MIRANDA R. HAWKS Early Adolescents’ Physical Activity and Nutrition Beliefs and Behaviors in an Urban Cluster in the Southeastern United States (Under the direction of JULIE K. ZADINSKY) Obesity in early adolescents is a significant public health problem that has adverse health consequences, to include increasing the risk of developing type two diabetes and hypertension. Factors such as the environment, nutrition, and physical activity contribute to obesity in early adolescents. The purpose of this ethnographic study was to explore the physical activity and nutrition beliefs and behaviors of early adolescents in an urban cluster in the southeastern part of the United States. The researcher recruited early adolescents at a community organization and collected data using three ethnographic methods: semi-structured interviewing, participant observation, and collection of artifacts. Data were analyzed using constant comparative analysis to shed light on the meaning of early adolescents’ communications about their physical activity and nutrition beliefs and behaviors. Themes that emerged from data analysis included recognizing benefits of physical activity and healthy eating, family influences, connecting with the community, peer influences, electronic media influences, and developing a sense of self. This study contributes to nursing science in three ways. First, all early adolescents recognized both physical activity and healthy eating as beneficial for promoting their health and improving the quality of their lives. Second, early adolescents described their mothers as the most influential family member for both their physical activity and healthy eating behaviors. Third, the community organization was identified as the main facilitator of early adolescents’ physical activities within their immediate environment outside their home. These findings explain three different points of entry that the nursing community can use, separately or together, for their health promotion strategies to encourage physical activity and healthy eating among early adolescents. INDEX WORDS: Early adolescents, physical activity, nutrition, healthy eating Copyright 2016 Miranda R. Hawks All Rights Reserved EARLY ADOLESCENTS’ PHYSICAL ACTIVITY AND NUTRITION BELIEFS AND BEHAVIORS IN AN URBAN CLUSTER IN THE SOUTHEASTERN UNITED STATES By Miranda R. Hawks Submitted to the Faculty of The Graduate School of Augusta University in partial fulfillment of the Requirements for the Degree of Doctor of Philosophy April 2016 ProQuest Number:10117820 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. ProQuest 10117820 Published by ProQuest LLC ( 2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346 Table of Contents Page ACKNOWLEDGEMENTS …………………………………………………………........ viii LIST OF FIGURES………………………………………………………………………. x LIST OF TABLES………………………………………………………………………… xi LIST OF APPENDICES…………………………………………………………………. xii CHAPTER 1: INTRODUCTION….………..……………………………………………. 1 Background……………………………………………………...……………………. 1 Statement of the Problem and Purpose……………………………………...……. 2 Significance………………………………………………………………………….… 3 Research Questions………………………………………….................................. 4 Interpretivism as a Philosophical Foundation…………………………………..…. 5 Ontological Assumption………………………………………………………….. 5 Epistemological Assumption…………………………………………………….. 6 Methodological Assumptions……………………………………..…………...… 6 Axiological Assumption…………………………………………………………... 7 Conceptual Framework…………………………………………............................. 8 Individual…………………………………………………………………..……..... 9 Environment……………………………………………………………………….. 10 Relationship between the Individual and the Environment………………....... 10 Definitions of Key Concepts and Terms………………………………………..….. 11 Bronfenbrenner’s Model………………………………………………………..... 11 i Concepts Related to Methodological Rigor…….……………………….……... 13 Other Concepts Used in the Study……………………………………………... 13 CHAPTER 2: PHYSICAL ACTIVITY AND NUTRITION LITERATURE REVIEW…. 17 Adolescent Physical Activity Standards………………………………………........ 17 U.S. Department of Health and Human Services……………………………... 18 American Academy of Pediatrics…………………………………………….…. 18 Strength-Training Recommendations………………………………………. 18 Organized Sports Recommendations………………………………………. 19 World Health Organization……………………………………………………..… 19 Institute of Medicine……………………………………..................................... 20 Physical Activity Guideline Adherence………………………………..……...… 20 DHHS Guideline Adherence……..…………………………………………... 20 Fitnessgram® …………………………………………………………………. 20 Adolescent Nutrition Standards……………………..…………….......................... 21 Dietary Guidelines for Americans 2010……………………………………….... 21 National School Standards……………………………..................................... 22 Qualitative Research on Adolescent Physical Activity and Nutrition……………. 23 Adolescent Physical Activity Beliefs and Behaviors…………………………..….. 24 Recognition of Health Benefits………………………………………………...... 25 Perceived Barriers………………………………………………………………… 25 Safety…………………………………………………………………………… 25 Cost and Time……………………………………………………………….… 26 Community Support…………………………………………………………… 26 Sex….…………………………………..…………………………………….… 26 Chronic Illness……………………………………………………………….… 27 ii Obesity Status……………………………………………………………….… 27 Culture………………………………………………………………………..… 28 Geographic Location…………….………………………………………….… 28 After-school Responsibilities……………………………………………….… 29 Adolescent Nutrition Beliefs and Behaviors……………………………………...… 29 Recognition of Health Benefits of Good Nutrition…….……………………..… 30 Perceived Barriers of Good Nutrition……………………………………...……. 31 Aesthetics of Fruits and Vegetables………………………………………… 31 Cost and Time……………………………………………………………….… 31 Sex……………………………………………………………………………… 31 Peer Influence ………………………………………………………………… 32 Home…………………………………………………………………………… 32 School………………………………………………………………………...… 33 Summary…………………………...………………………….………………...……. 34 CHAPTER 3: METHODS …………………………..……………………………….….. 36 Setting………………………………………………………………………………..... 36 Community………………………………………….………………………….….. 36 Community Organization…………………………………………………….…... 39 Participants…………………………………………………………………………..... 42 Rationale for Participant Selection…………………………………………….... 42 Participant Sampling Technique……………………………………………….... 42 Participant Recruitment and Enrollment ………………………………….……. 44 Sample Characteristics…………………………………………………….…….. 46 Early Adolescents as Participants…………………………………………….… 47 Data Collection……………………………………………………………………...… 49 iii Participant Observation……………………………………………………….….. 50 Participant Observation Overview….….……………………………………. 50 Participant Observation Implementation……………………………………. 52 Field Notes……………………………………………………………………... 53 Artifact Collection…………………………………………................................... 55 Semi-Structured Interviews……………………………………………………..... 56 Interview Guide Composition………………………………………………… 57 Interview Implementation…………………………………………………….. 58 Interviewing Techniques…….………….…………………………………..... 58 Artifacts…………………………………………………………………...… 58 Mapping Activity………………………………………………………...…. 58 Interview Transcription……………..…….…………………………………... 59 Data Analysis…………………………………………………………………………. 59 Methodological Rigor……………………………………………………………….... 61 Credibility…………………………………………….……………………………... 62 Transferability………………………………….…………………………………... 65 Dependability and Confirmability………………….…....................................... 66 Summary……………………………...……………………………………………….. 67 CHAPTER 4: PRESENTATION OF THE FINDINGS…………………………….….. 69 Recognizing Benefits of Physical Activity and Healthy Eating………………..…. 70 Physical Activity……………………………………………………………….….. 71 Healthy Eating………………………………………………………………….…. 73 Family Influences………………………………………………………………...…… 74 Influences of Mothers, Aunts, and Grandmothers…………………………….. 75 Physical Activity……………………………………………………………….. 75 iv Healthy Eating…………………………………………………………………. 77 Influences of Fathers, Uncles, and Male Cousins………………………….…. 79 Physical Activity……………………………………………………………….. 79 Healthy Eating…………………………………………………………………. 80 Influences of Family Practices…………………………………………………... 80 Physical Activity……………………………………………………………….. 80 Positive Influences……………………………………………………...…. 81 Responsibilities…………………………………………………………..... 82 Healthy Eating…………………………………………………………………. 83 Positive Influences……………………………………………………….... 84 Family Meals……………………………………………………………….. 84 Junk Food…………………………………………………………………... 85 Healthy Alternatives……………………………………………………….. 86 Weekends………………………………………………………………...… 86 Grandmother’s house……………………………………………………... 87 Influences of Organized Sports…………………………………………………. 88 Connecting Within the Community………………………………………………….. 89 Connecting at School…………………………………………………..……...…. 90 Physical Activity……………………………………………………………….. 90 Healthy Eating…………………………………………………………………. 92 Connecting with the Community Organization……………………………….... 93 Physical Activity……………………………………………………………….. 93 Healthy Eating…………………………………………………………………. 96 Connecting Within the Community………………………………………….…... 98 Physical Activity……………………………………………………………….. 98 v Healthy Eating………………………………………………………………….