Adolescents' eating, exercise, and weight control behaviors: does peer crowd affiliation play a role?

Sociocultural Influences on Exercise Behaviors and Attitudes in Adolescence

BACKGROUND

Research to date has identified a relationship between exercise in adolescence and 4 sociocultural influences: peers, family, media, and technology. Less is known, however, about the role that these sociocultural influences play in driving adolescents' exercise behaviors and attitudes, particularly social media and fitness tracking technology use. This study aimed to investigate how and why sociocultural factors are linked to exercise behaviors and attitudes in adolescent boys and girls.

METHODS

Eight focus groups were conducted in UK secondary schools with fifty-five 12- to 16-year-old adolescents (M = 14.11; SD = 1.49; n = 27 females). Following transcription and thematic analysis, 2 key themes were identified: (1) exercise pressures and (2) modeling exercise behaviors and attitudes.

RESULTS

Exercise pressures were reported to stem from parental and peer expectations around exercise, and from feeling pressure to meet externally prescribed fitness tracking technology goals. Adolescents also reported modeling the exercise behaviors of their parents or peers for social affiliation and as a means to achieve socially endorsed "ideal" body types.

CONCLUSIONS

These findings highlight the need for exercise interventions to consider the importance of exercise-related messages from others and tendencies toward conformity as a result of sociocultural expectations around exercise in adolescents.

Peer crowd affiliation, adherence, perceived support, and metabolic control in T1DM youth

Youth with type 1 diabetes (T1DM) can face many challenges when adhering to their complex regimen in the context of their peer crowd. The aim of this study was to determine if peer crowd affiliation was associated with adolescents' adherence behaviors, perceived peer support, and metabolic control. A sample of 128 adolescents with T1DM completed the Peer Crowd Questionnaire, Diabetes Social Support Questionnaire-Friends Version, and Self-Care Inventory-Revised, and HbA1c readings were collected during their clinic visit. Results from this study suggest that adherence behaviors mediated the relationship between Jock peer crowd affiliation and metabolic control. Results also suggested that perceived peer support did not mediate the relationship between peer crowd affiliation and metabolic control through adherence behaviors. When examining the path coefficients for the purposed models, results showed a positive relationship between adherence and metabolic control, and more perceived peer support was related to worse metabolic control. Adolescents who identified mostly with the Jock peer crowd may hold lifestyle values that are consistent with the diabetes regimen which may make their diabetes management easier. In general, adolescents with T1DM may have a more multifaceted aspect of one's identity and therefore, their peer crowd affiliation is not as salient.

Picture perfect? Gazing into girls' health, physical activity, and nutrition through photovoice

Background: Women face contradictions regarding their health: Pressure to be feminine, but also athletic; Criticism for being too sporty or muscular, but equally so for being perceived as lazy or overweight. These complexities are perpetuated through media and discourse.

Purpose: Using a feminist post-structural approach and photovoice, this study explored health, physical activity, and nutrition in adolescent girls and young women.

Methods: Photovoice enables reflection, promotes dialogue, and sparks change. The process involved conducting a workshop, collecting photos, and participatory analysis sessions, which engaged the participants (n = 7, ages 13–26) in photo selection, contextualization, and codifying.

Results: This resulted in three themes: First, (Breaking) Stereotypes, in which participants identified gender norms, conflicts, and contradictions; Second, Emotional Safety, or the contexts in which girls and young women feel confident and comfortable; Finally, Being Outside in Nature emerged as significant. Each theme is supported by quotations and photographs. This work suggests being outside in nature provides important context for girls and young women to feel emotionally safe, such that they may engage in the complex navigation of competing discourses surrounding health.

Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes

Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.

Freedom From Chew: Using Social Branding to Reduce Chewing Tobacco Use Among Country Peer Crowd Teens

Background. Peer crowds are macro-level, reputation-based subcultures with shared preferences, values, and behavior. The Country peer crowd has been the focus of tobacco industry research and marketing but has yet to be the primary focus of public health research. The current study explores the utility of Down and Dirty, a Social Branding tobacco education campaign, in changing Virginia Country teens’ chewing tobacco-related attitudes and behavior. The relationship between chew use and Country peer crowd identification was also explored. Method. To evaluate the campaign, a cross-sectional survey was administered online for 3 years from 2014 to 2016. Responses were collected via social media advertisements targeting 13- to 18-year-old Country youth from Virginia (total n = 1,264). Participants reported peer crowd identification, chew-related attitudes and behavior, and campaign engagement and appeal. Results. Compared with Wave 1, Waves 2 and 3 Country teens who engaged with Down and Dirty had greater odds of holding strong attitudes against chew. Among campaign-engaged Country teens, odds of chew use were lower at Waves 2 and 3, and lower odds were associated with liking the campaign. Related to chew prevalence, Country teens demonstrated greater odds of past 30-day chew use compared to non-Country teens, and higher Country identification was associated with greater odds of chew use. Discussion. Down and Dirty is a promising intervention associated with positive attitudinal and behavioral outcomes for high-risk Country teens. Additionally, this study helps document tobacco-related behavioral patterns of the Country peer crowd, a priority for ongoing tobacco education, especially around chew.

How family socioeconomic status, peer behaviors, and school-based intervention on healthy habits influence adolescent eating behaviors

Psychologists in schools can play an important role in developing policies and programs to promote healthy eating habits. This study analyses the contributions of family socioeconomic status, peer influence (schoolmates’ food consumption), and school-based nutrition interventions to explain adolescent eating behaviors. Data were obtained from the 2014 Health behaviour in school-aged children survey in Spain, with a sample of 6,851 adolescents (11- to 16-years-old). The results suggest that school-based healthy-eating programs could improve by considering parental education level and by implementing interventions focused on the peer social network. Policies that limit access to unhealthy products in schools – rather than simply offering healthy foods alongside unhealthy products – could be more effective.

Why Peer Crowds Matter: Incorporating Youth Subcultures and Values in Health Education Campaigns

Grounded on research showing that peer crowds vary in risk behavior, several recent health behavior interventions, including the US Food and Drug Administration's Fresh Empire campaign, have targeted high-risk peer crowds. We establish the scientific foundations for using this approach. We introduce peer crowd targeting as a strategy for culturally targeting health behavior interventions to youths. We use social identity and social norms theory to explicate the theoretical underpinnings of this approach. We describe Fresh Empire to demonstrate how peer crowd targeting functions in a campaign and critically evaluate the benefits and limitations of this approach. By replacing unhealthy behavioral norms with desirable, healthy lifestyles, peer crowd-targeted interventions can create a lasting impact that resonates in the target audience's culture.

Misperception of peer weight norms and its association with overweight and underweight status among adolescents

Previous research has revealed pervasive misperceptions of peer norms for a variety of behaviors among adolescents such as alcohol use, smoking, and bullying and that these misperceptions are predictors of personal behavior. Similarly, misperception of peer weight norms may be a pervasive and important risk factor for adolescent weight status. Thus, the comparative association of actual and perceived peer weight norms is examined in relation to personal weight status. Secondary school students in 40 middle and high schools (n = 40,328) were surveyed about their perceptions of the peer weight norm for same gender and grade within their school. Perceived norms were compared to aggregate self-reports of weight for these same groups. Overestimation of peer weight norms by more than 5 % occurred among 26 % of males and 20 % of females (by 22 and 16 lb on average, respectively). Underestimation occurred among 38 % of males as well as females (by 16 and 13 lb on average, respectively). Personal overweight status based on body mass index (BMI) was much more prevalent among respondents who overestimated peer weight norms as was personal underweight status among respondents who underestimated norms. Perception of the peer norm was the strongest predictor of personal BMI among all personal and school variables examined for both male and female students. Thus, reducing misperceived weight norms should be given more attention as a potential avenue for preventing obesity and eating disorders.

Associations between aspects of friendship networks and dietary behavior in youth: Findings from a systematized review

OBJECTIVE

To gather and synthesize current evidence on the associations between aspects of friendship networks (e.g., friends' dietary behavior, popularity) and an individual's dietary behavior among children and adolescents.

METHODS

A systematic search of six scientific online databases was conducted in August 2013. Eligible studies included child or adolescent participants (aged 6 to 18years), a measure of each participant's friendship network, and a measure of habitual dietary behavior for both the participant and the participant's nominated friend(s). Data on study design, participant characteristics, friendship networks, dietary behavior, and study outcomes were abstracted.

RESULTS

From a total of 9041 articles retrieved, seven studies were included in this review. Overall, friends' unhealthy food consumption was associated with an individual's unhealthy food consumption, and this association appeared to be stronger for boys compared with girls. More popular adolescents also tended to consume more unhealthy foods. Best friends' total energy intake was correlated with an individual's total energy intake. Similarities among friends' healthy food consumption, as well as daily breakfast consumption, were inconclusive. Longitudinal evidence showed that an individual's unhealthy food consumption tended to become similar to friends' unhealthy food consumption over time.

CONCLUSIONS

Social network analysis in the adolescent dietary behavior literature is beginning to emerge. Results highlight friends' particular influence on unhealthy food consumption among adolescents. Focus on modeling healthy dietary behaviors among adolescent friendship group may help reduce unhealthy dietary behaviors and promote healthy weight status among youth.

Socialization of social anxiety in adolescent crowds

In this study, we looked at whether social anxiety is socialized, or influenced by peers' social anxiety, more in some peer crowds than others. Adolescents in crowds with eye-catching appearances such as Goths and Punks (here termed Radical), were compared with three comparison groups. Using data from 796 adolescents (353 girls and 443 boys; M ( age ) = 13.36) at three timepoints, the results show that adolescents affiliating with the Radical crowd tended to select peers from the same crowd group. Being a member of a crowd in itself did not predict socialization of social anxiety, but adolescents in the Radical crowd were more influenced by their peers' social anxiety than adolescents who did not affiliate with the Radical crowd group. The results suggest that through a bidirectional process, adolescents affiliating with Radical crowds may narrow their peer relationship ties in time, and in turn socialize each other's social anxiety.

Do peers matter? A review of peer and/or friends' influence on physical activity among American adolescents

This systematic review investigated the relationship between peer and/or friend variables and physical activity among adolescents by synthesising cross-sectional, longitudinal, and experimental research conducted in the US. Seven electronic databases were searched to identify related articles published within the last 10 years and the articles reviewed included adolescents between 10 and 18 years. Studies reporting a measure of physical activity for adolescents and at least one potential peer and/or friend variable were included. Research demonstrated that peers and friends have an important role to play in the physical activity behavior of adolescents. Six processes were identified through which peers and/or friends may have an influence on physical activity including: peer and/or friend support, presence of peers and friends, peer norms, friendship quality and acceptance, peer crowds, and peer victimization. The theoretical significance of these results is assessed and the development of peer-related physical activity programs for adolescents is discussed.

Identifying interdisciplinary research priorities to prevent and treat pediatric obesity in New York City

It is well recognized that an interdisciplinary approach is essential in the development and implementation of solutions to address the current pediatric obesity epidemic. In two half-day meetings that included workshops and focus groups, faculty from diverse fields identified critically important research challenges, and gaps to childhood obesity prevention. The purpose of this white paper is to describe the iterative, interdisciplinary process that unfolded in an academic health center setting with a specific focus on underrepresented minority groups of Black and Hispanic communities, and to summarize the research challenges and gaps related to pediatric obesity that were identified in the process. Although the research challenges and gaps were developed in the context of an urban setting including high-risk populations (the northern Manhattan communities of Washington Heights, Inwood, and Harlem), many of the issues raised are broadly applicable. The processes by which the group identified research gaps and methodological challenges that impede a better understanding of how to prevent and treat obesity in children has resulted in an increase in research and community outreach collaborations and interdisciplinary pursuit of funding opportunities across units within the academic health center and overall university.

Children's acceptance of a peer who is overweight: relations among gender, age and blame for weight status

OBJECTIVE

To examine the role of blame as a mediator of the relationships between perceiver age and gender and children's acceptance of an overweight peer.

DESIGN

Cross-sectional study of children's perceptions of their overweight peers using structural equation modeling.

PARTICIPANTS

Two hundred and ninety-one children between the ages of 3 and 11 years.

MEASUREMENTS

Children viewed a videotape of a same-sex peer, dressed to appear overweight, interacting with an adult. After viewing the videotape, children responded to items assessing their perceptions of the child's social and emotional traits and how much the child was to blame for being overweight.Results:Confirmatory factor analysis indicated that the traits loaded on a single factor, acceptance.

RESULTS

of analyses for our structural equation model indicated that as blame increased, acceptance of the peer decreased. The relationships between gender and blame and gender and acceptance were not significant. Children were categorized into three age groups (3-4, 5-8 and 9-11 years) to examine the influence of age. Children between 5 and 8 years of age were less likely to blame the model compared with younger and older children.

CONCLUSION

Preschoolers reported the lowest acceptance, indicating a need for intervention for children in this age range. Furthermore, it will be important to conduct longitudinal studies to determine the influence of interventions as the child passes through different developmental stages.

Peer crowd identification and indoor artificial UV tanning behavioral tendencies

In this study, the relation between peer crowd identification and indoor tanning behavioral tendencies was examined. Participants were 174 undergraduate students at a large university in the USA. Results indicated peer crowd identification was significantly associated with indoor artificial UV tanning behavioral tendencies (attitudes, normative beliefs, past year use and intentions) independent of gender and skin type. Participants who identified with the popular peer crowd were at the greatest risk for indoor tanning UV exposure while identification with the brain crowd was protective against such behavior. The findings are discussed in terms of implications for future skin cancer intervention efforts.

Brief report: The relationship of parental support and conflict to physical activity in preadolescents with type 1 diabetes

OBJECTIVE

To use structural equation modeling to provide a preliminary examination of the relationship between parental support and conflict regarding physical activity behaviors in preadolescents with type 1 diabetes.

METHOD

Parent-child dyads (n = 85, M child age = 10.8) completed physical activity items from the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children completed physical activity items from the Center for Disease Control's Youth Risk Behavior Surveillance System, and activity was further measured via 24 hr recall interviews assessing physical activity behavior on a typical day.

RESULTS

Parental conflict was related to less frequent physical activity, whereas parental support was related to more frequent physical activity.

CONCLUSIONS

In this exploratory study, parental conflict and support for physical activity were related to physical activity in preadolescents with type 1 diabetes. Further research and development of interventions aimed at improving parental support and decreasing conflict around physical activity are warranted.

Childhood obesity: are we missing the big picture?

Childhood obesity is increasing worldwide, raising alarm about future trends of cardiovascular disease, diabetes and cancer. This article discusses what may underlie our failure to respond effectively to the obesity epidemic, and presents a wider perspective for future research and public health agendas. So far targeting individual-level determinants and clinical aspects of childhood obesity has produced limited success. There is growing interest in understanding the wider determinants of obesity such as the built environment (e.g. walkability), social interactions, food marketing and prices, but much needs to be learned. Particularly, we need to identify distal modifiable factors with multiple potential that would make them attractive for people and policymakers alike. For example, walking-biking-friendly cities can reduce obesity as well as energy consumption, air pollution and traffic delays. Such agenda needs to be driven by strong evidence from research involving multi-level influences on behaviour, as well as the study of wider politico-economic trends affecting people's choices. This article highlights available evidence and arguments for research and policy needed to curb the obesity epidemic. The upstream approach underlying these arguments aims to make healthy choices not only the most rational, but also the most feasible and affordable.

An overview of pediatric obesity

Pediatric obesity is increasing worldwide and disproportionately affects the economically and socially disadvantaged. Obese children are at risk of developing the (dys)metabolic syndrome, insulin resistance, early-onset type 2 diabetes mellitus, polycystic ovarian syndrome, hypertension, hyperlipidemia, and obstructive sleep apnoea. Those with diabetes may have mixed features of type 1 and type 2 diabetes mellitus. Pediatric obesity is the result of persistent adverse changes in food intake, lifestyle, and energy expenditure. It may be because of underlying a genetic syndrome or a conduct disorder. Children living in urban settings often lack safe, affordable, and accessible recreational facilities. Tight educational schedules mean less free time, while computer games and television have become preferred recreational activities. More families are eating out or eating take-out meals and processed foods at home because of pressures of work and time constraints. Consumer advertising targeted at children and the ready availability of vending machines encourage unwise food choices. Some children eat excessively because they are depressed, anxious, sad, or lonely. Often families and obese children are aware of the need for healthy eating and exercise but are unable to translate knowledge into weight loss. Population-based measures such as public education, school meal reforms, child-safe exercise friendly environments, and school-based and community-based exercise programs have been shown to be successful to varying degrees, but there remain individuals who will need special help to overcome obesity. Overeating (e.g. binge eating) may be a manifestation of disordered coping behavior but may also be because of defects in the neural and hormonal control of appetite and satiety. New pharmacological approaches are targeting these areas. We need a coordinated approach involving government, communities, and healthcare providers to provide a continuum of population-based interventions, focused screening, and personalized multidisciplinary interventions for the obese child and family.