Evidence in Youth
Within the past two decades, a multitude of studies regarding health promotion in youth have been grounded in the SCT. From a health perspective most interventions have targeted physical activity, screen time, and diet (e.g., fruit and vegetable intake). School-based, community-based, and clinically based interventions are widespread. The outcomes are mixed in terms of significant change in physical activity (Young, Plotnikoff, Collins, Callister, & Morgan, 2014), whereas screen time, fruit and vegetable intake, and caloric intake appear most likely to be positively impacted from these interventions (Cheung, Dart, Kalin, Otis, & Gortmaker, 2016; Gortmaker et al., 1999a; Hermann, 2001).
A primary care pilot intervention that focused on reduced screen time in African American children from low socioeconomic status backgrounds resulted in a significant increase in organized game play (an additional 2.5 hours per week) and outside physical activity (an additional one hour per week; Ford, McDonald, Owens, & Robinson, 2002). This intervention focused on educating families about the negatives associated with excessive media use and on setting limits on screen time. Control group families received counseling only regarding television viewing, while the intervention group families received counseling plus a behavioral intervention that included an electronic television time manager. Although screen time was the main focus of the intervention, positive physical activity outcomes resulted.
An after-school program using social and environmental aspects for SCT—Fun 5—designed to increase children’s physical activity, resulted in a 14,097 minute increase in moderate-to-vigorous physical activity per week for children who were overweight or obese (Iversen, Nigg, & Titchenal, 2011). Core intervention components included the use of an active recreational program, the promotion of healthy eating, implementation of booster sessions throughout, and communication with parents via newsletters regarding educational materials about the importance of maintaining an active lifestyle for children. Similarly, the Stanford Girls Health Enrichment Multisite Studies (GEMS) Pilot Study, an after-school program targeting African American girls to promote healthy eating and physical activity habits, found a 7 percent increase in physical activity for the intervention group relative to the control group (Robinson et al., 2003; Robinson et al.,
2010). The authors chose a dance intervention because they felt it had “proximal intrinsic incentive value to participants” (pp. SI—66). It tapped into the social, cultural, and historical importance of dance in the African American communities, and the researchers believed it would mean more to this sample than simply the potential weight and health benefits of activity. GEMS Jewels dance classes were offered five days a week at three local community centers close to participants’ homes. Participants were encouraged to attend the dance classes as often as possible during the three-month intervention, but were not forced to participate. The SCT framework was emphasized through offering a healthy snack reward for participant motivation, homework help strategies to build parent self-efficacy, and incorporating female African American dance leaders to model the importance of dance/activity and to address the socio-cultural barriers in reducing screen time.
Nader et al. (1999) conducted a three-year longitudinal study of health education curricula, training to increase physical activity during physical education, and a school food service intervention program entitled CATCH (Coordinated Approach to Child Health) from grades 3-5. The program focuses on physical activity and nutrition programming, a physical education framework that encompasses goal setting and increasing children’s self-efficacy for exercise and nutrition habits, and food guidelines for the school cafeteria. It was a four center Randomized Controlled Trial (RCT) that included 56 intervention and 40 control elementary schools. The 5th grade intervention group (followed up three years later in 8th grade) showed higher self-reported physical activity than the control group, demonstrating that a comprehensive intervention founded in the SCT principles of goal setting and feedback produces sustainable effects for children’s health behaviors. Although Nader et al.’s (1999) study is the only one to follow the effects of the CATCH intervention over a long period of time, results of the CATCH program have been consistently positive in the last two decades for improving a variety of children’s health-related behaviors (Rice, Brown, & Parry, 2014).
The impact on screen time appears to be greater than that of physical activity or dietary outcomes for interventions grounded in SCT. The screen time study mentioned earlier in which intervention families received an electronic television time manager (Ford et al., 2002) showed a non-significant decrease in overall family television use and meals consumed while watching television. Eat Well and Keep Moving is an elementary-school-based intervention that uses elements of SCT to improve physical activity and increase healthy eating behaviors in children (Cheung et al., 2016). The intervention was first implemented in six intervention and eight matched control schools (Gortmaker et al., 1999a). The program utilized classroom teachers over the course of two years to teach the program in math, science, language arts, and social studies. The curricula can be adapted to meet the needs of the school and is implemented across multiple contexts, including the cafeteria, gym, and classroom. The materials focus on reducing fat intake and TV viewing while increasing physical activity and fruit and vegetable consumption. Results specific to screen time have consistently shown a reduction in television viewing (Gortmaker et al., 1999a; Hermann, 2001). The intervention focused on the SCT framework through the use of targeted goal setting and developing skills to improve perceived self-efficacy in making healthier food choices and remaining physically active. Behavioral change was the primary goal of the intervention, and secondary goals consisted of increasing student knowledge of healthy eating and activity choices, which included decreasing screen time.
A different school-based program designed to reduce screen time, increase physical activity, and improve dietary intake for elementary children found a significant decrease in television viewing and video game playing for the intervention group (Robinson et al., 2010). Within this program, elementary teachers incorporated 18 lessons during their class time to decrease media use for the students. Initially, the students were asked to self-monitor their usage in hopes that it would motivate them to want to reduce their media time. Then they were challenged to engage in no media for ten days, followed by a seven hour per week budget challenge. Newsletters with suggested strategies were sent to parents to improve parent self-efficacy related to motivating their children reduce screen time and enhance the socio-cultural aspects of the children’s behavior by providing peer social supports.
The GEMS after-school dance program described earlier resulted in 20 percent less time spent on television and video games by African American girls aged 8 to 10 (Robinson et al., 2010). The SCT emphasis for this intervention included providing students with cognitive and behavioral skills to enable change in the target behaviors (particularly goal setting), improve perceived self-efficacy to implement those behaviors, and provide the socio-cultural aspects of SCT (particularly in the form of social support from teachers) needed to overcome barriers for improving healthy behaviors. The interdisciplinary approach of this intervention allowed students to receive similar messages from different teachers across a variety of content areas, improving generalization of students’ health behaviors across settings.