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Intervention construct validity procedures test the efficacy of a program to impact on targeted theory constructs. To examine the intervention construct validity of the Planning to be Active (PBA) and Mentored Planning to be Active (MPBA) programs on high school youth residing in Appalachia. Twenty high schools in Appalachia were randomly assigned to either the teacher lead PBA program or the peer mentor led MPBA program. All participants (n = 633) completed a set of valid and reliable instruments assessing SCT variables: social support for exercise friends, social support for exercise family, self-efficacy for exercise and the self-regulation skills (behavioral goal setting, exercise self-monitoring, building social support, overcoming barriers, and self-reward). PBA and MPBA are effective approaches to increasing social support, self-efficacy for exercise and increasing the use of self-regulation skills to increase physical activity. The results identify constructs that were not improved suggesting areas for curriculum refinement. PBA and MPBA have established construct validity. Intervention construct validity methods identified program strengths and weaknesses. Intervention construct validity is an evidence-based approach to program improvement. Intervention construct validity establishes a foundation for testing theory impact on health behaviors. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the efficacy of a behavioral skills mentoring program (Mentored Planning to Be Active [MBA]) to a teacher‐led program (Planning to Be Active [PBA]) for increasing physical activity in Appalachian teens on health outcomes (weight loss, body mass index (BMI), and body fat). Methods: Secondary analysis of a larger group‐randomized controlled trial was conducted in 20 rural Appalachian schools. Descriptive Pearson correlations and multivariate analyses with between‐subject effects were conducted. Effect sizes (ES) using Cohen's d and odds ratios (OR) with 95% confidence intervals were calculated. Findings: The obese MBA group lost 77.5% more weight by T3 compared to the PBA group; T2 was (F = 8.51, P =.000) and T3 was (F = 7.62, P =.000). ES was 0.34. OR = 1.45 (95% CI: 0.558‐3.792) at T2 and OR = 3.32 (95% CI: 1.103‐9.978) at T3. Extremely obese in the MBA group lost 80.0% more weight compared to the PBA group; T2 was (F = 5.23, P =.025) and at T3 (F = 6.33, P =.015) ES was 0.58. OR = 4.36 (95% CI: 0.981‐19.34). Extremely obese females lost more weight compared to males (F = 4.75, P =.034). BMI and body fat had similar results; youth in the MBA group had the most improvement. Conclusions: Rural Appalachian youth are disproportionately extremely obese. BMI does not capture adiposity or cardiovascular risk. BMI, BMI percentile, raw weight, fat mass, and percent body fat are more complete analyses of adiposity and cardiovascular risk. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Sugar-sweetened beverages ( SSBs) are the largest source of added sugar in the US diet. In adolescents aged 12-19, these drinks account for 13% to 28% of total daily calories. Compared with other adolescents, those residing in Appalachia have the highest consumption rates of SSBs. METHODS Using a Teen Advisory Council (TAC), a student-designed and student-led intervention was conducted at 2 high schools in a rural Appalachian county. Using repeated-measures models design with Bonferroni correction, data were collected on daily and weekly consumption of SSBs and of water at baseline, immediately post-intervention, and 30 days post-intervention. Vending machine surveys were completed. RESULTS The 186 participants reported purchasing SSBs from school vending machines (41.4%), cafeteria (36.5%), and school stores (7.7%). Daily SSB servings decreased from an average of 2.32 ( SD = 2.14) to 1.32 ( SD = 1.29) (p < .001). Weekly consumption decreased from an average of 4.30 ( SD = 2.40) days/week to 2.64 ( SD = 1.91) (p < .001). Water consumption increased 19% from baseline to immediately post-intervention. CONCLUSIONS Student-directed efforts to support behavioral change are feasible and effective at affecting individual lifestyle behaviors. Small and manageable changes may lead to net improvements in lifestyle behaviors. [ABSTRACT FROM AUTHOR]

Background: To better understand the unique challenges of Appalachians, community-based studies are needed to establish benchmark rates. This study compares obesity rates and obesogenic behaviors among Appalachian adolescents to other adolescent populations or clinical recommendations., Methods: This study was conducted in 11 Appalachian schools. Body mass index, body mass index percentile, and body fat percentage were measured using a Tanita DC-430U analyzer. Physical activity was measured using Actigraph wGT3X-BT accelerometers. Sugar-sweetened beverage consumption was self-reported. Pearson's correlations, independent t tests, and multivariate analyses with tests of between-subject effects were conducted., Results: Mean (n = 345) age was 15.23 (SD = 1.02) years. Appalachian adolescents were extremely obese (13.1%) by more than double that of national adolescent rates. Nearly 29% of males and over 55% of females were at increased cardiovascular risk. Only 15% were moderately active for at least 60 minutes a day, but only for 1 day per week. Mean afterschool sedentary time was 4.75 hours. Only 2.1% recorded vigorous activity for a minimum of 10 minutes at 1 day per week. Nearly all regularly consumed sugar-sweetened beverages., Conclusion: Obesogenic health disparities were evident in Appalachia. Rates of obesogenic factors among Appalachian adolescents exceed national rates. Appalachian adolescents were far less active, and extreme obesity is a major health concern.

Background: Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Appalachians are the most sedentary U.S. population and teens are particularly sedentary. Obesity prevention through improving physical activity is a top priority in Rural Healthy People 2020. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Organized sports has not been effective at improving daily physical activity or health outcomes for Appalachian teens. The purpose of this study is to test the efficacy of a 10-week school-based intervention in promoting self-regulation of physical activity among adolescents not participating in organized sports. By using accelerometers, our study will measure both sedentary time and planned exercise during waking hours., Methods: The design for this four-year study is a group-randomized controlled trial (G-RCT). We will recruit high schools in 3 waves, with 4 in Wave 1, 8 in Wave 2, and 8 in Wave 3, for a total of 20 schools. For each wave of schools, we will randomly assign half of the schools to each condition--intervention (peer-to-peer mentoring [MBA]) and comparison (teacher-led [PBA])--for a total of 10 schools in each of the two conditions by study's end. We will collect data at baseline (T 1 ), 3 months post intervention (T 2 ), and 6 months post intervention (T 3 ). Linear Mixed Models (LMMs) and Generalized Linear Mixed Models (GLMMs) will be used to test the main hypotheses. Power for this study was based the primary analysis comparing BMI outcomes at T 2 between the groups, adjusting for baseline BMI values., Discussion: This study provides age-appropriate lifestyle education and skill building. Peer-to-peer mentoring by local high school students and school-based tailored support strengthens sustainable behavioral change. Focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia such as overcoming environmental, social, and psychological barriers may improve adherence to physical activity. Serving as role models, peer mentors may improve their own lifestyle behaviors, providing a dual intervention., Trial Registration: NCT02329262 .

Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting., Competing Interests: Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Comparisons in the health status of rural dwellers and care access have not traditionally considered culturally defined areas such as Appalachia. This study examined differences in parent health status, child health status, and access to care between those living in Ohio's 29 Appalachian counties and those living in Ohio's 30 rural counties. We analyzed data from the 2008 Ohio Family Health Survey including Bayesian hierarchical modeling. Child health differed by gender and ethnicity. Parent health status differed by region. Parent and child health status were related to care access. Health and access disparities exist within rural and Appalachia Ohio.