Month: January, 2011

Data Analysis

29 January, 2011 (18:40) | Smoking | By: Health news

Data were analyzed with SPSS version 10.0. The statistical tests used in the data analysis included descriptive statistics, the Phi, contingency, and point biserial correlations, and logistical regression analyses. Descriptive statistics were reported for the demographic variables(gender, race, grade, and disposable income), and smoking behavior (frequency, age of initiation, ability to quit, and quit attempts), perceived availability (1=very difficult and 7=not at all difficult), and sources (commercial or social) of tobacco. Correlations were also reported. The dependent variable was adolescent provision of tobacco to other adolescents in the past month. The independent variables were demographics, social influences (friend or family), perceived sanctions (high, medium, low), perceived availability, source of most recent cigarettes (commercial or social), age of initiation, purchase attempts, number of weekly cigarettes, and ownership of tobacco merchandise. School sanctions were defined as low (nothing to sent to the office), medium (stay after school to required to attend special class), and high (suspended from activities to expelled).

A logistic regression analysis was used to identify potential predictor variables of adolescent provision of tobacco to other adolescents using SAS 8.0. The independent variables were demographics, social influences, perceived sanctions, perceived availability, sources of cigarettes, smoking behavior, and ownership of tobacco brand items. The dependent variable was adolescent provision of tobacco to other adolescents in the last 30 days. Variables were included in the final logistic regression model by forward stepwise selection. The likelihood-ratio(LR) test was used to determine removal of variables from the model at each step. Entry of variables at each step based on .25 and the significance criterion for selection of whether a variable remained in the model was .05 (Allison, 1999). Nagelkerke’s Max-rescaled R2 was used to estimate the variation in the outcome variable explained by the logistic regression model (Nagelkerke, 1991; Norusis, 1999).

Sources of Tobacco
Smokers perceived that it was easy to get cigarettes from friends, vending machines, and over-the-counter purchases. It was difficult to get cigarettes from family members (M = 3.4) and by stealing (M = 3.0) them from a store. Weekly smokers reported that it was not difficult to get cigarettes from friends (M = 6.2), vending machines (M = 5.5), and through over-the-counter purchases (M = 5.2). Weekly smokers (M = 4.1) perceived that it was easier to get cigarettes from family members than ever smokers (M = 3.4). Friends accounted for the largest reported source of initial, most recent and ever source of cigarettes. Family accounted for the second largest initial and ever source. Store purchases accounted for the second most recent source. If family and friends are combined as an initial source of tobacco, approximately 93% of ever smokers obtained cigarettes from social sources, compared with 6% who obtained them from commercial sources. Less than 1% reported getting their most recent cigarettes by stealing them from a store. Students were certain in their ability to quit smoking (M=5.0, SD=2.2).

Methods and Sample Characteristics

29 January, 2011 (04:33) | Smoking | By: Health news


The sample for this study included 569 students from grades 8-10 attending five public (n = 290) and nonpublic (n = 355) funded schools in a racially and ethnic diverse part of Philadelphia, Pennsylvania. Students completed a voluntary and anonymous 68-item questionnaire in spring 2000. Grades 8-10 were chosen as the sample for the survey because these students would be no older than 15 or 16 years old and therefore they would be old enough to have started to smoke in large numbers and yet too young to be sold cigarettes legally. A stratified, multistage purposive sampling procedure was used in selecting the sample. The diverse section of Philadelphia was chosen to conduct the study, due to the heterogeneity of its culturally diverse population and a health service agency estimated that merchant sales of tobacco to minors was the highest in Philadelphia. Klepp et al. (1996) suggested that a student population be chosen for conducting a study in which tobacco use was a salient issue. Students from public and nonpublic funded schools located in a diverse section of Philadelphia were selected in the sample to be more inclusive and representative of the neighborhood population.

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A current list (1997-1998) of schools in the diverse section of a Philadelphia school cluster was obtained from the School District of Philadelphia and the Pennsylvania Department of Education. The primary sampling unit was comprised of students in five (5) schools in the diverse section of Philadelphia, a public funded middle and high school, and two nonpublic funded elementary schools and one high school. Seven schools were approached and 2 did not want to participate. The first stage consisted of selecting neighborhood (few nonresident enrollment) schools that were ethnically/racially diverse. The second stage involved selecting classrooms in the schools to administer the survey. In the high schools, subjects such as Health, Physical Education, English, and Social Studies were chosen because these were required and there was very little overlap of students.

Sample Characteristics

The sample consisted of 75% males and 25% females (Table 1). There was an equal distribution of males (46.7%) and females (53.3%) in the eighth grade, but there were more males than females in grades 9-10 due to the unisex character of the nonpublic high school surveyed. The sample included Asians (12%), African Americans (32.9%), Hispanics (3.3%), American Indians (0.7%), and Whites (50.9%). Measures of disposable weekly income indicated that 22.5% had less than $10 a week for discretionary income, and 54.8% had more than $25 to spend. The reported level of cigarette use included ever (48.9%), past month (19.3%), weekly (17%), and daily (15.3%) use (Table 1). More ninth graders indicated that they smoked in these four categories than eighth and tenth graders. On average, smokers reported smoking eight cigarettes daily, and 40 cigarettes weekly. The mean age of initiation for the total sample was approximately 12 years. Smokers were sure that they could quit (M=5.0, SD=2.2) and attempted to approximately 2 times in the last year (M= 1.8, 4.2).

A discussion of the estimates of reliability and validity were reported elsewhere (Ma, et al., 2003). Items measuring social and commercial sources of tobacco had good levels of test-retest reliability, based on values of Kappa between 0.40 and 0.75 (SPSS, 1999).

Adolescents Who Provide Tobacco to Other Adolescents in a Racial/Ethnic Diverse Population. Part 2

28 January, 2011 (21:24) | Smoking | By: Health news

Adolescents can also obtain tobacco from social sources. These social sources include parents, older siblings, other adults, peer friends, and theft (Forster, et al., 1997; Florida Department of Health, 1998; Forster, et al., 1989). The majority of current smokers obtained their first cigarette from family or friends (CDC, 1996; Florida Department of Health, 1998; Forster, et al., 1997; Wolfson & Forster, 1997). There is a pressing need to address the social availability of tobacco to youth (Wolfson & Forster, 1997).

One form of social source of tobacco to minors is adolescent provision of tobacco to other adolescents. Friends and family are important sources of tobacco to adolescents (Cummings, Sciandra, Pechacek, Orlandi, & Lynn, 1992; Forster, et al., 1997; Greenlund, Johnson, Webber, Berenson, 1997) and the source of cigarettes is a function of frequency of use (Emery, Gilpin, White, & Pierce, 1999). As adolescents progressively smoke more than one cigarette a day, they purchase cigarettes themselves rather than relying on others to give or purchase cigarettes for them. Students perceive that tobacco is easy to get, especially from friends and family (Forster, et al., 1997).

A study found that of those students who reported smoking in the past 30 days, 68% of them reported providing tobacco to another adolescent during that period. Of those that provided tobacco, 66.3% gave to someone their age, 37.4% gave to a younger friend, 16.6% gave to a sibling, and 12.9% gave to a stranger (Wolfson & Forster, 1997).

Factors which correlate with adolescent provision of tobacco to other adolescents have included adolescent smokers who: were heavy smokers, had many friends who smoked, had mothers who smoked, owned tobacco related merchandise, and had access to commercial sources (Wolfson & Forster, 1997). This study suggests that there may be a close relationship between social and commercial availability, a finding supported in previous studies (Hinds, 1992). The authors caution that the results of this cross-sectional study are limited, due to the sample selected. The characteristics of samples of the available research literature tend to emphasize rural, small, homogeneous populations, and typically include students who attend public schools. There is a need to determine sources of tobacco to youth in a large urban, heterogeneous population, to distinguish between gift or sale, and to include students from public and nonpublic schools, such as in Philadelphia. Further, there is a need to address the social availability of tobacco to youth, and to further assess the extent and predictors of adolescent provision of tobacco to other adolescents (Wolfson & Forster, 1997). Past studies which have investigated the relationship between tobacco use and the various psychosocial factors may not be applicable with other ethnic/racial populations.

The purpose of this study was to examine the sources of tobacco and the adolescent provision of tobacco to other adolescents in an ethnically/ racially diverse and large urban student population in Philadelphia, Pennsylvania.

Adolescents Who Provide Tobacco to Other Adolescents in a Racial/Ethnic Diverse Population

28 January, 2011 (17:17) | Smoking | By: Health news

This study examined the sources of tobacco and the adolescent provision of tobacco to other adolescents in an ethnically/racially diverse, large heterogeneous urban, adolescent population in Philadelphia, Pennsylvania. A stratified multistage purposive sampling procedure was used to select an ethnically/racially diverse sample, which consisted of 569 students in grades 8-10 in five public and nonpublic funded schools. A logistical regression analysis was used to examine potential predictor variables of adolescent provision of tobacco to other adolescents. Social sources of tobacco were more common than commercial. Gas stations/convenience stores, grocery stores, recreational/sports centers, and pharmacies were the most reported commercial sources. Among adolescent smokers, 46% of smokers gave tobacco to another adolescent. Tobacco was sold (32.2%) and given as a gift (67.8%). Positive correlates of adolescent provision included family availability, best friends and father smoked, purchased cigarettes in the last 30 days, and ownership of tobacco brand merchandise.

Cigarette smoking rates vary among ethnic/racial groups in the United States (CDC, 1998; Livingood, Woodhouse, Sayre, & Wludyka, 2001). Adolescents obtain tobacco from commercial and social sources. Adolescents perceive that tobacco is readily available and availability is a primary factor for tobacco use onset (CDC, 1995; Florida Department of Health, 1998; Forster, Wolfson, Murray, Wagenaar, & Claxton, 1997). Adolescent smoking rates remain high among American teens. Over one-third of students smoke by the time they leave high school and one-fifth are smoking monthly by the eighth-grade (Johnston, O’Malley, & Bachman, 2000). Current cigarette smoking is higher among white (38.6%), than Hispanic (32.7%), and Black (19.7%) students (CDC, 2000). In Philadelphia, results from the 1999 Youth Risk Behavior Surveillance (YRBS) survey showed that 67.9% of adolescents used cigarettes in their lifetime, 23% currently used, and 10.3% were frequent users and use varies by ethnic/racial group (CDC, 2000; Ma, Shive, Legos, & Tan, 2003).

Primary commercial sources of cigarettes for occasional and regular smokers include gas stations, convenience stores, vending machines, grocery stores, drug stores, stealing, and taverns (Cismoski & Sheridan, 1993; Forster, Knut-Inge, & Jeffery, 1989; Forster et al., 1997; Hinds, 1992). Commercial sources were determined to be an important source of tobacco to minors and efforts were made to restrict youth access. Previous studies have shown that there are racial/ethnic differences in merchant sales to adolescents. In a California study, an analysis of 432 purchase attempts which used Black, White, and Latino adolescent confederates, found that older (16-year-old) Black males and females were the most likely to be sold cigarettes (Klonoff, Landrine, & Alcaraz, 1997). Clerks were more likely to sell to a minor if that minor was 14-16 years old, Latino, or a 16 year old Black girl or boy, whereas being a Latino boy decreased the likelihood of sales. Black children were sold more packs of cigarettes in Black neighborhoods than White children (Landrine & Klonoff, 1997). Further, 91% of cigarettes sold to both White and Black children were by non-Black clerks, and of those packs sold to Black children in Black neighborhoods, 93% were sold by non-Black clerks. Representative non-Black clerks selling cigarettes to Blacks in Black neighborhoods were Asians (67%), Whites (12.7%), and Latinos (13%). Black (7%) clerks were the least likely to sell tobacco to Black minors in Black neighborhoods. There are differences in merchant sales of tobacco to different racial/ethnic minors, and in clerks’ willingness to sell. It appears that socio-cultural variables play an important role in access to tobacco by minors.

Qualitative Exit Survey. Conclusion

27 January, 2011 (21:52) | Nutrition | By: Health news

The qualitative surveys implied that the nutrition information presented resulted in gained knowledge and skills that were utilized by the participants. As the participants began to use the skills and tools provided in the program curriculum their awareness of undesired behaviors and healthy alternatives increased. Participants reported that they were eating better and exercising more.

This study was non-controlled and relied only on outcomes from those who participated and completed the program. Reliance on self-reports for eating and activity behavior assessed by the Likert survey could be biased due to test-retest bias and increased knowledge rather than actual behavior changes. Collection of eating and activity record data from the participants may have helped to assess and verify behavior changes. There are limitations to the use of leg-to-leg BIA for assessing small changes in percentage body fat, especially for growing children. The data for ethnicity, age, income, and education level of the parent was not collected, nor was food availability/security issues or availability of safe recreation environments. This type of information can be helpful for identifying barriers to change for the participants.

The family-based lifestyle change intervention, LEAP program, was effective for decreasing BMI and increasing fitness level for both the child and adult participants. Survey responses for both the parents and the children indicated positive changes in eating and activity behaviors and attitudes after completing the program. Parental involvement may be associated with the achievement of desired changes for children. Social and family support is an important factor in the modification of family-based lifestyle behaviors. Interventions need to target multiple areas at both the personal and family environmental levels, as there is a reciprocal interaction between behavior and multiple levels of influence. Short-term outcomes were favorable for both the child and parent participants. Further research is needed to evaluate the long-term effects.

Qualitative Exit Survey. Part 5

27 January, 2011 (18:32) | Nutrition | By: Health news

The greater decrease in BMI as compared with the current study might be attributed to the intervention design, which utilized a structured exercise-training component, and the older age of the participants. The L.E.S.T.E.R. (Let’s Eat Smart Then Exercise Right) program, which uses a modified stoplight diet, behavior modification, physical activity and targets family lifestyle had positive weight loss for 26 children ages six to 11 after an eight-week intervention (Kibbe & Offner, 2003). Consistent with the current study, L.E.S.T.E.R. participants had improvements in eating & exercise patterns, knowledge and attitude and significant decreases in anthropometric measures. Heard (2004) reported that 87% (n=425) of the L.E.S.T.E.R. children achieved a significant decrease of about 1.0 BMI unit (p = .03). 77% (n = 107) of the LEAP children achieved a significant decrease of 1.0 BMI unit (p <.01) versus the 0.74 BMI unit mean decrease for all children in the study, which included children that had an increase in BMI.

The results of the current study indicate a significant mean decrease in percent body fat for the child participants from week one to week eight. Bio-impedance analysis to measure percent body fat is less commonly used as an outcome measure for body composition changes in children undergoing small changes in weight. The use of the Tanita body composition analyzer has been reported to be an accurate method for measuring body fat in adult women during weight loss (Powell, Nieman, Melby, Cureton, Schmidt, & Howley, et al, 2001). A validation study reported no significant differences in % body fat measures with leg-to-leg BIA and UWW between obese and non-obese women and was accurate in measuring small body composition changes during weight loss in the obese (Utter, Nieman, Ward, & Butterworth, 1999). However, leg-to-leg BIA as an assessment of body fat change for children is not as well defined and results can vary by age, gender, especially for girls, and among different ethnicities (Daniels, Khoury, & Morrison, 1997; Taylor, Jones, Williams, & Goulding, 2002).

Results from the Likert scale eating and activity survey and the exit survey demonstrated that both the child and parent participants achieved desired changes toward healthy behaviors. The child participants reported an increase in daily physical activity levels in response to the pre and post survey statement — “I exercise 60 minutes or more each day”. In support, the parent survey scores indicated stronger agreement to the statements — “I structure an active family lifestyle” and “I exercise 30 minutes a day with my child”. Both the children and parents indicated stronger agreement with the statement “I eat 5 or more fruits and vegetables each day” at the end of the program. These results are consistent with results from a six-week program, FIT KIDS, for overweight children aged six to 12 and their parents, which is similar to the LEAP program in design and goals. According to information currently distributed by FIT KIDS, pre-post questionnaires showed that “86% of the children report eating more fruits and vegetables, 71% drink more water and 64% report exercising more as a family” (Passehl, 2005).

Qualitative Exit Survey. Part 4

26 January, 2011 (18:44) | Nutrition | By: Health news

Study results support the research hypotheses that there is a significant difference in the variables tested for children and parents before and after participation in the eight-week program. Both the LEAP children and parents achieved a mean decrease in BMI, an increased fitness level and desired changes in self-reported eating and activity behavior. In addition, the child participants achieved a significant decrease in percent body fat as measured by bio-impedance analysis. Qualitative survey results implied that behavior changes might have been influenced by increased nutrition knowledge, self-awareness, and attitude changes as well as the support system provided by program staff, family interactions, and group members.

Outcome-based reviews of family-based interventions that include nutrition education, parent involvement, behavior modification and physical activity have shown varied results Grey, 2004; Edmunds, Waters, & Elliott, 2001; Wilson, O’Meara, Summerbell, & Kelly, 2003). It should be noted that it is difficult to compare results across studies due to differences in methodologies, intervention design and target age groups. Wilson et al., (2003) concluded that multidisciplinary family-based interventions that involve parents are effective for the treatment of pediatric overweight. Kibbe and Offner (2003) report that pediatric weight management programs similar to the program investigated in the current study have been effective for weight loss and decreases in BMI and percent body fat in the short-term (8-20 weeks) as well as at long-term follow-up (6 mo-10 y).

On its website, Kidshape, an eight-week weight management program for youth and their families, reported weight loss for 87% of the participants with 80% maintaining the weight loss for at least two years (Kidshape, 2005). A smaller percentage, 56%, of children in the current study achieved significant weight loss while 6% had no change in weight, which is consistent with the program goal of decelerating weight gain. Levine, Ringham, Kalarchian, Wisniewski, & Marcus, (2001) reported a 1.7 unit decrease in BMI in 16 severely overweight children after completion of 10 and 12 week intervention programs. While the changes in mean BMI are greater than that of the current study, Levine et al. used diet restriction and structured physical activity with the goal of reducing weight in severely overweight children for the longer period of 10 to 12 weeks. The Committed to Kids program is a family-based intervention that includes diet, physical activity, behavior change and parental involvement for overweight children and youth. Sothern and associates (2002) reported a 3.0 unit decrease in BMI in 56 adolescents at 10-weeks and an additional 1.1 unit decrease at 1 year using the Committed to Kids approach.

Qualitative Exit Survey. Part 3

26 January, 2011 (15:08) | Nutrition | By: Health news

• “Exercising (being disciplined to do so).”
• “Trying to break old habits!”
• “The most difficult part of this program was changing eating habits to healthier foods most of the time.”
• “Changing initially old habits and establishing more of an awareness of better choices.”
• “Trying to eat healthy and exercise more.”
• “Eating more wheat.”
• “Giving up Taco Bell and getting up and dancing.”

Several parents responded that the most difficult part of the program surrounded feelings, family and group interactions, and increased awareness of inactivity, which is the last theme in this category. Representative statements from four parents follow.
• “Admitting to my feelings about my daughter & my own weight issues.”
• “My need to communicate w/ my spouse.”
• “Sharing my feelings with the other adults.”
• “Following through on the family-team concept of meeting daily. Getting all the reading in.”

Three parents and four children felt that there was nothing really difficult about the program for them.
The last question from the exit survey was what changes would you like to see in the LEAP program? This is an important question that can help identify wants and needs of the participants. Two parents and two children again made comments regarding time; changing the amount of outside work, the amount of time for class and replacing the food journal seemed to be a factor. However, for six parents it was not a matter of managing the time as it was for the previous question but instead the comments leaned toward increasing the length of the program. Three of those responses are listed below.
• Nothing it was great. Be longer than 8 weeks.”
• “I think to have the class last two to four weeks longer. Seems like we read a lot per week.”
• “I’d like to see the same number of sessions, but over a longer period of time. For example meet every two weeks. I feel this would give more time to absorb & practice some of the concepts.”

Twelve parents and nine children felt that no changes were needed. One parent wrote, “No changes necessary-just keep on serving the kids in our community.” and one child wrote, “I would like to see no changes in the program because it is perfect!!!!!!!!!!!!.”

The LEAP nutrition education program is a family-based intervention that includes nutrition education, physical activity, and behavior choice theory to increase awareness and promote adoption of a healthy lifestyle including healthy eating & activity patterns. The program focuses on both the individual level and the social environmental level to influence behaviors and attitudes associated with risk for overweight.

Qualitative Exit Survey. Part 2

25 January, 2011 (20:37) | Nutrition | By: Health news

Three children commented: 1) I like the fact that I met a couple of people that felt the way as I did. 2) Hanging out with the kids and 3) I liked it because of the family time, and talking about each other.
Responses to the question, “What was the most valuable part of the LEAP program?” help elucidate perceived benefits of the program. Comments from parents are presented in Table 7 and are organized by themes. The parents valued learning information and skills, increased awareness, improved attitudes or feelings, family interactions and the social support and encouragement. The responses from the children exemplified similar thoughts about the value of the program to them. Representative responses from children are listed below.

• “How they showed us to eat better kinds of foods.”
• “Learning proportions.”
• “I learned a lot of healthier habits.”
• “Probably the food summary where I check if the foods I eat are green, red, or yellow.”
• “The most valuable thing of leap is being satisfied with yourself.”
• “Learning about my feelings.” and “Talking about how I feel.”
• “Knowing that there are others like me so you are not embarrassed.”

When asked what was the most difficult part of the program the participants responses were categorized into three themes: 1) time requirements, 2) behavior change and 3) feelings, interactions and awareness. In regards to time twelve parents and seven children commented that completing the homework each week was difficult. Three parents and four children made comments regarding difficulty completing the food records. Seven parents and six children mentioned time for exercise or simply exercise as being difficult for them. Seven parents indicated that getting to class on time or the time involved in travel to and from class, the length of the class or making it each week was a difficulty. Samples of comments regarding time as a difficulty are listed below.
• “Making time to exercise every day.”
• “Filling out the daily logs-Getting the exercise in.”
• “Trying to schedule activity.”
• “Making it here every week. It was worth the effort.”
• Children:
• “It was probably getting the exercise in.”
• “Getting all the steps in.”
• “The most difficult thing about leap is keeping a daily food record.”

Behavior change is not an easy task for anyone. Ten parents and five children considered behavior changes as the most difficult part of the program for them. When time was not mentioned in a statement about exercise the assumption was that the exercise behavior was the difficulty. The following statements were written regarding behavior changes.

Qualitative Exit Survey

25 January, 2011 (16:15) | Nutrition | By: Health news

Themes were identified and are organized by the questionnaire categories along with representative responses from parents followed by child responses supporting each theme. Forty four parents and 27 children completed exit surveys. The four themes identified in the transcripts for what was liked and what was most valuable about the program were: 1) information and skills, 2) awareness and feelings, 3) behavior and family interactions, and 4) social support and encouragement. Themes identified for what was most difficult included: 1) time requirement, 2) behavior change, and 3) feelings, interactions and awareness.

Responses to the question regarding what was liked about the program are important to help the program identify what the participants enjoyed and therefore develop those features. Comments indicated that participants liked the information and skills learned during the sessions. In addition, it appeared that the learning brought out an awareness that may have spurred desired behavior changes toward healthier eating and activity patterns. Comments from parents that represent themes 1 and 2 are listed below.

• “I like every thing, because I learned about eating well, how to buy healthy foods for the family.”
• “We learned many valuable tools to help us change our habits. We are much more aware of healthy food choices & appropriate daily activity levels.”
• “I like the way it helps children/adults understand a weight problem and how it helps us to make changes.”
• “Learning so much. This class has really motivated us to get moving. We actually exercise now! We’re happier too.

Comments from the children indicate that they also liked learning and that the information helped them learn skills and become aware of behaviors in order to make desired changes. Responses from children that represent themes 1 and 2 follow.

• “It’s fun and you learn valuable eating solutions.”
• “It helps me make better food choices and portion control.”
• “I like that I see great results and I’m eating better.”
• “It just made me feel better.”

The most frequently mentioned comments for what was liked was the social support (theme 4) and encouragement from staff and other group members. Representative responses from parents include:

• “It was fun a fun program. There was always encouragement. My son loved it.”
• “It is a small group, with leaders that are helpful, not judgmental.”
• “I liked the way they taught kids to make better choices without making the feel bad about their weight.”
• “It was interesting learning that others had similar obstacles and being able to share solutions.”
• “Families coming together with their own overweight children and discussing concerns. Very accepting and non-derogatory environment.”

Eating and Activity Behavior Survey

22 January, 2011 (20:02) | Nutrition | By: Health news

Fitness test scores changed significantly from pre to post for both child and parent participants. A significant increase in strength and endurance, measured by the number of curl-ups performed in one minute was obtained for girls (mean = 3.8; SD = 8.0; p = .001) but not boys (mean = 1.4; SD = 9.9; p = .4). The same results were found for flexibility, measured by sit and reach, between boys and girls. Girls had a significant increase in flexibility (mean = 1.2; SD = 3.3; p = .02) compared with boys (mean = 0.8; SD = 5.4; p = .4). When boys and girls were combined for analysis there was a significant increase for both curl-up and sit and reach measurements overall (mean = 2.7; SD = 9.0; p = .004 and mean = 1.0; SD = 4.3; p = .03, respectively). Parent fitness test scores increased for both strength and endurance and flexibility (mean = 3.1; SD = 5.6; p < .001 and mean = 2.4; SD = 3.8; p < .001, respectively). Figure 2 represents the percentage of child and adult participants that achieved significant (p<.01) increases in fitness test scores pre to post. For those with pre and post fitness test scores, 62% of child and 69% of parent participants achieved increases in strength and endurance, measured by the number of curl-ups completed in one minute. In addition, 57% of child and 62% of parent participants achieved increased flexibility, measured by the sit-and-reach test.

Eating and Activity Behavior Survey
Approximately one-half of the 107 child-parent pairs who began the LEAP program completed both pre and post Likert questionnaires. Changes in knowledge and behavior toward diet and activity patterns were examined using paired samples t-tests. Lower scores indicate stronger agreement with desired behavior. Tables 5 and 6 show the mean change scores pre- to post- test for the child and parent participants, respectively. Girls tended to have a greater change scores in the desired direction compared to boys. Even so, changes occurred in the desired direction (toward a lower score) in that children were more likely to agree with the eating and exercise behavior statements from pre to post. When boys and girls responses were combined for analysis there were significant changes for the eating behavior statements (p < .01) and for the activity statement (p < .05) on the child questionnaire. There were also significant changes in the desired direction among the parent participants for all knowledge and behavior statements (p < .001). The mean pre scores for both child and parent participants were generally in the “neither agree” nor “disagree” and “agree” categories. Mean post scores indicated a change toward the “agree” and “strongly agree” categories. For example, children were more likely to agree to the statements, “I eat five servings of fruits and vegetables every day” (pretest mean = 3.1; SD = 0.9) to (posttest mean = 2.5; SD = 1.2 and “I exercise at least 60 minutes most days of the week” (pretest mean = 2.5; SD = 1.3) to (posttest mean = 2.0; SD = 1.1); parents were more likely to agree to the statements “I encourage my child to eat at least five servings of fruits and vegetables daily” (pre mean = 2.4; SD =1.2) to (post mean =1.8; SD =0.8) and “I structure and active lifestyle for my child that includes at least 60 minutes of exercise daily” (pre mean = 3.3; SD = 1.2) to (post mean = 2.7; SD = 1.0). Additionally, parents were more likely to agree with statements regarding role modeling, participating in at least 30 minutes of activity with their child, eating at least five servings of fruits and vegetables daily, and knowledge regarding accurate portion sizes and reading food labels. These findings illustrate desired changes in child and parent self-reported eating and activity knowledge and behavior.

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