A pilot study evaluating the effects of a youth advocacy program on youth readiness to advocate for environment and policy changes for obesity prevention

Abstract

Youth advocacy for obesity prevention is a promising but under-evaluated intervention. The aims of this study are to evaluate a youth advocacy program’s outcomes related to youth perceptions and behaviors, develop an index of youth advocacy readiness, and assess potential predictors of advocacy readiness. Youth ages 9–22 in an advocacy training program (n = 92 matched pairs) completed surveys before and after training. Youth outcomes and potential predictors of advocacy readiness were assessed with evaluated scales. All 20 groups who completed the evaluation study presented their advocacy projects to a decision maker. Two of six perception subscales increased following participation in the advocacy program: self-efficacy for advocacy behaviors (p < .001) and participation in advocacy (p < .01). Four of five knowledge and skills subscales increased: assertiveness (p < .01), health advocacy history (p < .001), knowledge of resources (p < .01), and social support for health behaviors (p < .001). Youth increased days of meeting physical activity recommendations (p < .05). In a mixed regression model, four subscales were associated with the advocacy readiness index: optimism for change (B = 1.46, 95 % CI = .49–2.44), sports and physical activity enjoyment (B = .55, 95 % CI = .05–1.05), roles and participation (B = 1.81, 95 % CI = .60–3.02), and advocacy activities (B = 1.49, 95 % CI = .64–2.32). The youth advocacy readiness index is a novel way to determine the effects of multiple correlates of advocacy readiness. Childhood obesity-related advocacy training appeared to improve youths’ readiness for advocacy and physical activity.

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References

  1. 1.

    Institute of Medicine. Preventing childhood obesity: health in the balance. Washington, DC: The National Academies Press; 2005.

    Google Scholar 

  2. 2.

    Institute of Medicine. Accelerating progress in obesity prevention: solving the weight of the nation. Washington, DC: The National Academies Press; 2012.

    Google Scholar 

  3. 3.

    Linton LS, Edwards CC, Woodruff SI, et al. Youth advocacy as a tool for environmental and policy changes that support physical activity and nutrition: an evaluation study in San Diego County. Prev Chronic Dis. 2014; 11: E46.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Millstein RA, Sallis JF. Youth advocacy for obesity prevention: the next wave of social change for health. Transl Behav Med. 2011; 1: 497-505.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Millstein, RA, Woodruff SI, Linton LS, Edwards CC, Sallis JF. Development of measures to evaluate youth advocacy for obesity prevention. Revised manuscript under review: Int J Behav Nutr Phys Act.

  6. 6.

    Carlisle S. Health promotion, advocacy and health inequalities: a conceptual framework. Health Promot Int. 2000; 15: 369-376.

    Article  Google Scholar 

  7. 7.

    Martin J. The role of advocacy. Preventing childhood obesity: evidence policy and practice. 2010; 192–199.

  8. 8.

    World Health Organization. Advocacy strategies for health and development: development communication in action. Geneva: World Health Organization; 1995.

    Google Scholar 

  9. 9.

    Winkleby MA, Feighery E, Dunn M, et al. Effects of an advocacy intervention to reduce smoking among teenagers. Arch Pediatr Adolesc Med. 2004; 158: 269-275.

    Article  PubMed  Google Scholar 

  10. 10.

    Dzewaltowski DA, Karteroliotis K, Welk G, et al. Measurement of self-efficacy and proxy efficacy for middle school youth physical activity. J Sport Exerc Psychol. 2007; 29: 310-332.

    Article  PubMed  Google Scholar 

  11. 11.

    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84: 191.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Rosenberg M. Society and the Adolescent Self-Image. Princeton: Princeton University Press; 1965.

    Book  Google Scholar 

  13. 13.

    Zimmerman MA. Psychological empowerment: issues and illustrations. Am J Community Psychol. 1995; 23: 581-599.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Zimmerman MA, Rappaport J. Citizen participation, perceived control, and psychological empowerment. Am J Community Psychol. 1988; 16: 725-750.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Ryan GJ, Dzewaltowski DA. Comparing the relationships between different types of self-efficacy and physical activity in youth. Health Educ Behav. 2002; 29: 491-504.

    Article  PubMed  Google Scholar 

  16. 16.

    Prochaska JO, DiClemente CC, Toward A. Comprehensive Model of Change. Springer; 1986.

  17. 17.

    Evans WD, Ulasevich A, Blahut S. Adult and group influences on participation in youth empowerment programs. Health Educ Behav. 2004; 31: 564-576.

    Article  PubMed  Google Scholar 

  18. 18.

    Holden DJ, Messeri P, Evans WD, et al. Conceptualizing youth empowerment within tobacco control. Health Educ Behav. 2004; 31: 548-563.

    Article  PubMed  Google Scholar 

  19. 19.

    Davison KK, Lawson CT. Do attributes in the physical environment influence children’s physical activity? A review of the literature. Int J Behav Nutr Phys Act. 2006; 3: 19.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Ding D, Sallis JF, Kerr J, et al. Neighborhood environment and physical activity among youth: a review. Am J Prev Med. 2011; 41: 442-455.

    Article  PubMed  Google Scholar 

  21. 21.

    Kaczynski AT, Henderson KA. Environmental correlates of physical activity: a review of evidence about parks and recreation. Leis Sci. 2007; 29: 315-354.

    Article  Google Scholar 

  22. 22.

    Kain J, Gao Y, Doak C, et al. Obesity prevention in primary school settings: evidence from intervention studies. Preventing childhood obesity: evidence, policy, and practice. Oxford: BMJ Books, Wiley-Blackwell; 2010: 79-87.

    Book  Google Scholar 

  23. 23.

    Prosser L, Visscher TLS, Doak C, et al. Obesity prevention in secondary schools. Preventing Childhood Obesity. Evidence, Policy and Practice. Oxford: BMJ Books, Wiley-Blackwell; 2010: 88-93.

    Book  Google Scholar 

  24. 24.

    Steckler AB, Linnan L, Israel B. Process Evaluation for Public Health Interventions and Research. San Francisco: Jossey-Bass; 2002.

    Google Scholar 

  25. 25.

    Holden DJ, Evans WD, Hinnant LW, et al. Modeling psychological empowerment among youth involved in local tobacco control efforts. Health Educ Behav. 2005; 32: 264-278.

    Article  PubMed  Google Scholar 

  26. 26.

    Holden DJ, Crankshaw E, Nimsch C, et al. Quantifying the impact of participation in local tobacco control groups on the psychological empowerment of involved youth. Health Educ Behav. 2004; 31: 615-628.

    Article  PubMed  Google Scholar 

  27. 27.

    Prochaska JJ, Sallis JF, Long B. A physical activity screening measure for use with adolescents in primary care. Arch Pediatr Adolesc Med. 2001; 155: 554-559.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Prochaska JJ, Sallis JF. Reliability and validity of a fruit and vegetable screening measure for adolescents. J Adolesc Health. 2004; 34: 163-165.

    Article  PubMed  Google Scholar 

  29. 29.

    McKenzie TL, Marshall SJ, Sallis JF, et al. Student activity levels, lesson context, and teacher behavior during middle school physical education. Res Q Exerc Sport. 2000; 71: 249-259.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    McKenzie TL, Sallis JF, Prochaska JJ, et al. Evaluation of a two-year middle-school physical education intervention: M-SPAN. Med Sci Sports Exerc. 2004; 36: 1382-1388.

    Article  PubMed  Google Scholar 

  31. 31.

    Patrick K, Calfas KJ, Norman GJ, et al. Randomized controlled trial of a primary care and home-based intervention for physical activity and nutrition behaviors: PACE+ for adolescents. Arch Pediatr Adolesc Med. 2006; 160: 128-136.

    Article  PubMed  Google Scholar 

  32. 32.

    Patrick K, Norman GJ, Calfas KJ, et al. Diet, physical activity, and sedentary behaviors as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med. 2004; 158: 385-390.

    Article  PubMed  Google Scholar 

  33. 33.

    Grow H, Saelens B, Kerr J, et al. Where are youth active? Roles of proximity, active transport, and built environment. Med Sci Sports Exerc. 2008; 40: 2071-2079.

    Article  PubMed  Google Scholar 

  34. 34.

    Forman H, Kerr J, Norman GJ, et al. Reliability and validity of destination-specific barriers to walking and cycling for youth. Prev Med. 2008; 46: 311-316.

    Article  PubMed  Google Scholar 

  35. 35.

    Winkleby MA, Feighery EC, Altman DA, et al. Engaging ethnically diverse teens in a substance use prevention advocacy program. Am J Health Promot. 2001; 15: 433-436.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Altman DG, Feighery E, Robinson TN, et al. Psychosocial factors associated with youth involvement in community activities promoting heart health. Health Educ Behav. 1998; 25: 489-500.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009; 87: 123-154.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Evaluation was performed at San Diego State University. Program funding for YEAH! is provided by The California Endowment and Kaiser Permanente.

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Authors

Corresponding author

Correspondence to Rachel A. Millstein PhD, MHS.

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Funding

This paper was supported by a grant (# 68508) from the Active Living Research program of the Robert Wood Johnson Foundation.

Conflicts of interest

Authors Millstein, Woodruff, Linton, and Edwards declare that they have no conflicts of interest. Author Sallis has received grants from the National Institutes of Health, Robert Wood Johnson Foundation (Active Living Research), Centers for Disease Control and Prevention, Nike Inc., and the California Endowment. He is also a part owner of Santech, Inc., and has a consulting relationship with the University of North Carolina, Greensboro, on an NIH grant.

Additional information

Implications

Practice: Youth advocacy training for obesity-related environment and policy change has preliminary evidence of effectiveness and should be further developed for use in practice.

Policy: Youth advocacy is a promising strategy for engaging more people in the policy change process for improving health environments.

Research: The present evaluation documents positive short-term outcomes of youth advocacy training on youth participants, justifying more rigorous and longer-term evaluations.

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Millstein, R.A., Woodruff, S.I., Linton, L. et al. A pilot study evaluating the effects of a youth advocacy program on youth readiness to advocate for environment and policy changes for obesity prevention. Behav. Med. Pract. Policy Res. 6, 648–658 (2016). https://doi.org/10.1007/s13142-016-0408-6

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Keywords

  • Childhood obesity
  • Built environment
  • Nutrition
  • Physical activity
  • Policy