THE ROLE OF SOCIAL RELATIONSHIPS IN DIET QUALITY AND OBESITY AMONG URBAN, LOW-INCOME, AFRICAN AMERICAN ADOLESCENTS
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Date
2015-07-09
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Johns Hopkins University
Abstract
Adolescent overweight and obesity rates are alarmingly high, and experts have called for multi-level, systems-oriented interventions to address this significant public health issue. Researchers have identified links between adolescents’ eating behaviors, weight status, and physical activity patterns and those of their parents and/or their friends. However, there is a significant gap in the literature related to in-depth knowledge about how parents, friends, and other social contacts interact with youth around nutrition and physical activity, including the types of social support they provide; and how to best implement and evaluate youth-led intervention components within larger interventions.
The B’More Healthy Communities for Kids study (BHCK) is a multi-level, systems-oriented obesity prevention intervention that targets low-income, urban, African American youth (age 10-14) in Baltimore City, Maryland. BHCK was designed to intervene at multiple levels of the food system and environment to promote healthier eating choices. This thesis is a sub-study of BHCK, and is the first study to conduct in-depth explorations of the roles of multiple social relationships on urban, minority adolescents’ eating and physical activity habits, and to implement and evaluate a youth-led intervention uniquely positioned within a multi-level obesity intervention.
Multiple research paradigms and methods were used in this thesis. Quantitative surveys were completed with 297 low-income urban African American youth to assess demographics, anthropometrics, dietary intake, social support, and perceptions of change agents (i.e., influential individuals who could be engaged to aid in behavior change efforts). In-depth interviews were completed with 38 youth, 10 parents, and 16 youth-leader participants to assess the perceived roles and interactions that various social contacts have with youth surrounding eating and physical activity habits, and to assess the impact of the youth-leader intervention. Pre- and post-intervention surveys were completed with the 16 youth-leaders and a comparison group of 10 young people to assess changes over time in dietary intake, psychosocial factors, and leadership skills within and between the two groups.
The results of this study identified that youth have multiple social contacts that interact with them around nutrition and physical activity. Parents and grandparents play multiple roles and have multiple interactions with youth related to eating and activity, and are generally supportive of healthier behaviors. However, some youth also experienced social support for unhealthy eating from their parents, which may be related to lower diet quality. Other social relationships have semi-distinct roles that guide their interactions with youth around nutrition and physical activity. Friends serve as individuals who participate in physical activity with youth, while aunts and other family members provide novel food experiences, and professionals (teachers, doctors/nurses) provide information on nutrition and physical activity to youth.
The BHCK youth-led intervention involved 16 Baltimore-based college students who served as youth-leaders and delivered a total of 98 nutrition interventions sessions to younger youth participants in seven participating Baltimore City recreation centers. The youth-leaders identified and described specific ways in which their participation in the BHCK intervention influenced the health behaviors of themselves, the youth-participants and others, with quantitative evidence showing that the intervention youth-leaders experienced statistically significant increases in their behavioral intentions for healthier eating relative to a comparison group.
These results provide important information related to designing strategies and implementing social environment changes within the context of systems-oriented interventions focused on urban, African American youth. First, researchers and interventionists should be mindful of the potential for youth to be receiving social support for unhealthy eating behaviors, and that this is particularly concerning when coming from parents. Second, social relationships play unique roles related to nutrition and physical activity with youth, and social environment interventions should consider enhancing the existing health-promoting roles that social relationships provide. Third, one potential way to intervene in the social environment is to engage youth-leaders to deliver highly interactive nutrition intervention sessions to youth in community settings.
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Nutrition, obesity, adolescent, youth, youth-leader, social support, social environment, social roles, African American, urban, diet, physical activity