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Eat Healthy, Live Happy 1 Running Head: Eat Healthy, Live Happy

Eat Healthy, Live Happy: Obesity Prevention Programs Among African American Youth Based on the Social Cognitive Theory April Chu University of Texas School of Public Health

Eat Healthy, Live Happy 2 Introduction Childhood obesity is a worldwide public health problem that many children are facing today. Childhood obesity is caused by an energy imbalance between calories consumed and calories expended. About one in three American children and teens are overweight or obese, nearly triple the rate in 1963 (Overweight in Children, 2010). According to the Institute of Medicine, the epidemic of childhood obesity is developing in all 50 states across all socioeconomic levels, and among all racial societies in both genders. Particularly, the obesity prevalence tended to be highest in the southeastern regions of United States (Kaplan et al., 2005, p. 131). Data from National Health and Nutrition Examination Survey (NHANES) 2007-2008 indicated that 46.6% of non-Hispanic black and Mexican American adolescents between the ages of 12-19 had a Body Mass Index (BMI) at or above the 95th percentile based on year 2000 CDC growth charts. This prevalence is significantly higher with African American females (Ogden & Carroll, 2010). The rising trend of obesity is alarming and a major contributing factor is sugar-sweetened drinks consumption. Many studies have shown a positive correlation between excessive intake of sugar-sweetened beverages and weight gain and obesity in both children and adults (Malik et al., 2006, p.274). This disparity is thus leading to some extensive health complications. According to Must & Strauss (1999), an obese child can develop gallstones, hepatitis, and sleep apnea as short term consequences (p.2). In addition, overweight and obese children have an increased risk of developing life-threatening conditions including coronary heart disease, type 2 diabetes, high blood pressure, stroke, liver and gallbladder disease (CDC, 2009). Obesity itself is a major cause of morbidity, but the health conditions associated with obesity also contributes to increased morbidity and mortality (Maffeis & Tatò, 2001, p. 42). A study suggested that approximately

Eat Healthy, Live Happy 3 50% of childhood obesity cases carry through adulthood, and early onset obesity was a contributing factor of morbidity and mortality. Therefore, there is a need for an effective prevention and treatment for childhood obesity program. The prevalence of obesity has dramatically increased over the past decade, which has a significant economic impact in health care costs as well. Wang & Dietz estimated that 96% of hospital discharges are associated with obesity and obesity related diagnosis. They reported that from 1979-1981 to 1997-1999 period, the pattern of diabetes almost doubled from 1.43% to 2.36%, obesity and gallbladder diseases both tripled from 0.36% to 1.07% and 0.18% to 0.59%, while sleep apnea increased fivefold from 0.14% to 0.75%. The discharge data further indicated the annual hospital cost for obesity-related diseases increased from $35 million to $127 million during the two 3 year period (Wang & Dietz, 2002, p. 1-2). Another study estimated that medical expenses due to overweight and obesity children or adolescents directly made up for 9.1% of the total U.S. medical expenditures in 1998, and possibly reached 78.5 billion U.S. dollars. Moreover, the study predicted costs of medical care with the rising trend of obesity would range from $860 billion to $956 billion by year 2030, accounting for 1 in every 6 U.S. dollars spent on health care (Wang et al., 2008, p. 2323 & 2329). Failure to control the current obesity and overweight trends, the potential financial cost for both employers and government agencies would continually increase. To battle this serious health issue, Healthy People 2020 has modified many health objectives that were distinctively related to childhood obesity. Healthy People 2020 Objective 5 was addressed to “reduce the proportion of children and adolescents who are overweight or obese� (Health People 2020, 2009). Their aim is to reduce the rate of overweight or obese children and adolescents from 11% at baseline in 1988-1994, down to 5% in 2010 (Healthy

Eat Healthy, Live Happy 4 People 2010). In addition, Health People 2020 Objective 17 was created to “reduce consumption of calories from solid fats and added sugars in the population aged 2 and older” (Healthy People 2020, 2009). The goal is to cut down discretionary caloric intake, primarily from saturated fat, and added sugars. To achieve this, children and adults need to familiar themselves with their calorie need, and manage these calories in conjunction with exercise. Obesity not only occurs in the United States, it is also a leading health crisis around the world. The World Health Organization (WHO) recognizes childhood obesity as a global catastrophe, thus they developed a worldwide strategy known as the “Global Strategy on Diet, Physical Activity, and Health” to prevent childhood obesity. This global strategy identified 4 main objectives: (1) reduce risk factors for chronic diseases, (2) increase awareness and understanding of the benefits of a healthy diet and physical activity, (3) develop, strengthen, and implement global, regional, and national policies and action plans, (4) monitor science and research on healthy eating and exercise (WHO, 2004). To achieve these objectives, WHO focused on improving diet and promoting physical activity. To gain a better understanding in this field, the National Institutes of Health (NIH) designed a Childhood Obesity Prevention and Treatment Research (COPTR) to examine different approaches to prevent and reduce excessive weight gain among overweight, non-overweight and obese youth. It will study long-term intervention methods and target other stratums of influence that corresponds to childhood obesity. In addition, NIH is going to evaluate community programs and policies in 300 diverse communities across the nation to encourage healthier eating, increase active lifestyles, and reverse the growing trend of childhood obesity (National Institute of Health, 2010). It is certain that both international and national organizations have identified childhood obesity as a problem growing out of control and their establishment of objectives is necessary step to quelling this preventable problem.

Eat Healthy, Live Happy 5 Interventions are necessary to prevent and treat childhood obesity. A number of schoolbased intervention programs including a revised health curriculum and nutritional education have shown success (Sharma, 2006, p. 263). Targeting a specific population group is essential to recommend the appropriate needs for that population and successfully approach the public health problem. Research indicated low income urban African American adolescents have the highest unhealthy eating patterns, especially due to consumption of sweetened beverages every day (Wang et al., 2010, p. 1340). Their poor eating habits directly influence the prevalence of childhood obesity. In addition, this particular population group is at greater risk for many of the health complications that were described previously. Thus, it is crucial to design and implement a school-based intervention for them. Individual and Environmental Influences Individual and environmental determinants are factors that can contribute to the individualâ€&#x;s behavior. They can encourage the individual to perform certain behaviors, or depress their behaviors. Distinction in knowledge, self-esteem, and motivation are individual components that permitted to increase risk of obesity in middle school children of ethnic minorities (Stevens, 2010, p. 235). Besides personal factors, their surrounding environment can impact their lifestyle. External variables such as neighborhood safety, parental involvement, and family and peer social support can help them to adopt healthy eating and physical activity behaviors (Stevens, 2010, p. 239). Minority groups often refrain from playing in public places due to high crime neighborhoods. They also have limited access to facilities to be involved with any sport activities. Therefore, they may not have the same opportunities to be active compared to upper socioeconomic status children.

Eat Healthy, Live Happy 6 The individual and environmental determinants for dietary and exercise behaviors among African American adolescents are in need of an intervention to improve their health status. A theory that has been proven successful with many school-based interventions is the Social Cognitive Theory. The Social Cognitive Theory provides a compelling foundation to approach the interaction between the individual, environmental, and behavior, which can support useful insight to prevent and manage public health problems (McAlister et al., 2008, p.170). One example of a school-based intervention that was composed using the Social Cognitive Theory is Planet Health. This program implements classroom and physical education curriculum as the objectives of intervention. It targeted 4 behavioral changes consisting of reducing television viewing, increasing moderate and vigorous physical activity, decreasing high-fat food intake, and increasing fruits and vegetables intake. The intervention was successful resulting in less time watching the television, increased consumption of fruits and vegetables, and decreases in high fat food consumption. However, there was no significant improvement in the physical activity level. Another intervention example is the “Challenge!” program. It used both the Social Cognitive Theory and the Motivation Interviewing strategy in the intervention. This program is delivered in a home and community based setting by college mentors, and it focuses on adolescents‟ BMI, body composition, physical activity, and diet. This program also allowed the adolescents to taste healthy snacks during each session. The intervention reported an improvement in body composition, prevented a decline in physical activity, prevented an increase in BMI category, and lastly, reduction in snack and dessert consumption. In Frenn‟s Study, the program was designed to reduce fat intake and increase physical activity in middle school children. But the intervention was based on Pender‟s Health Promotion Model and Transtheoretical Model, not Social Cognitive Theory. The program looked into

Eat Healthy, Live Happy 7 different stage of change, temptation, and self-efficacy construct in relation to low-fat diets. The results denoted lower percentages of fat consumption in the post test, and a longer duration of exercise was performed. Finally, the last intervention was James‟ Study. This intervention did not use any specific theory; however it is strongly related to my targeted behavior for the public health problem. The program enforced the message of discouraging the consumption of „fizzy‟ drinks and the benefit avoiding „fizzy‟ drinks in each session. The program also used creative ideas to reiterate the messages by organizing it in music competitions, art presentations, web sites and quizzes. Results showed that the consumption of carbonated drinks decreased with the intervention, which also brought down the percentage of overweight and obese children.

Eat Healthy, Live Happy 8 Table 1 defines different effective interventions related to childhood obesity. Author Program Time Theory Design Outcome Measures Gortmake Planet 2 Social Randomized controlled Self-reported r et al. Health. school Cognitive field study physical activity, years. Theory television viewing, 32 classroom curriculum fruit and vegetables lessons (integrated in intake, and language arts, math, consumption of science and social high-fat food. studies) focused on decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity. Black et Challenge! 2 years. Social Randomized controlled Body composition, al. Cognitive trial of a home and physical activity Theory community setting level, diet patterns, Youth Adolescent Motivational 1 on 1 setting, 12 Food Frequency Interviewing sessions Questionnaire. Each session, adolescents made and tasted healthy snacks and engaged in physical activity with their mentors

Results Intervention helped reduced number of television hours per day, increased fruit and vegetable intake, and decrease energy from fat.

The percentage of overweight and obese youth had declined. Intervention effect was significant in reducing consumption of snacks/desserts, and prevented a decline in physical activity.

Eat Healthy, Live Happy 9

Frenn et al.

James et al.

Frenn‟s study.

James‟ Study.

1 school year.

1 school year.

Pender‟s health promotion model

Quasiexperimental design

Transtheoreti cal Model

4 Classroom sessions to influence low-fat diet, and duration of physical activity Cluster randomized controlled trial

No known theory

Pretest / Posttest

One Hour session for each class each term, emphasize the message of discouraging the consumption of „fizzy‟ drinks, and the benefit of it

Control fat in diet, and increase physical activity.

Intervention reduced the percentage fat intake, and improved the duration of exercise.

Reduce consumption Intervention showed a of carbonated drinks. significant increase in consumption of water. In addition, the percentage of overweight and obese children and carbonate drinks consumption both decreased in the intervention group.

Eat Healthy, Live Happy 10 The Intervention

Eat Healthy, Live Happy Mission: To teach adolescents healthy living is a fun living. Theoretical Framework – eat a well balanced diet To combat childhood obesity in African American adolescents, I decided to use the Social Cognitive Theory to develop a school-based intervention that will specifically target their negative health habits. Children spend many hours in school, and it is the best environmental setting to deliver healthy dietary and exercise patterns to them to reduce the epidemic of this public health problem. Social Cognitive Theory was created by Albert Bandura. It provides an extensive framework for understand the causes that influence human behavior. This theory also focuses on peopleâ€&#x;s potential abilities to change their environments to achieve their desire purpose. This theory has been shown effective in altering behavioral change particularly in health education. Furthermore, this theory suggests the combination of personal, behavioral, and environmental determinants create human behavior (McAlister et al., 2008, p.170). Intervention Objectives Eat Healthy, Live Happy program is designed to increase overall health in African American adolescents. The primary objective is to introduce healthy food choices and enhance active lifestyles in a fun and exciting environment. We will concentrate on equipping the adolescents with the knowledge and skills to make good decisions about the foods they consume. In addition, we want to increase their awareness on health conscious issues. This program aims to provide skills that they can carry with them in adulthood. Intervention Design

Eat Healthy, Live Happy 11 The Eat Healthy, Live Happy program is an after school program that will be available to the adolescents once a week after school for 12 weeks. The program will be implemented in low socioeconomic status neighborhood schools in the Houston Area. The number of schools that participate in the program will depend on the number of volunteered nutritionist, coaches, teachers and volunteers that are interested to commit to the 12 weeks program. The first 50 minutes of the lesson will be held in the school‟s gymnasium, and then the rest of the time will be conducted in a specific classroom. The lesson plans will be given out by the trained volunteered staff members every Friday after school for 2 hours. For each lesson, students will take part in daily physical activities, learn valuable fitness and nutrition-related information, and prepare healthy snacks that adolescents enjoy. Lesson Structure: 

Warm-up (10 minutes): Everyone will get together and stretch to prepare for their physical activity. Each week, two students are chosen to lead the stretches in front of the group. While the students are stretching, the instructor will briefly introduce the lesson plan of the day, and allow students to ask questions that come to their mind.

Let’s get moving (30 minutes): Students will engage in physical activity or active games that required them to work as a team. This will teach them how to develop teamwork skills, and be involved at the same time.

Breathe & Relax (10 minutes): Students will allow taking a water break, and relaxing before the next activity starts. They will also be given opportunity to provide feedback about the physical activity and be reminded the rest of the lesson plan for the day.

Eat Healthy, Live Happy 12 

Brain Power (25 minutes): Students will be learning about different fitness and nutrition-related information to teach them how to adopt a healthy lifestyle.

Hands-on Healthy Cooking time (30 minutes): Students will break into groups, and they will learn how to make healthy snacks by following recipes.

Chit Chat (15 minutes): The session will end with some positive feedback from the instructors, and students will be allowed to give us some thoughts about the activities of the day.

Curriculum structure: Week 1







8 9

Objective  Everyone introduce themselves  Set up ground rules for each activities  Gather a list of snacks that they like to eat and make them during Hands-on Healthy Cooking time  Learn the different components that make up a food pyramid, and identify foods for each component  Learn about the importance of a food pyramid  Activity: placing food under the appropriate component of the food pyramid  Learn to read the food labels and understand the meaning of each component  Activity: Practice reading food labels  Learn the importance of healthy eating habits  Activity: Distinguish between healthy eating habits and poor eating habits  Identify unhealthy food items such as sugar beverages consumption, intake of high-fat, salty food.  Discuss the impact of unhealthy food consumption to the body now and later in life  Tips on how to shop healthy and smart at the grocery store with your parents  Address basic functions of the body parts  Learn the importance of having a healthy body  Activity: work together in a team to demonstrate the advantage of having a healthy body  Learn about well-balanced meal  Activity: Create your own well-balanced meal on paper  Learn about the importance of being physically active

Eat Healthy, Live Happy 13

10 11

  


Activity: List physical activities that are good for your body Recognize ways to perform physical activities at home Learn basic healthy cooking skills that they can do with their parents at home Discuss the overall information learned throughout the program

Constructs Operationalized An important factor when developing an intervention is to choose an appropriate theory and apply it. The Social Cognitive Theory focuses on reciprocal determinism in the relationship between people and their environment (McAlister et al., 2008, p. 170). This theory contains many constructs, but I chose to only operationalize the constructs that supports my intervention. Table 2 defined the selected construct‟s definitions, and provides a better understanding on how the constructs play a role in the intervention. Reciprocal determinism Each week‟s lesson plan is designed to influence the interaction between individuals, environment and behavior. Together, they can reflect on the adolescents‟ performance. Outcome expectations To fully change the adolescents‟ behaviors in the Eat Healthy, Live Happy program, it is crucial to help them understand the values behind a healthy lifestyle. We expect the adolescents to adopt the behaviors by participating in each lesson, and observe others. In the intervention, the adolescents will be able to connect with the trained staffs. By watching the trained staffs perform the physical activity and adopting healthy eating habits, it will acknowledge the adolescents that the end result of participating in those tasks will be beneficial to them. Self-efficacy Our goal is to increase the adolescents‟ confidence and for them to execute the learned lessons outside of the program and onto their adult years. We want to encourage them to

Eat Healthy, Live Happy 14 continue engaging in physical activities, and adopt a healthy eating lifestyle. In return, they will live a healthier, longer life. Collective efficacy We incorporate many valuable nutritional and fitness advice in the program which can help reduce the obesity prevalence. They can teach their parents and peers about the lessons they gained through the program, and lower the obesity trend. Their ability to perform these tasks can influence healthy living now and later. Observational Learning We increase the studentsâ€&#x; knowledge about nutrition and fitness as well as engage them in different types of physical activities. This is achieved through the skills learned about the food pyramid, reading food labels, identifying the differences between healthy food items and unhealthy food items. By reinforcing these behaviors, it will encourage the adolescents to reproduce the actions and maintain them. Facilitation We focus on providing the space in the gymnasium for the adolescents to participate in the physical activities. In addition, we will use the classroom to teach them how to adopt healthy behaviors. If the classroom cannot hold all the students, then we will separate them into different classrooms. The advantage is that the program is held after school, therefore all the classrooms will most likely be available for us to use. Population targeted The population in this intervention is targeted to 6th – 8th grade females, particularly African Americans living in low socioeconomic neighborhood. As mentioned before, African American females had a higher percentage of Body Mass Index (BMI) at or above the 95th

Eat Healthy, Live Happy 15 percentile compared to other ethnicities. Therefore, they are at the highest risk for developing serious health complications such as coronary heart disease, type 2 diabetes, high blood pressure, stroke, liver and gallbladder disease. Targeting a specific population allows us to customize the best intervention to meet their needs. Setting The Eat Healthy, Live Happy program will take place in the school‟s gymnasium to perform the physical activities. Then, we will use the classroom to implement the rest of the lesson plan. The entire program will be held indoors because it is easier to keep track of the students, and also due to safety issues. Who will deliver intervention The program will recruit school coaches, teachers, nutritionists and volunteers from the Houston area. Volunteers should have a true passion in teaching life changing habits to the adolescents. In addition, we will offer it to college students who are pursuing a teaching degree, thus giving them a practical opportunity to increase experience in this field. All of them will work together to prepare and supervise the intervention. They are also required to attend training sessions, which consists of the introduction and principles of the program, and training for the curriculum. The mandatory training session will be from 9am – 4pm at the program coordinator‟s office. They will report to the coordinator via email every week about the adolescents‟ progress in the program. They are also responsible to act as a liaison between parents and program coordinator. Time Period The program will occur once a week for 12 weeks during the second semester of each school year. It will be held right after school every Friday for two hours. Usually students do not

Eat Healthy, Live Happy 16 have homework assigned to them on the weekend, therefore I want to use this opportunity and implement the intervention on Friday after school. Evaluation of Intervention Evaluation of this intervention allows us to see if the program is successful or not. It will also provide feedback on the effectiveness of the intervention. A questionnaire will be administered at the beginning and the end of the program to determine if the intervention has changed participantsâ€&#x; behaviors. Questionnaire will be anonymous. The participants will have the opportunity to complete it privately on the first and last week of the program. Then, we can use participantsâ€&#x; opinion to improve the intervention for the following school year. Recruitment Strategies I am targeting schools with predominantly African American students only. Although childhood obesity is affecting all racial societies, but we want to implement the intervention in this particular population group first because they are at the highest risk of developing childhood obesity. The program will come at no cost to the participants. Flyers will be sent home to the parents, and posted around the school. Each school will have a designated coordinator, and they will be responsible for communicating with the school administrator, parents, and the other staff members that are delivering the intervention. The participants must bring back parental consent forms, and a copy of the most current report card with their grades at or above a C, to be involved in the program. Conclusions The Eat Healthy, Live Happy program is expected to be successful in achieving its objectives and goals. Our mission is to encourage adolescents to adopt a healthy lifestyle by offering many nutrition and fitness related information to them. The lesson plans we created are educational and different each week, thus they can keep the adolescents interested to the various

Eat Healthy, Live Happy 17 topics we will introduce them. The intervention can provide the skills necessary for them to maintain healthy behaviors, as well as teaches the adolescents to work together as team, and develop friendship. In addition, the skills they learned are useful throughout their lifetime. On the other hand, there are several factors that can limit the level of success. If there are not enough volunteered staffs to deliver the intervention, then the adolescents may not be able to absorb all the materials planned for them. If the students have poor academic score, they are not allowed to participant even if they are interested in the intervention. Some parents might not think the intervention can improve their childrenâ€&#x;s lifestyle. Thus, they may not agree to let their child to be involved since a parental consent form is required. We recognize that these adolescents are living in a low socioeconomic neighborhood, therefore their family might have financial situation and they cannot purchase healthy food items at the grocery store. Thus, the children cannot fully adapt to healthy behaviors. Ultimately, we hope that through this program, the participants will commit to the new healthy behaviors that will lead to a lifetime of hale and happiness.

Eat Healthy, Live Happy 18 References Black, M. M., Hager, E. R., Le, K., Anliker, J., Arteaga, S., DiClemente, C., Gittelsohn, J., Magder, L., Papas, M., Snitker, S., Treuth, M. S., & Wang, Y. (2010). Challenge! Health Promotion/Obesity Prevention Mentorship Model among Urban, Black Adolescents. Houston academy of Med, 280-288. CDC: Overweight and Obesity-Health Consequences. (2009, August 19). Retrieved November 14, 2010, from Frenn, M., Malin, S., & Bansal, N. K. (2003). Stage-Based Interventions for Low-Fat Diet with Middle School Students. Journal of Pediatric Nursing, 18 (1), 36-45. Gortmaker, S. L., Peterson, K., Wiecha, J., Sobol, A. M., Dixit, S., Fox, M. K., & Laird, N. (1999). Reducing Obesity via a School-Based Interdisciplinary Intervention among Youth. Arch Pediatr Adolesc Med, 153, 409-418. Healthy People 2020: Objective 5. (2009, October 30). Retrieved November 14, 2010, from utrition+and+Weight+Status&Objective=NWS+HP2020%E2%80%935&TopicAreaId=3 5. Health People 2020: Objective 17. (2009, October 30). Retrieved November 14, 2010, from utrition+and+Weight+Status&Objective=NWS+HP2020%E2%80%9317&TopicAreaId= 35. Health People 2010: Objective 19-3. Retrieved November 14, 2010, from James, J., Thomas, P., Cavan, D., & Kerr, D. (2004). Preventing Childhood Obesity by Reducing Consumption of Carbonated Drinks: cluster randomized controlled trial. BMJ, 1-6. Koplan, J. P., Liverman, C. T., & Kraak, V. I. (2005). Preventing Childhood Obesity: Health in the Balance: Executive Summary. Journal of American Dietetic Association, 105 (1), 131-138. Maffeis, C. & Tatò, L. (2001). Long-Term Effects of Childhood Obesity on Morbidity and Mortality. Horm Res, 55 (1), 42-45. Malik, V. S., Schulze, M. B., & Hu, F. B. (2006). Intake of Sugar-Sweetened Beverages and Weight Gain: a Systematic Review. Am J Clin Nutr, 86, 274-288. McAlister, A. L., Perry, C. L., & Parcel, G. S. (2008). How Individuals, Environments, and Health Behaviors Interact: Social Cognitive Theory. In K. Glanz, B. K. Rimer, & K.

Eat Healthy, Live Happy 19 Viswanath (Eds.), Health behavior and health education: Theory research and practice (4th ed., pp. 169-188). San Francisco, CA: Jossey-Bass. Must, A. & Strauss, R. S. (1999). Risks and Consequences of Childhood and Adolescent Obesity. International Journal of Obesity, 23 (2), 2-11. National Institutes of Health: funded studies aim to prevent, treat childhood obesity. (2010, September 9). Retrieved November 15, 2010, from Ogden, C. & Carroll, M. Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 Through 2007-2008. (2010, June). Retrieved November 14, 2010, from Overweight in Children. (2010, June 10). Retrieved November 14, 2010, from Sharma, M. (2006). School-based Interventions for Childhood and Adolescent Obesity. Obesity review, 7, 261-269. Stevens, C. J. (2010). Obesity Prevention Interventions for Middle School-Age Children of Ethnic Minority: A Review of the Literature. Journals for Specialists in Pediatric Nursing, 15 (3), 233-243. Wang, G. & Dietz, W. H. (2002). Economic Burden of Obesity in Youths Aged 6 to 17 years: 1979-1999. Pediatrics, 109 (5), 1-6. Wang, Y., Beydoun, M. A., Liang, L., Caballero, B. & Kumanyika, S. K. (2008). Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Obesity, 16, 2323-2330. Wang, Y., Jahns, L., Tussing-Humphreys, L., Xie, B., Rockett, H., Liang, H., & Johnson, L. (2010). Dietary Intake Patterns of Low-Income Urban African-American Adolescents. J Am Diet Assoc., 110, 1340-1345. WHO: Global Strategy on Diet, Physical Activity, and Health. (2004, May). Retrieved November 15, 2010, from

Eat Healthy, Live Happy 20 Table 2 Social Cognitive Theory Construct Definitions as defined by McAlister, Perry & Parcel (2008). Construct Book Definitiona Reciprocal “Environmental factors influence individuals and groups, but individuals and determinism groups can also influence their environments and regulate their own behavior” Outcome “Beliefs about the likelihood and value of the consequences of behavioral expectations choices” Self-efficacy “Beliefs about personal ability to perform behaviors that bring desired outcomes” Collective “Beliefs about the ability of a group to perform concerted actions that bring efficacy desired outcomes” Observational “Learning to perform new behaviors by exposure to interpersonal or media learning displays of them, particularly through peer modeling” Facilitation “Providing tools, resources, or environmental changes that make new behaviors easier to perform” ᵃMcAlister, Perry & Parcel, 2008, p. 171

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