population, we randomly selected 361 and used content analysis to code up to three responses to an open-ended question asking what illnesses are caused by insufficient physical activity. Chi-square and Fisher’s exact tests examined relations between disease codes and socio-demographics; t-tests and Mann–Whitney U tests examined relations between codes and physical activity intentions and behavior.

Results: Ten codes emerged: cardiovascular (63.5% of participants), metabolic (65.8%), musculoskeletal (10.5%), fatigue (2.0%), psychiatric (8.0%), respiratory (3.4%), gastrointestinal (0.9%), cancer (3.4%), other (2.8%), unexpected interpretation (1.4%). 55.6% of participants named < 3 diseases. Code frequencies were generally similar across demographic groups, ps > .05. Physical activity intentions and behavior were higher among people who either mentioned cardiovascular (p_intentions = .001, p_behavior = .001) or metabolic (p_intentions = .01, p_behavior = .005) conditions, or who named < 3 diseases (p_intentions = .006, p_behavior = .001).

Conclusion: In our socio-demographically diverse sample, awareness of diseases that are associated with insufficient physical activity was largely related to cardiovascular and metabolic problems. Future health communication efforts should raise awareness of the harms of insufficient physical activity for cancer and other diseases.     

Family Attitudes and Reactions toward Pregnancy among Women with Physical Disabilities

BackgroundHistorically, people with disabilities who become parents have confronted discriminatory societal attitudes and public policies. Today, although more women with disabilities are bearing children, little is known about the perceptions of their pregnancies, even among their family members. In addition, little is understood about how family members’ attitudes and reactions affect women with physical disabilities around the time of pregnancy.MethodThis qualitative study involved interviews with 25 women with physical disabilities from across the United States who had a baby within the past 10 years. Semistructured telephone interviews were conducted. Interviews were audio-recorded, professionally transcribed, and analyzed using an iterative, interpretive process.FindingsWomen reported a wide range of physical disabilities. Before, during, and after pregnancy, participants reported experiencing wide-ranging attitudes and reactions from family members concerning their pregnancies. These responses fell into six categories: 1) initial negative reactions, 2) concern about mother's well-being, 3) questioning of parenting capability, 4) negative perceptions of disability, 5) genetic concerns, and 6) excited and supportive.ConclusionsThis study sheds light on the attitudes and reactions toward pregnancy that women with physical disabilities experience from family members. Our findings suggest the need for increased social support and family education. Greater availability of peer supports as well as information for women with disabilities considering pregnancy is also needed.     

Predictors of Change Over Time in the Activity Participation of Children and Youth With Physical Disabilities

Little is known about predictors of change over time in the intensity of the leisure and recreational activity participation of children with physical disabilities. This study reports data from 402 children and youth with physical disabilities (216 boys and 186 girls), ages 6 to 15, collected on 3 occasions over a 3-year period. Latent growth curve modeling was used to determine the significant child, family, and community predictors of change in the intensity of their participation in 5 types of activities (recreational, active physical, social, skill-based, and self-improvement). Differences in predictors were examined for boys versus girls, and older versus younger children. Significant predictors of change were found only for recreational and active physical activities. The findings indicate that factors associated with change in participation intensity are dependent on the type of activity and vary as a function of children's gender and age. Implications for research and service delivery are discussed, including the importance of a contextualized, holistic, and developmental approach to intervention.     

Effects of Exergaming and Message Framing in School Environments on Physical Activity Attitudes and Intentions of Children and Adolescents

Although interventions targeting the health of students in schools are becoming common, few studies have examined how health messages operate at the group level in school environments. This study examines the effects of message-based health interventions (extrinsic vs. intrinsic goal framing) in group environments (exergame competitive vs. exergame noncompetitive) on eliciting attitudes and intentions toward physical activity among children and adolescents. We conducted a 7-week school-based intervention program involving 336 children and 259 adolescents in Singapore in which pre- and post-intervention responses were recorded. Our findings revealed the difference in responses between child and adolescent groups. Children who participated in noncompetitive exergames with extrinsically framed health messages and those who participated in competitive exergames with intrinsically framed health messages demonstrated more favorable attitudes toward physical activity. However, the same effects were absent in our adolescent group. These findings suggest that the integration of exergames into competitive and noncompetitive environments can serve as a gateway to traditional physical activity in schools when strategically combined with intrinsically and extrinsically framed messages. Practical and theoretical implications for schools and health educators are discussed.     

Using Virtual Pets to Promote Physical Activity in Children: An Application of the Youth Physical Activity Promotion Model

A virtual pet was developed based on the framework of the youth physical activity promotion model and tested as a vehicle for promoting physical activity in children. Children in the treatment group interacted with the virtual pet for three days, setting physical activity goals and teaching tricks to the virtual pet when their goals were met. The virtual pet became more fit and learned more sophisticated tricks as the children achieved activity goals. Children in the control group interacted with a computer system presenting equivalent features but without the virtual pet. Physical activity and goal attainment were evaluated using activity monitors. Results indicated that children in the treatment group engaged in 1.09 more hours of daily physical activity (156% more) than did those in the control group. Physical activity self-efficacy and beliefs served as mediators driving this increase in activity. Children that interacted with the virtual pet also expressed higher intentions than children in the control group to continue physical activity in the future. Theoretical and practical potentials of using a virtual pet to systematically promote physical activity in children are discussed.     

An Examination of Triple Jeopardy in Rural Youth Physical Activity Participation

Purpose: Chances for a healthy life are not equally distributed across society. Instead, genetic, social, and environmental factors help determine the probability that a child will be healthy and active. We investigate the probability that youth will be physically active by examining 3 consistent correlates of physical activity. The individual and interaction effects of self-efficacy, social support, and access to physical activity areas are used to predict rural youth physical activity participation. We hypothesize that youth lacking all 3 activity supports will be in “triple jeopardy” for physical activity participation. Methods: Data were collected using a researcher-administered questionnaire with 147 youth in 2004. Youth ages 9-18 were enrolled in grades 4, 7, and 11 in 2 diverse rural counties in Georgia. Findings: Overall, a greater number of disadvantageous statuses were related to a lower probability of physical activity participation. Low self-efficacy, low social support, and no access to physical activity areas were related to lower levels of physical activity participation among rural youth. These variables exerted a stronger impact when factors were allowed to interact than when their isolated effects were summed. Conclusions: This study assessed correlates of physical activity among rural youth. These investigations, while scarce, can help identify subgroups of the population that may need to be targeted for intervention. Findings indicate that lived experience of youth (captured by the interaction of physical activity correlates) may be critical for understanding patterns of active and sedentary living.     

An Examination of Adolescent Recall of Anti-Smoking Messages: Attitudes,Message Type,and Message Perceptions

Delayed message recall may be influenced by currently held accessible attitudes, the nature of the message, and message perceptions (perception of bias and message elaboration). This study examined the potential of message perceptions to mediate the influence of valenced attitude accessibility and message type on unaided recall of anti-smoking Public Service Announcements (PSAs). In a field experiment, ninth grade students (N = 244) watched three PSAs and responded to items on laptop computers. Twelve weeks later, follow-up telephone surveys were conducted to assess unaided recall. Both valenced attitude accessibility and message type were associated with message perceptions. However, only perception of message bias partially mediated the relationship between message type and unaided recall.     

Rural Latino Youth Park Use: Characteristics, Park Amenities, and Physical Activity

Less than half of youth engage in sufficient physical activity to achieve health benefits. Key environmental factors of park and recreation spaces may influence youth physical activity. We sought to ascertain youth characteristics and behaviors that attract youth to parks with specific amenities and encourage physical activity while at the parks in a rural, predominantly Latino community. We examined the quality of amenities in the 13 parks and recreation spaces that middle school aged youth have access to in their community using the Environmental Assessment of Parks and Recreation Spaces (EAPRS) tool. Middle school students completed surveys in the school classroom (n = 1,102) regarding park use, physical activity, and intrapersonal characteristics (e.g., motivators). We used logistic regression to identify correlates of any park use, use of higher quality field and court parks, and active and sedentary park use. Younger age, participation in an after school activity, and identification of a team as a motivator were positively associated with any park use. Use of higher quality court and field parks was associated with participation in an after school activity and being Latino. The odds of being active in the parks were greater for boys and Latinos. Older age and alcohol use are correlated with being sedentary at the park, while odds of being sedentary at the park were lower for boys and youth who met physical activity guidelines. Organized team activities may encourage active use of higher quality fields and courts parks by Latino youth; thereby, increasing their level of physical activity.     

Health Literacy Teaching Beliefs,Attitudes, Efficacy,and Intentions of Middle School Health and Physical Education Teachers

BACKGROUND

Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships.

METHODS

This study adopted a cross‐sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent.

RESULTS

Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions.

CONCLUSION

Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction.

     

Parent Perceptions of Neighborhood: Relationships with US Youth Physical Activity and Weight Status

Context is important for understanding and making change to improve health outcomes. The purpose of this study was to examine the relationship between parent perceptions of neighborhood and youth aerobic physical activity and weight. This study is a secondary data analysis of 64,076 parents and guardians of children and adolescents (6–17 years) participating in the 2007 National Survey of Children’s Health. Logistic regression models were used to evaluate the relationship between neighborhood characteristics, including constructs for social capital, physical condition, resource availability, and safety, and youth likelihood of meeting healthy standards for physical activity and weight. Neighborhood characteristics, including social capital, resource availability, and safety were significantly associated with increased likelihood of youth achieving healthy physical activity and normal weight parameters even with adjustment for individual and family-level demographic and behavioral characteristics. Findings support neighborhood assessment during behavioral counseling and continued exploration of neighborhood context as a means to positively impact youth physical activity and weight outcomes.     

Annals Journal Club: Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions,Behaviors, and Body Mass Index

PURPOSE

Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors.

METHODS

Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation – Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates.

RESULTS

In path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident.

CONCLUSIONS

Individuals’ feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions.     

Dating Issues for Women with Physical Disabilities

A study of dating issues for 250 single women with physical disabilities and 180 single women without disabilities was undertaken to determine (a) differences between women with and without disabilities and (b) predictors of dating outcomes for women with disabilities. A survey was sent to a national sample of women with disabilities along with a similar survey to give to a female friend without a disability. Dating outcomes included (a) satisfaction with dating frequency, (b) perceived constraints on attracting partners, (c) perceived personal barriers to dating, (d) perceived societal barriers to dating, and (e) perceived communication problems. Women with disabilities were disadvantaged on all but (e). Between 21% and 47% of the variance in the outcomes was accounted for in multiple regression analyses. Potential interventions suggested by the findings are discussed.     

Driving for Adults with Acquired Physical Disabilities

The purpose of this paper is to document and give context to consensus statements for drivers with physical disabilities, and specifically chronic obstructive pulmonary disease, by expert clinicians in driver rehabilitation and researchers in the area of driver assessment. A brief introduction to the profession of driver rehabilitation sets the context for how individuals with physically based impairments have facilitated the development of the specialty area.     

Reproductive Technologies for Women with Physical Disabilities

Issues regarding reproductive technologies for women with physical disabilities are discussed. Consideration is given to birth control, motherhood, access issues, the artificial insemination process, prenatal and genetic testing, and the issue of choice. An interview with a woman with a physical disability, who is a feminist and a disability rights activist, about her experience with reproductive technologies, provides a personal perspective for this discussion.