Date of Award
Campus Access Dissertation
Dawn K Wilson
The high rate of obesity in youth contributes to the rising prevalence of metabolic syndrome and type 2 diabetes, particularly in underserved adolescents (low income, minorities) who show an increased risk for chronic disease. The present study integrated social cognitive theory and family systems theory within a bioecological framework to examine key social contextual influences on diet and physical activity (PA) in youth who are at high risk for chronic disease (diabetes, metabolic syndrome). Previous literature has supported the evaluation of social contextual variables, including parenting factors, and home and neighborhood influences, in understanding health behaviors. However, there is a dearth of literature on underserved populations, and little research examines these relations in adolescents at high risk for developing chronic diseases. The current study expanded on previous literature by examining the impact of individual factors including metabolic risk and self-efficacy, as well as family and environmental influences on diet and PA. Furthermore, the current study was novel in conducting exploratory analyses on metabolic risk for type 2 diabetes as a moderator of social contextual variables and health behaviors to better understand the onset of chronic disease. It was hypothesized that positive social contextual factors (e.g., fewer barriers, more support) would show positive relations with diet (i.e., fruit, vegetable, and reduced fat intake) and PA (light PA and moderate-to-vigorous PA) in minority and low-income adolescents. Social contextual variables included youth-reported relapse prevention self-efficacy, parent-reported parental limit-setting and monitoring, parental support, home PA resources, neighborhood supports for PA, and geographic information systems estimates of proximity to food markets and establishments. Moderation analyses with social-contextual variables and health behaviors (diet and PA) were explored with two directional hypotheses: a) that relations would be stronger in youth at higher risk such that they are more receptive to social contextual influences due to increased awareness, or b) that relations would be weaker such that further disease progression outweighs any potential social contextual benefits. Results of regression analyses showed no significant predictors of moderate-to-vigorous PA (F(9,191)=1.88, R2 = .08) but showed significant effects of parental (β = .16) and neighborhood support (β = .14) on light PA (F(9,191)=2.91, R2 = .12). Results also showed self-efficacy (β = -.27) was significantly associated with lower fat intake and limit-setting (β = .22) was significantly associated with higher fat intake. No significant effects were found for fruit and vegetable consumption (F(9,191)=2.21, R2 = .10). Exploratory results indicated that youth at higher metabolic risk showed weaker relations between positive social contextual variables and health behaviors. The current study emphasizes the importance of taking an ecological approach to understanding health behaviors in adolescents, particularly those at highest risk for developing chronic diseases including metabolic syndrome, type 2 diabetes, and cardiovascular disease later in life. Furthermore, results can be used to inform the development of more effective interventions to prevent the onset of chronic disease in underserved youth and more accurate early identification of those at greatest risk.
Lawman, H. G.(2012). Relations Among Risk For Metabolic Syndrome, Social Ecological Factors, Nutrition, and Physical Activity In Underserved Youth. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/2311