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Motivators of and Barriers to Eating Healthy Foods and Snacks among Adolescents

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Title:
Motivators of and Barriers to Eating Healthy Foods and Snacks among Adolescents
Creator:
Wippold, Guillermo M
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[Gainesville, Fla.]
Florida
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University of Florida
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english
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1 online resource (32 p.)

Thesis/Dissertation Information

Degree:
Master's ( M.S.)
Degree Grantor:
University of Florida
Degree Disciplines:
Psychology
Committee Chair:
TUCKER,CAROLYN M
Committee Co-Chair:
GRABER,JULIA A
Committee Members:
WHITEHEAD,NICOLE ENNIS
Graduation Date:
5/3/2014

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Subjects / Keywords:
Adolescents ( jstor )
Criminal motive ( jstor )
Factor analysis ( jstor )
Food ( jstor )
Fruits ( jstor )
Good nutrition ( jstor )
Motivation research ( jstor )
Obesity ( jstor )
Snacking ( jstor )
Vegetables ( jstor )
Psychology -- Dissertations, Academic -- UF
adolescent -- barriers -- disparity -- health -- motivators
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bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Psychology thesis, M.S.

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Abstract:
Obesity in the U.S. is now considered a growing epidemic. This health problem is also one of the health disparities of national concern. It is particularly alarming that obesity disparities exist among youth as well as among adults as indicated by the fact that adolescents from low-income and minority groups are disproportionately affected by obesity compared to their non-Hispanic white counterparts. Engaging in health promoting behaviors such as routinely eating healthy foods and snacks and engaging in physical activity are ways of preventing and reducing obesity and obesity disparities. The major purposes of the present study are (a) to identify the motivators of and barriers to eating healthy foods and snacks among culturally diverse adolescents, and (b) to determine if the strengths of endorsement of these motivators and barriers differ by race, gender, and age. In the present study, a series of factor analyses was used to identify the motivators of and barriers to eating healthy foods and snacks among the culturally diverse adolescent participants in the national study. Specifically, an adolescent motivator of eating healthy foods and snacks scale, adolescent barrier to eating healthy foods and snacks scale, and sub-scales for each of these two scales were identified. MANOVAs were used to determine if the mean scores for these scales and sub-scales differ by race, age, and gender. Results have implications for customizing adolescent health promotion interventions, including those to reduce and prevent obesity. ( en )
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In the series University of Florida Digital Collections.
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Includes vita.
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Includes bibliographical references.
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Description based on online resource; title from PDF title page.
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This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Thesis:
Thesis (M.S.)--University of Florida, 2014.
Local:
Adviser: TUCKER,CAROLYN M.
Local:
Co-adviser: GRABER,JULIA A.
Electronic Access:
RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2015-05-31
Statement of Responsibility:
by Guillermo M Wippold.

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UFRGP
Rights Management:
Applicable rights reserved.
Embargo Date:
5/31/2015
Resource Identifier:
908645716 ( OCLC )
Classification:
LD1780 2014 ( lcc )

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1 MOTIVATORS OF AND BARRIERS TO EATING HEALTHY FOODS AND SNACKS AMONG ADOLESCENTS By GUILLERMO WIPPOLD A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2014

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2 2014 Guillermo Wippold

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3 To my parents and to my abuela

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4 ACKNOWLEDGEMENTS I am very appreciative of my advisor, Dr. Carolyn Tucker. Her exemplary mentorship has facilitated this process. I am thankful to my friends, who have always kept me connected to reality. I would also like to thank the members of my cohort, the past and present graduate student s whom I have had the pleasure to work with these years and to the undergraduate research assistants.

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5 TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................ ................................ ................................ ............. 4 ABSTRACT ................................ ................................ ................................ ................................ ..... 6 CHAPTER 1 INTRODUCTI ON ................................ ................................ ................................ .................... 8 Literature Review ................................ ................................ ................................ ..................... 8 Research Questions ................................ ................................ ................................ ................. 11 2 METHODS ................................ ................................ ................................ ............................. 13 Participants ................................ ................................ ................................ ............................. 13 Instruments ................................ ................................ ................................ ............................. 13 The Youth Form of the Motivators of and Barriers to Health Smart Behaviors Inventory (MB HSBI Youth). ................................ ................................ ..................... 14 Demographic Data Questionnaire ................................ ................................ ................... 15 Procedure ................................ ................................ ................................ ................................ 15 3 RESULTS ................................ ................................ ................................ ............................... 17 Exploratory Factor Analyses ................................ ................................ ........................... 17 Multivariate Analyses of Variance ................................ ................................ .................. 18 4 CONCLUSIONS ................................ ................................ ................................ .................... 20 APPENDIX: FACTOR LOADINGS ................................ ................................ ........................... 27 LIST OF REFERENCES ................................ ................................ ................................ ............... 29 BIOGRAPHICAL SKETCH ................................ ................................ ................................ ......... 32

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6 Abstract of Thesis Presented to th e Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science MOTIVATORS OF AND BARRIERS TO EATING HEALTHY FOODS AND SNACKS AMONG ADOLESCENTS By Guillermo Wippold May 2014 Chair: Carolyn Tucker Major: Psychology Obesity in the U.S. is now considered a growing epidemic. This health problem is also one of the health disparities of national concern. It is particularly alarming that obesity disparities exist among youth as well as among adults as indicated by the fact that adolescents from low income and minority groups are disproportionately affected by obesity compared to their non Hispanic white counterparts. Engaging in health promoting behaviors such as routinely eating healthy foods and snacks and engaging in phy sical activity are ways of preventing and reducing obesity and obesity disparities. The major purposes of the present study are (a) to identify the motivators of and barriers to eating healthy foods and snacks among culturally diverse adolescents, and (b) to determine if the strengths of endorsement of these motivators and barriers differ by race, gender, and age. In the present study, a series of factor analyses was used to identify the motivators of and barriers to eating healthy foods and snacks among th e culturally diverse adolescent participants in the national study. Specifically, an adolescent motivator of eating healthy foods and snacks scale, adolescent barrier to eating healthy foods and snacks scale, and subscales for each of these two scales were identified. MANOVAs were used to determine if the mean scores for these scales and subscales differ by race, age, and gender.

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7 Results have implications for customizing adolescent health promotion interventions, including those to reduce and prevent obesit y.

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8 CHAPTER 1 INTRODUCTION Literature Review Whether it is from media outlets, daily observations, or academic research, evidence is mounting that adolescent obesity is an alarming epidemic in the United States of America (U.S.). Consequently, in this co untry, the promotion of adolescent health has become a major priority of the national focus on obesity is the fact that First Lady Michelle Obama has spearheaded a within a generation (Edmunds, 2010). The statistics concerning adolescent and childhood obesity in the U.S. are distressing. Obesity affects approximately 1 2.5 million children and teens in the U.S., which roughly equates to 17% of the population of this country (Centers for Disease Control, 2011). Obesity among children in the U.S. is now recognized as a national epidemic. Furthermore, obesity is also a heal th disparity disease as indicated by the reality that racial and ethnic minorities are disproportionately affected by this growing obesity epidemic (Centers for Disease Control, 2011). Over the years, researchers have been uncovering the causes of obesit y and the health related tolls that occur in association with this disease. Data suggests that the contemporary obesity epidemic may be fueled by poor nutrition (Finkelstein, Hill, & Whitaker, 2008), lack of physical activity (Lee, Burgeson, Fulton, & Spai 2007), and inadequate health literacy (Brown, Teufel, & Birch, 2007). Youth obesity has been associated with adverse health outcomes such as hypertension, high cholesterol, and abnormal glucose tolerance or diabetes (CDC Ground Rounds, 2011; Deckelbaum & Williams, 2001).

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9 Along with physical health impairments, adolescent obesity also causes victimization through stigmatization. For example, one study (Puhl, Peterson, & Luedicke, 2012) concluded that overweigh t adolescent males and females are more likely to be recipients of bullying than their non overweight counterparts and that the amount of bullying increased with weight. There is much research indicating that engaging in health promoting behaviors such as healthy eating and physical activity is critical to reducing and preventing obesity among adolescents as well as among children and adults (Tucker et al., 2012). For example, it has been found that early adolescent dietary intake patterns may help predi ct obesity in young adulthood in women (Ritchie et al., 2007; Albertson et al., 2007). It has also been found that adolescents who participate in physical education five days a week may decrease the odds of adult obesity by 28% (Menschik, Ahmed, Alexander, & Blum, 2008). Due to the fact that adolescents often eat junk food (i.e., food and snacks high in fat, sodium, and/or sugar and thus unhealthy) as part of the adolescent experience (Croll, Neumark Sztainer, Story, 2001), it is particularly important to develop interventions and strategies that interventions, it is important to know the motivators of and barriers to eating healthy foods and snacks among adolescents Currently there is a dearth of research that identifies such motivators and barriers. The few common adolescent motivators of healthy eating found in the literature include prevention of disease and becoming overweight (Dixey, Sahota, Atwal, & Turner, 20 01) and attention to the positive benefits of eating healthy (Croll et al., 2001). The limited focus on the motivators of and barriers to healthy eating among adolescents is likely due to the availability of few inventories for assessing these variables. One such inventory is the Adolescent Physical Activity Perceived Benefits and Barriers Scales, which was

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10 designed based on focus group studies and contemporary literature with preadolescent (ages 11 14) girls (Robbins, Wu, Sikorsii, & Morley, 2008). It is only recently that a reliable and valid measure for assessing the motivators of and barriers to engaging in health promoting behaviors including eating healthy foods and snacks was published. This inventory is called the Youth Form of the Motivators of and Barriers to Health Smart Behaviors Inventory (Tucker et al., 2011). It is an inventory designed to be completed by adolescents and children. It is novel in that its items were generated by culturally and age diverse children and adolescents. This inven tory is particularly useful because the motivators of and barriers to each of its domain health promoting behaviors (i.e., Healthy Breakfast, Healthy Foods and Snacks, Healthy Drinks, and Physical Activity) can be assessed separately for each domain. Thus, this inventory can be used to assess the motivators of and barriers to eating healthy foods and snacks the health promoting behavior domain of interest in the present study. influence their eating habits have not reported race or ethnicity. If race and ethnicity were reported, the samples were primarily composed of non Hispanic white participants (Shepard et al., 2006). Knowing race and ethnicity of participants in studies of healthy eating is important because minorities and individuals from low income households invariably experience some different influences (e.g., cultural influences) on their eating behaviors than do their non Hispanic white counterparts. For example, the influences on the eating behaviors of youth in low income and minority communities are disproportionately affected by these communities often being located in areas with limited access to fresh food, known colloquially as food deserts (Beaulac, Kristjansso n, & Cummins, 2009).

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11 Support for obtaining the views of culturally diverse youth regarding the influences on their eating behaviors comes from the fact that much of the past research to identify these influences has involved only experts as research parti cipants. In a systematic review of such research conducted by Shepard et al. (2006), the identified barriers and facilitators of healthy eating among youth were identified by professional experts rather than by youth. In addition to research findings ind icating racial differences among adolescents with regard to eating healthy foods and snacks, there are research findings indicating some differences in this health promoting behavior in association with sex (i.e., being a female or male adolescent) (Bauer, Larson, Nelson, Story, & Neumark Sztainer, 2008; Fitzgerald, Heary, Kelly, Nixon, & Shevlin, 2013). Bauer et al. (2008) found that female adolescents tended to regard anxiety about weight as the primary catalyst to eating healthy. It was also found that m ale adolescents were A paucity of research has assessed if there are age and race differences in healthy eating habits among adolescents. Knowing whether such differences (e.g., race, g ender, and age) exist will shed light on current adolescent health disparities and provide valuable information for creating customized intervention model programs that are readily adaptable for meeting the diverse health promotion challenges of adolescent s. Research Questions The major purposes of the present study are (a) to identify the motivators of and barriers to eating healthy foods and snacks among culturally diverse adolescents, and (b) to determine if the strengths of endorsement of these motivat ors and barriers differ by race, gender, and age. The following research questions will be examined: (a) What are the motivators of and barriers to eating healthy foods and snacks among the participating sample of culturally diverse adolescents?; and (b) A re there significant differences in the strengths of the found adolescent

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12 motivators of and barriers to eating healthy foods and snacks in association with race, gender, and age?

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13 CHAPTER 2 METHODS Participants Data from a national sample of youth recruited for a research study to establish the reliability and validity of the Youth Form of the Motivators of and Barriers to Health Smart Behaviors Inventory was used. Study participants constituting this sample were 567 culturally diverse youth from seventeen states plus the District of Columbia. These participants were also from among the four major geographic regions of the United States as follows: roughly 65% of the participants were from the South, 9% from the M idwest, 7% were from the West, and 2% were from the Northeast. Approximately 16% of the participants did not report their home state. The study participants in the youth national sample included 245 (45%) males and 283 (54%) ged from 9 to 17 years with the average age being 12.19 (SD = 2.14). However, for the present study, the participants were the adolescents (ages 11 to 17) from among the youth sample for the national study who completed the Healthy Foods and Snacks porti on of the inventory. Thus, the sample for the present study consisted of 172 adolescents. The average age of these participants was 13.14 (SD = 1.58). Among these participants were 96 (55.8%) females and 71 (41.3%) males. With regard to race/ethnicity, the re were 39 (22.7%) Asian Americans, 63 (36.6%) African Americans, 36 (20.9%) Hispanics, 18 (10.5%) non race/ethnicity. Instruments Instruments used in the national stud y include: (a) the Youth Form of the Motivators of and Barriers to Health Smart Behaviors Inventory (MB HSBI Youth), (b) a Demographic Data

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14 Questionnaire, (c) the Health Smart Behaviors Goal Agreement Form, and (d) the Physical Health subscale of the Schoo l Health Efficacy Questionnaire. Of these instruments, the proposed research will utilize the Healthy Foods and Snacks domain of the MB HSBI Youth and the Demographic Data Questionnaire. The Youth Form of the Motivators of and Barriers to Health Smart Beh aviors Inventory (MB HSBI Youth). The MB HSBI Youth was developed by Tucker et al. (2011). This inventory consists of four health smart behavior domains: (a) Healthy Breakfast, (b) Healthy Drinks, (c) Healthy Foods and Snacks, and (d) Physical Activity. E ach domain of the MB HSBI Youth consists of two scales, a motivators scale and a barriers scale. Each scale consists of specific subscales. Following are the subscales and a sample item for each subscale in parenthesis for the motivators scale under the He althy Foods and Snacks domain: (a) Knowledge and Commitment for the The instruction on the MB HSBI Youth is to bubble in the how much one agrees or disagrees with each behavior listed. The items are ranked on a 4 point Likert scale ranging from strongly disagree to strongly agree. The reliability and v alidity of the Healthy Foods and Snacks domain are reported by the authors of the MB HSBI Youth to be good (Tucker et al., 2011). motivator scale and .85 for the barr

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15 Demographic Data Questionnaire The Demographic Data Questionnaire (DDQ) was used to assess the following information for each participant in the present study: race/ethnicity, age, and gender. Procedure The researchers for the larger national study (from which the data for the present stud y were obtained) obtained permission to conduct the study from the Institutional Review Board at the University of Florida. The national study (and thus for the present study) occurred at health care sites, faith based organizations, schools, and YMCAs tha t were identified with the assistance of health promotion professionals (e.g., leaders of YMCAs and directors of state offices of minority health) across the country. The list of potential data collection sites were contacted via letter or telephone and in vited to participate in the study, which involved identifying a site contact person who would recruit study participants and have each participant complete a set of study questionnaires (the assessment battery). Contact persons were individuals involved in their community such as members of social clubs, hospital employees, teachers, and church members. The contact persons were trained by telephone to enlist participants and administer the assessment battery to each participant. Each contact person then e xecuted these research roles after passing a verbal study execution competency questionnaire. The contact person corresponded weekly by telephone with the researchers to provide updates on their progress and to discuss how to address any research related p roblems encountered. Participant recruitment was conducted through a variety of methods, including word of mouth, posting flyers, and making announcements at local churches, YMCAs, schools, and other

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16 civic organization sites. Interested potential partici pants were each given a data collection packet by his or her community contact person. This packet contained a cover letter, an informed s signature, the MB HSBI Youth, and two envelopes one envelope for the signed consent and assent forms and one for the completed assessment battery. Two envelopes HSBI Youth and o ther assessments. Once researchers received the signed consent and assent forms for each youth participant from a contact person, the researchers mailed the parent/primary caregiver for the youth a $10 money order as compensation.

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17 CHAPTER 3 RESULTS Exploratory Factor Analyses To address the first research question (What are the motivators of and barriers to eating healthy foods and snacks among the participating sample of culturally diverse adolescents?), two exploratory factor analyses (EFA) with pr omax rotations were conducted employing a weighted least squares mean and variance adjusted (WLSMV) chi squared test of model fit in Mplus 7 and using the original 21 motivator items of the MB HSBI in one EFA and the original 19 barrier items of the MB HS BI Youth in the other EFA. The EFA using the motivator scale items in each factor/subscale only if that item produced a correlation of above .40 or more with t hat factor only. The following two motivator items did not yield a correlation that met this correlation criterion and thus were dropped fro I have the di with eigenvalues above 1. Items were retained in each factor only if that item produced a correlation of above .40 or more with a single factor. The following items d id not meet this criterion corre ealthy foods and snacks cost more than unh ealthy Two ensuing EFAs were conducted without the dropped items. One o f these EFAs was conducted on the motivators scale items, and the other was conducted on the barriers scale items. le loadings of above .4. Thus, this EFA was repeated without the specified multiple loading item. Final results of the two EFAs with items

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18 appropriately dropped item are presented in Tables 1 and 2. As shown in these tables the two factors/subscales in the motivators scale for the adolescent participants were Knowledge & Commitment and Routine, and the three factors/subscales in the barriers scale were Lack of Exposure, Pessimistic Attitude, and Temptation. was calculated for each new adolescent subscale. The Knowledge and Commitment ( =.860) and the Routine ( =.869) subscales within the motivator scale yielded good measures internal consistency. The Lack of Exposure ( =.715), Pessimistic Attitude ( =.795), and Temptation ( =.594) subsc ales within the barrier scale yielded adequate measures of internal consistency. Multivariate Analyses of Variance To address the second research question (Are there significant differences in the strengths of the found adolescent motivators of and barrie rs to eating healthy foods and snacks in association with race, gender, and age?), two multivariate analyses of variance (MANOVAs) were used given the conceptual inverse associations of motivator scales and barrier scales and of the subscales within each s cale. Prior to conducting these MANOVAs, age was dichotomized to reflect the ages of adolescents in middle school (i.e., ages 11 14) and the ages of adolescents in high school (i.e., ages 15 17). Additionally, assumptions necessitated by a MANOVA were exam ined. This examination revealed outliers (greater than 3 standard deviations above the mean) in the Knowledge and Commitment and Pessimistic Attitude subscales. These outliers were trimmed. No transformations were necessary. One MANOVA was conducted to ex amine race, gender and age differences in scores on the two found subscales of the motivator scale of the eating healthy foods and snacks domain. These subscales were Knowledge and Commitment and Routine. The Multivariate Tests indicated a statistically no n F (8, 284) =

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19 .746, p F (2, 141) = 1.060, p Trace = .036, F (2, 141) = 2.622, p = .076]. The second MANOVA was conducted to examine race, gender and age differences in scores on the three found subscales of the barrier scale of the eating healthy foods and snacks domain. These subscales were Pessimistic Attitude, Lack of Exposure, an d Temptation. The Multivariate Tests indicated a statistically non significant F (12, 417) = 1.039, p .015, F (3, 137) = .677, p F (3, 137) = 1.317, p = .271]. Thus, no follow up univariate analyses were conducted to address the second research question.

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20 CHAPTER 4 CONCLUSIONS The youth form of the Motivators of and Barriers to Health Smart Behaviors Inventory (MB HSBI Youth) was develop ed to measure the motivators and barriers associated with engaging in health promoting behaviors among culturally diverse youth (children and adolescents combined), including youth who are racial/ethnic minorities and/or have a low household income. The pu rposes of the present study were (a) to identify the motivators scale and its associated subscales and the barriers scale and associated subscales of the Healthy Foods and Snacks domain of the MB HSBI Youth for adolescent participants in the national study used to develop this inventory, and (b) to determine if scores on the identified subscales differ in association with race/ethnicity, gender, or age. To identify these scales and subscales exploratory factor analyses (EFAs) were used. The number of motiv ator subscales/factors and barrier subscales/factors and the names of each subscale/factor were consistent with the results for the youth (children and adolescents combined) in the national study used to develop the MB HSBI Youth. The two motivators subsca les were (a) Knowledge and Commitment and (b) Routine. The three barrier subscales were (a) Lack of Exposure, (b) Pessimistic Attitude, and (c) Temptation. It is noteworthy, however, that four items in the subscales that emerged from the EFAs applied to t he youth (children and adolescents combined) motivator and barrier item scores in the study to develop the MB HSBI Youth were dropped from the subscales that emerged from the EFAs applied to the adolescent only motivator and barrier item scores used in the present study. The dropped items may be items that are uniquely associated with children versus adolescents. One of the dropped items was dropped from the Routine motivator subscale that emerged from the EFA applied to the adolescent only data used in th e present study. Specifically this item

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21 adolescents whose data were used in the present study do not view discipline as a key motivator to engage in healthy eating given that as adolescents they have more control over their eating than when they were children. Therefore this may suggest that having discipline may be less relevant in light of the increased freedom that comes with their movement from childhood to adolescenc e. The second dropped item was dropped from the Knowledge and Commitment subscale of the motivators scale. Specif ealthy foods keep my body in may perceive exercise rather than healthy foods as necessary for body shaping. This explanation is informed It is also the case that one item was dropped from the Pessimistic Attitude barriers su ealthy foods and snacks cost more than unhealthy foods and experience peer pressure to eat unhealthy fo ods and snacks and thus the relative cost of healthy vers us unhealthy food and snacks may be irrelevant for adolescents. By contrast, children may not experience such peer pressure, and thus knowing that healthy foods and snacks cost more than unhealthy fo ods and snacks may in fact be a barrier to them eating healthy foods and snacks. from the Lack of Exposure barrier subscale that emerged in the present study may ha ve to do with the fact that adolescents very often eat at fast food restaurants where the few available

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22 healthy foods are easily typically known (i.e., salads). Because of their higher education level, adolescents may have the knowledge necessary to find h ealthy foods in any restaurants. It is I do not understand why eating fruits and vegetables study using youth (children and adoles cents combined) to develop the MB HSBI Youth, switched to the Pessimistic Attitude barrier subscale in the present study involving the adolescent data only. This switch suggests and vegetables as a significant concern given their age; instead they may simply have a distaste for fruits and vegetables (i.e., a negative attitude toward them), which is a typical reaction during the adolescent stage of development. Adolescents are more likely to enj oy eating fast foods with their friends rather than eating cooked vegetables at home given the influence of peer socialization needs. Knowledge and Commitment (M = 3.19, SD = .55) was the most strongly endorsed motivator subscale. Of the items composing the Knowledge and Commitment subscale, the mo st SD = .7) and the lea here are healthy options at most restaurants SD = .91). The motivators subscale Routine (M = 2.74, SD = .73), was endorsed with less strength than Knowledge and Commitment. Of the items composing the motivator subscale Routine, the most strongly endorse I am used to eating healthy foods an st strongly endorsed item was The most strongly endorsed items in each motivator subscale mentioned above suggests that adolescents may be confide nt in their abilities to understand the importance of eating healthy

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23 foods and snacks and to follow through with that understanding if eating healthy foods and snacks is part of their daily routine. Additionally, these most strongly endorsed items suggest that interventions to foster eating healthy foods and snacks among adolescents should include an emphasis on promoting an understanding of the nutritional importance of eating healthy and on creating an eating routine that includes eating healthy foods. T emptation (M = 2.66, SD = .76) was the most strongly endorsed barrier subscale. Of the items composing this subscale, the mo hen my family or I make or buy a meal, I do not think about whether or not it has fruits or vegetabl = 1.03), and the lea hen someone cooks or gives me unhealthy The most strongly endorsed item in the Lack of Exposure (M = 2.07, S D = .67) barrier 1.09) and th 1.64, SD = .92). The most strongly endorsed item in the barrier subscale Pessimistic Att itude (M = 1.87, I do not like the taste of low st I do not understand why eating fruits and vegetables can help me .94). The most strongly endorsed barrier subscale items may be reflective of the typical adolescent experience. The endorsement ratings for these items suggest that adolescents tend to not place much emphasis on the presence of fruits and vegetables i n their meals, which may be a product of their distaste for low fat foods. These ratings may suggest that adolescents regard their school cafeteria, a main source of weekly meals, as lacking in fruits and vegetables. If such

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24 healthy food options are indeed lacking at the school cafeteria of the adolescents whose data were used in the present study, these adolescents may have few opportunities to become accustomed to the taste of diverse fruits and vegetables. Two of the three least strongly endorsed barrie r subscale items focus on not having know o one has ever taug I do not comparative lower endorsement of these items as barriers to eating healthy foods and snacks suggest that some adolescents may be comfortable with their capabilities of identifying healthy foods and snacks and have learned at least to some degree why eating healthy foods and snacks is important. The MANOVAs applied to determine if scores on the identified subscales in the present study differed in association with race/ethnicity, gender, or age revealed differences among these demographic variables were non significant. This finding was surp rising given that previous (Djordjevic Nikic & Dopsaj, 2013), that being an adolescent male was positively associated with high fat and sugar intake pattern (McNaughton et al., 2008), and that fruit and salad intake was negatively associated with age (McNaughton et al., 2008). The differences in results between this study and other studies may be attributed to the fact that youth and adolescent participants in the study to develop the MB HSBI Youth and thus the adolescents whose data were used in the present study included large percentages of African Americans (36.6%) and Hispanics/Latinos (20.9%). Additionally, this study intentionally targeted areas/organizations with high percentages of low income adolescents, which is not the case in most of the studies that have reported age and gender differences in eating behaviors.

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25 The present study is part of the earlier study to develop the MB HSBI Youth in that the data from the adolescents only (but not the children) who were in this earlier study were used in the present study; consequently, some of the limitations in the present study are due to the limitations in the study to develop the MB HSBI Youth. Specifically, even t hough the investigators of the latter study went to great lengths in order to collect an ethnically/racially diverse sample that would accurately represent the youth of the United States, a large proportion of study participants came from the Southern Unit ed States. This geographic imbalance limits the generalizability of the findings in both studies. The size of the adolescent sample used in the present study poses certain limitations with regard to the analytic tools employed in this study. Ideally, an exploratory factor analysis would be performed on a larger number of participants than those available in the present study. However, there was a large enough number of cases to have a variable ratio of 4:1 5:1, which is deemed satisfactory (Cattell, 197 8). Additionally, the sample size is just below the 200 participants characterized as a large sample (Gorsuch, 1974). Given the limitations of the present study, future studies that seek to replicate and validate the findings from this study may benefit f rom having a larger and randomly selected sample of adolescents. Such a sample may result in the exclusion and inclusion of different motivators and barriers subscale items for the eating healthy foods and barriers domain of the MB HSBI Youth and different strengths of ratings of these items and of their overall subscales. Additionally, a larger number of adolescent participants would enable use of a confirmatory factor analysis.

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26 Future studies may seek to identify adolescent specific scales and subscale s for all domains of the MB HSBI Youth (i.e., Healthy Breakfast, Healthy Drinks, and Physical Activity). Such studies may lead to an adolescent specific version of this inventory. The present study has important implications for counseling psychologists, particularly those interested in counseling healthy psychology. Given the training of the counseling psychologists in multicultural counseling and research as well as in mental and physical health promotion to prevent disease, these professionals are perfe ctly suited to conduct culturally sensitive health promotion assessment research similar to the present study. Counseling psychologists are also trained to use a developmental approach to understanding human behavior an approach that appears needed in th e present study given the finding in this study that some of the motivators of and barriers to eating healthy foods and snacks might be different for adolescents compared to children. Additionally, counseling psychologists are well trained in culturally se nsitive inventory development. Thus, these professionals can assume leadership in conducing the next step in research needed to develop an adolescent specific version of the MB HSBI Youth that can be used with multicultural adolescent populations.

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27 APPENDIX FACTOR LOADINGS Factor loadings for the subscales of the Motivator scale Item Factor Knowledge & Commitment Routine 1. There are healthy options at most restaurants I go to. 0.56 0.005 2. I understand why healthy foods are good for my body. 0.829 0.024 3. TV programs show people getting fat from eating too much unhealthy food. 0.508 0.089 4. I think eating healthy will help me live a long, healthy life. 0.746 0.077 5. There are healthy foods that are easy to take with me. 0.538 0.264 6. There are many fruits that I like. 0.662 0.036 7. I can find healthy foods in many places. 0.551 0.102 8. Fruit is an easy snack to take with me or eat on the go. 0.59 0.158 9. I can buy healthy foods on sale. 0.573 0.007 10. There are many healthy foods that I like. 0.756 0.064 11. Someone has taught me why fruits and vegetables are healthy. 0.875 0.17 12. Eating healthy foods and snacks helps me have a body weight that I am happy with. 0.642 0.072 13. I can find healthy snacks that come in handy, small packages. 0.596 0.023 14. Eating healthy is habit for me. 0.13 0.844 15. I am used to eating healthy foods and snacks every day. 0.048 0.802 16. People around me eat healthy foods and snacks. 0.095 0.665 17. Eating healthy foods is part of my regular routine. 0.005 0.779 18. Healthy foods and snacks keep my stomach full for longer. 0.223 0.565 19. I eat healthy foods everyday so that I can be healthy. 0.041 0.874

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28 Factor loadings for the subscales of Barrier scale Item Factor Lack of Exposure Pessimistic Attitude Temptation 1. There are not many healthy foods, or fruits and vegetables, at my home. 0.655 0.097 0.176 2. At school, there are not many fruits and vegetables available. 0.525 0.193 0.024 3. In my culture or family, it is not common to eat many fruits. 0.698 0.089 0.156 4. It is hard to tell which foods are healthy and which foods are unhealthy. 0.447 0.168 0.026 5. My family members do not like eating fruits and vegetables every day. 0.619 0.063 0.042 6. No one ever taught me how to eat healthy. 0.647 0.101 0.003 7. It is hard to find healthy foods that I can easily take with me 0.397 0.003 0.35 8. I do not like the smell of vegetables. 0.046 0.779 0.07 9. Vegetables do not look good to eat. 0.039 0.779 0.014 10. I like to eat unhealthy foods when I feel stressed. 0.078 0.493 0.228 11. I do not understand why eating fruits and vegetables can help me have a healthy weight. 0.333 0.472 0.029 12. I get bored of eating the same vegetables over and over. 0.374 0.534 0.138 13. I do not like the taste of low fat foods. 0.098 0.66 0.169 14. Sometimes I just forget about trying to eat healthy. 0.001 0.047 0.709 15. When my family or I make or buy a meal, I do not think about whether or not it has fruits or vegetables in it. 0.079 0.001 0.562 16. When someone cooks or gives me unhealthy food, I eat it. 0.106 0.065 0.648

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29 LIST OF REFERENCES Albertson, A., Franko D., Thompson, D., Eldridge, A., Holschuh, N., Affenito, S., Bauserman, R., & Striegel Moore, R. (2007). Longitudinal patterns of breakfast eating in Black and White adolescent girls. Obesity, 15 2282 2292. Bauer, K., Larson, N., Nelson, M., Story, M., & Neumark Sztainer, D. (2008). Socio environmental, personal and behavioural predictors of fast food intake among adolescents. Public Health Nutrition, 12(10), 1767 1774. Beaulac, J., Kristjansson, E., & Cummins, S. (2009). A systematic review of food d eserts, 1966 2007. Prev Chronic Dis, 6(3) Bell, J., Dietz, W. H., Ogden, C. L., Popovic, T., Rogers, V. W., & Schuler, C. (2011, January 21). CDC grand rounds: childhood obesity in the United States. Morbidity and Mortality Weekly Report 60 (2), 42+. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA248578356&v=2.1&u=gain40375&it=r &p=ITOF&sw=w Brown, S., Teufel, J., & Birch, D. (2007). Earl y adolescents perceptions of health and health literacy. Journal of School Health 77 (1), 7 15. doi: 10.1111/j.1746 1561.2007.00156.x Cattell, R.B. (1978). The scientific use of factor analysis in behavioral and life sciences New York: Plenum. Centers for Disease Control and Prevention. (2010, June 4). Youth risk behavior surveillance United States, 2009. Morbidity and Mortality Weekly Report, 59 (SS 5). Retrieved from http://www.cdc.gov/mmwr/ pdf/ss/ss5905.pdf Croll, J. K., Neumark Sztainer, D ., & Story, M. (2001). Healthy eating: What does it mean to adolescents? Journal of Nutrition Education, 33, 193 198. doi:10.1016/S1499 4046(06)60031 6 Deckelbaum, R. J., & Williams, C. L. (2001). Childhood Obesity: The Health Issue. Obesity Research 9 (4) 239 243. Dixey, R., Sahota, P., Atwal, S., & Turner, A. (2001). Children talking about healthy eating: Data from focus groups with 300 9 11 year olds. Nutrition Bulletin, 26, 71 79. doi:10.1046/j.1467 3010.2001.00078.x Djordjevic Nikic, M., & Dop saj, M. (2013). Characteristics of eating habits and physical activity in relation to body mass index among adolescents. J Am Coll Nutr, 32(4) 224 233. Parks & Recreation 45(9), 15 16. Finkelstein, D., Hill, E., & Whitaker, R. (2008). School food environments and policies in us public schools. PEDIATRICS 122 (1), 251 259. doi: 10.1542/peds.2007 2814

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30 Fitzgerald, A., Heary, C., Kelly, C., Nixon, E., & Shevlin, M. (2012). Self efficacy for healthy eating patterns. Appetite, 63, 48 58. Gorsuch, R.L. (1974). Factor analysis Philadelphia: Saunders. Lee, S., Burgeson, C., Fulton, J., & Spain, C. (2007). Physical education a nd physical activity: Results from the school health policies and programs study 2006 Journal of School Health 77 (8), 435 463. doi: 10.1111/j.1746 1561.2007.00229.x Menschik, D., Ahmed, S., Alexander, M., & Blum, R. (2008). Adolescent physical activit ies as predictors of young adult weight. Arch Pediatr Adolesc Med., 162 (1) 29 33. McNaughton, S., Ball, K., Mishra, G., & Crawford, D. (2008). Dietary patterns of adolescents and risk of obesity and hypertension. J Nutr., 138, 364 370. O'Brien, M., N ader, P., Houts, R., Bradley, R., Friedman, S., Belsky, J., & Susman, E. (2007). The ecology of childhood overweight: a 12 year longitudinal analysis. International Journal of Obesity 31 (9), 1469 1478. doi: 10.1038/sj.ijo.0803611 Puhl, R., & Latner, J. children. Psychological Bulletin 133 (4), 557 580. doi: 10.1037/0033 2909.133.4.557 Ritchie, L., Spector, P., Stevens, M., Schmidt, M., Schreiber, G., Striegel Moore, R., Wang, M., & Crawford, P. (2007). Dietary patterns in adolescence are related to adiposity in young adulthood in Black and White females. The Journal of Nutrition,137 399 406. Robbins, L., Wu, T., Sikorskii, A., & Morley, B. (2008). Psychometric assessment of the Adolescent Phys ical Activity Perceived Benefits and Barriers Scales. Journal of Nursing Measurement, 16 98 112. Shepherd, J., Harden, A., Rees, R., Brunton, G., Garcia, J., Oliver, S., & Oakley, A. (2006). Young people and healthy eating: a systematic review of research on barriers and facilitators. Health Educ. Res. 21 (2), 239 257. doi: 10.1093/her/cyh060 Sims, M., Diez Roux, A., Boykin, S., Sarpong, D., Gebreab, S., Wyatt, S., Hickson, D., Payton, M., Ekunwe, L., Taylor, H. The socioeconomic gradient of diab etes prevalence, awareness, treatment, and control among African Americans in the Jackson Heart Study. Annals of Epidemiology, 21 (12), 892 898. 2010 Retrieved from http://healthyamericans.org/ reports/obesity2010/Obesity2010Report.pdf

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31 Tucker, C.M., Butler, A.M., Loyuk, I.S., Desmond, F.F., & Surrency, S.L. (2009). Predictors of a health promoting lifesty le and behaviors among low income African American mothers and White mothers of chronically ill children. Journal of the National Medical Association 101 103 110. Tucker, C., Rice, K., Hou, W., Kaye, L., Nolan, S., Grandoit, D., Gonzales, L., Smith, M., Desmond, F. (2011). Development of the motivators of and barriers to health smart behaviors inventory. Psychological Assessment, 23(2), 487 503. Tucker, C., Rice, K., Desmond, F., Hou, W., Kaye, L., & Smith, T. (2012). The youth form of the motivators of and barriers to health smart behaviors inventory. Psychological assessment 24 (2), 490 502. doi: 10.1037/a0026262

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32 BIOGRAPHICAL SKETCH Guillerm o Wippold received his Bachelor of Arts in psychology and Spanish and Hispanic studies from The University of Texas at Austin. Currently, the author is pursuing his Doctor of Philosophy in counseling psychology at the University of Florida.


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