Received Date: February 11, 2015; Accepted Date: March 17, 2015; Published Date: March 23, 2015
Citation: Diehl SB, Ketcham CJ, Duffy DM (2015) Healthy Living Interventions in a Residential Girl Scout Camp. J Child Adolesc Behav 3:197. doi: 10.4172/2375-4494.1000197
Copyright: © 2015 Diehl SB et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Lifestyle habits developed in childhood often carry over into adulthood and that developing healthy habits at a young age can help prevent weight-related health problems later in life. The purpose of this study was to develop and implement an interventional curriculum based on nutrition, physical activity, and self-concept in adolescent girls to promote the development of healthy lifestyle habits. Ten girls between 11 and 14 years old (n = 12.5 ± 0.97) were recruited to participate in a five-day Girl Scout camp. Physical parameters were measured and each participant filled out a questionnaire regarding eating habits, nutritional knowledge, physical activity, and self-concept. Educational curriculum and activities corresponding to the above domains were incorporated into each day. Participants were guided in setting goals for healthy lifestyle changes over the coming months and provided with journals to track their progress. It was found that 60% of participants had a Body Mass Index (BMI) above the 85th percentile. All participants scored positive in self-concept, but a negative correlation was found between BMI percentile and selfconcept. Notable relationships were found between variables of nutrition, physical activity, and self-concept. Results suggested that the participants were of an important age range during which self-concept was still positive and was beginning to be shaped, indicating adolescence as a good time to intervene and influence positive self-concept through understanding the relationship of nutrition and physical activity on health.
Physical activity; Nutrition; Self-concept; Adolescent girls; Intervention
About 33.8% of American adults are obese  and a dramatic increase in childhood obesity and overweight has been seen in the United States over the recent past  with childhood obesity rates now reaching 17% . Obese children are not only at risk for many immediate harmful effects, but they are also at a greater risk of becoming obese adults . Developing healthy lifestyle habits at a young age is imperative to maintaining health and preventing disease throughout one’s lifetime . Areas of nutrition, physical activity, and self-concept have been identified as important in promoting healthy habits and preventing obesity .
Nutritional habits have been shown to play a significant role in the health of American adolescents. Healthy dietary habits can help to prevent chronic disease risk while poor dietary habits can have detrimental effects on areas of physical, cognitive, and emotional health [3,7-11]. Despite the potential benefits, the majority of adolescents in the United States do not meet nutritional guidelines [4,12]. One study by Striegel-Moore et al.  found that 95% of the 2379 girls surveyed failed to satisfy the Healthy People 2010 recommendations when it came to daily fruit and vegetable intake.
Physical activity is also a significant component of healthy lifestyle habits that can play a role in adolescent wellbeing. Regular physical activity contributes to muscular strength and endurance while strengthening bones, preventing chronic disease, promoting mental health, and benefiting cognitive function [3,4]. Resistance training, aerobic exercise, flexibility, balance, and coordination are all important aspects of physical activity that can provide benefits such as promoting cardiovascular health, aiding in weight control, preventing sports injuries and chronic disease, promoting bone mineral density, and improving motor skills vital to normal functioning [14-17].
The effects of physical activity levels can be measured through health parameters such as blood pressure, heart rate, and steps per day. In previous studies, high blood pressure has been associated with high BMI and low physical fitness level in adolescents . Step counting through pedometers is a simple way to determine if young subjects have met the recommended 60 minutes of daily physical activity with approximately 10,000-11,700 steps equating to the guidelines . Many body composition and fitness measures may not be appropriate as a standard measure in pediatric populations. Growth and sexual maturation factors can be unaccounted for in these criteria, BMI percentiles are more valid for comparisons in this age range .
Self-concept in adolescent girls can have a significant impact on both physical activity and dietary habits during this vulnerable period in life, thus affecting the development of healthy lifestyle habits . Adolescent females seem to be particularly impacted by body image; an aspect of self-concept. Influences of print and television media have been found to be associated with body dissatisfaction and the desire to be thinner in girls as young as 6 years old. This preoccupation can lead to issues such as disordered eating, low self-esteem, and obesity . Body weight itself has been negatively associated with self-esteem in this population, affecting perceived social acceptance, athletic competence, scholastic competence, and more . This provides evidence for the detrimental implications of adolescent obesity on not only physical, but also psychological health.
Providing education and positive guidance in the areas of nutrition, physical activity, and self-concept and the integration of these areas would be valuable in developing healthy lifestyle habits for prevention of overweight and obesity in adolescent girls. Programs such as “New Moves”  have been implemented in some high schools to offer advice on nutrition, self-image, and physical activity attitudes, and to provide access to exercise. Adolescent girls who participated showed a significant increase in physical activity levels and reported the program had a positive effect on their attitudes toward exercise, eating habits, and self-image. Therefore, educational programming may be beneficial in preventing overweight and obesity in adolescent girls, but more research into this area would be of great value to the field . The purpose of this study is to develop an educational and experiential intervention involving basic nutritional, physical activity, and self-concept components in an effort to promote healthy lifestyle habits in adolescent girls. The intervention will serve as a pilot curriculum.
This study looked at a sample of 10 adolescent girls ranging in chronological age from 11 to 14 years old (n = 12.5 ± 1.0 years) with a mean BMI of 25.7 ± 7.3 kg/m2. Biological age and puberty status were not gathered from our participants. One participant was excluded from select physical tests due to medical reasons and one participant failed to complete the questionnaire. Further demographic information was collected on the participants and can be found in Table 1. The study took place at the Ginger Cascades Girl Scout camp in Lenoir, NC over a period of 5 days. Participants signed up for the “It’s Your Life, Live It” camp session which was advertised in the Girl Scout Summer Camp brochure for the Peaks to Piedmont counsel. IRB approval was obtained and consent forms were signed by participants and their parents before the start of the camp.
|Participant||Age (yrs)||BMI (kg/m2)||BMI Percentile (%)|
Table 1: Participant demographics
At the start of the study, participants were asked to fill out a questionnaire about their current eating habits and activity levels. The designed questionnaire included components of nutrition, physical activity, and self-concept both in the form of original questions and from previously designed questionnaires. The nutritional components of the administered questionnaire came from the Food Frequency Questionnaire  and original questions which focused on knowledge of a healthy meal, eating habits, and fast food frequency. As part of the questionnaire, participants were asked to give an example of what they consider to be a healthy meal and scored on representation of food groups and quality of the foods named (1 point for each food group and an additional point for high-quality foods). Each member of the research team independently scored participants and an average score was used for analysis.
|Awareness of Healthy Meal & BMI Percentile||r = -0.620, p = 0.056|
|Awareness of Healthy Meal & Coordination/ Balance Perception||r = 0.736, p < 0.05|
|Awareness of Healthy Meal & Self-concept||r = 0.639, p < 0.05|
Table 2: Nutrition Variable Correlations.
Physical measures including body composition, cardiac fitness/endurance, muscular strength/endurance, flexibility, and coordination/balance were taken at the beginning of the study. Body composition was measured through height, weight, body mass index, body fat percentage, and waist and hip circumferences. Body mass index was plotted using the standard curve for BMI percentile in girls between the ages of 2 and 20 years . Participants who fell outside of the range for girls between 2 and 20 years of age in BMI percentile were assigned percentiles based on the extent to which their BMIs exceeded the 100th percentile. Cardiac fitness and endurance were measured through resting heart rate, blood pressure, and the YMCA Step Test exercise . The Y-Balance test ™ (move2perform.com) was used to measure coordination/ balance. The Y-Balance measures dynamic balance; participants stood on one foot while moving an apparatus with the other foot in multiple directions. The President’s Challenge curl-up test  and the sit-and-reach test  were also included. Participants completed each of the physical tests by rotating through stations being administered by one of the research team members. In addition, components of physical activity were included in the questionnaire given at the beginning of the week. Participants were asked to name their favorite physical activities and scored based on whether they named lifetime physical activities (i.e. recreational sports, walking, etc.) or exercises (i.e. going to the gym, push-ups, sit-ups, etc.). They were also asked to report their favorite leisure-time activities and scored based on whether these were active (sports, playing outside, etc.) or sedentary (electronics time, reading, etc.). Lastly, journals were provided as a tool for participants to record their pedometer-based daily steps, daily physical activity, food group intake, set personal goals, and self-assess their progress.
|Dynamic Balance & BMI Percentile||r = -0.644, p = 0.061|
|Dynamic Balance & Flexibility||r = 0.681, p < 0.05|
|Perception of Fitness & Perception of Strength||r = 0.745, p < 0.05|
Table 3: Physical activity variable correlations.
Self-concept was assessed by means of the questionnaire that participants were asked to complete at the start of the camp. The self-concept portion of the questionnaire was developed by selecting questions from the Physical Self-Description Questionnaire II , Physical Self-Perception Profile , and the addition of original questions. Perceptual composite measures of self-concept, fitness, coordination/balance, strength, and body esteem were analyzed by grouping appropriate questionnaire items.
|Self-concept & BMI Percentile||r = -0.624, p = 0.054|
|Self-concept & Body Esteem||r = 0.878, p < 0.005|
|Body Esteem & BMI Percentile||r = -0.730, p < 0.05|
Table 4: Self-concept variable correlations.
Intervention curriculum centered on the areas of nutrition, physical activity, and self-concept and was delivered for 1-3 hours during each of the five days of the camp. The curriculum included educational activities and group sessions.
Nutritional curriculum focused on learning about the basic food groups, recommended daily servings of each food group, serving sizes, balanced meals, healthy food substitutions, discretionary calories, mindful eating, and the influence of nutrition on self-concept. Demonstrations of comparing household objects to servings of food, having participants give examples of healthy meals, and going over the MyPlate diagram (choosemyplate.gov) were used to generate discussion between the research team and subjects. The educational discussions were made applicable through activities including a grocery store scavenger hunt, baking with healthier substitutions, and allowing subjects to assemble their own healthy recipe books.
Physical activity curriculum focused on the components of physical activity, FITT (Frequency, Intensity, Time, Type) principles, daily recommendations, incorporating variety, leading active lifestyles, measures of physical activity and what they mean, and how physical activity can influence one’s self-concept. Aerobic exercise, strength, flexibility, and coordination were emphasized as important aspects of physical activity. Participants were given heart rate monitors to use during hikes and relay games in order to observe how the heart responds to physical activity. Rock-climbing was used to demonstrate coordination in physical activity and how it can be improved with practice. In addition, a Nintendo Wii™ console was used to demonstrate that physical activity can be enjoyable and reaches beyond planned exercise. Emphasis was placed on highlighting the aspects of physical activity in combination with enjoyable lifetime physical activity.
Self-concept was integrated throughout physical activity and nutritional education with some individual focus during group discussions. Topics of self-efficacy, individual differences, media influences, and setting and keeping personal goals were the focus of self-concept curriculum. These topics were addressed through both individual and group conversation between the research team and participants.
Aspects of nutrition, physical activity, and self-concept were integrated throughout group and individual discussions to bring attention to the interconnectedness of these areas. Journals were provided as a place for participants to record their daily physical activity, nutritional intake, goals, and feelings about both the process and themselves during the camp week. Subjects were asked to continue journal use throughout the following summer to track their progress.
Data analysis was focused on knowledge, behavior, and self-concept assessments as performed through questionnaires in relation to measured physical characteristics and performance. Pearson Correlations were calculated to assess associations between variables using SPSS (v.20) with significance value set at p < 0.05 and trends reported at p < 0.1. Demographic, physical measures, and self-concept variables were included in the analysis to determine any area of significant correlation in baseline measures. Questionnaires were scored and also included in data analysis to determine any significant correlations.
Body mass index percentile was negatively correlated with awareness of a healthy meal (r=-0.620, p=0.056). Perception of coordination/balance and self-concept were positively correlated with awareness of a healthy meal (r=0.736, p<0.05 and r =0.639, p<0.05). Overall, 6 out of 9 participants were aware of healthy meals and were able to provide an example. The same proportion (6/9) indicated that healthy eating was important to them. Four of the 10 participants reported eating sweets multiple times per day and 6 of the 10 participants reported eating fast food at least twice per week.
Dynamic balance was negatively correlated with body mass index percentile at nearly significant levels (r=-0.644, p=0.061). Dynamic balance and flexibility were positively correlated (r=0.681, p<0.05). Questionnaire variables of perception of fitness and perception of strength showed a significant, positive correlation (r=0.745, p<0.05). All participants fell below the 85th percentile for the President’s Challenge curl-up test. On questionnaires, 7 out of 9 participants reported that exercise was important to them and 6 out of 10 named exercises as their favorite physical activities as opposed to naming lifetime physical activities. When asked what they liked to do during their free time, 7 out of 9 participants reported active leisure-time activities rather than sedentary.
Self-concept and body mass index percentile were negatively correlated (r=-0.624, p = 0.054) while self-concept and body esteem were positively correlated (r=0.878, p<0.005). All participants (10/10) had positive self-concepts as reported through the questionnaire. A significant negative correlation was found between body esteem and BMI percentile (r=-0.730, p<0.05). The most important factors to the group as a whole were body weight and sport (scoring 4.2 and 4.7 out of 5, respectively) when asked to rank certain personal and physical activity aspects by level of importance. The least important factors were strength, flexibility, healthy eating, and exercise. Six of the 9 participants indicated appearance as being important to them.
Trends in stratification
Data was analyzed by stratifying the participants and comparing results from the 3 participants in the highest BMI percentiles with the results of those from the participants in the lowest BMI percentiles. When asked to rate the importance of several physical activity and personal aspects, the most important category (5 being very important) among the highest BMI percentile group was sport (average score of 5 out of 5) while the most important categories in the lowest BMI percentile group were strength, coordination, exercise, body weight, and sport (average scores of 4 each). Appearance was more important to those of the highest BMI group (average score of 4.67) than those of the lowest BMI group (average score of 3). Endurance was also of greater importance to those in the highest BMI group (average score of 4.67) than those in the lowest BMI group (average score of 3.5). The lowest self-concept score (3.9) was seen in the participant falling within the highest BMI percentile. Among the highest BMI percentile group, 2 of the 3 participants fell below the 50th percentile on V-sit flexibility score while the 3rd participant in this group, who fell among the highest BMI percentile of the entire sample, was above the 85th percentile for flexibility. Among the lowest BMI percentile group, 2/3 of participants scored above the 85th percentile on the V-sit flexibility test while the 3rd participant scored below the 50th percentile.
This study evaluated the effects of healthy lifestyle intervention in adolescent girls with a focus on nutrition, physical activity, and self-concept. Findings indicated areas of importance regarding lifestyle intervention in this population, gaps in knowledge, successes in conveying information in a manner relevant to adolescent girls, and room for improvement in curriculum.
Awareness of a healthy meal showed notable relationships with several variables. Results showed a negative correlation between BMI percentile and awareness of a healthy meal, suggesting that participants who knew more about eating healthfully may have been able to implement this knowledge to obtain better nutritional quality and maintain lower BMI percentiles. The positive correlation seen between healthy meal awareness and coordination/balance measures could indicate that participants who were more aware of healthy eating could possess more healthful habits or awareness of their bodies overall. This could also indicate that participants with higher nutritional knowledge have more practice with physical activities requiring coordination and balance. The positive correlation between healthy meal awareness and self-concept measures could suggest that participants who are confident in their ability to eat healthfully could carry that confidence over into having an overall more positive self-concept. The relationship could also be attributed to positive family or social influences playing a role in eating habits and overall positive overall self-concept. Overall, there was a high awareness of healthy meals among participants and healthy eating was rated at a high level of importance. Despite this knowledge and importance there was a relatively high frequency of fast food and sweets consumption. This disconnect provides evidence that knowledge alone does not dictate actions.
Results from physical testing indicated that all participants were below the 85th percentile for curl-ups in their age group. This suggests a lack of core strength among this age group across body types. Due to the interrelated nature of core strength, posture, coordination, and balance, poor core strength may negatively affect physical performance in these areas. The positive correlation between perception of strength and perception of fitness could have been influenced by the fact that strength perception was based on a single question. It is also possible that participants of this age group were not clear about the difference between strength and fitness and that they may have been difficult to distinguish. The majority of participants reported exercises as their favorite physical activity. This could indicate a lack of clear perception about what it means to live an active lifestyle and could also be attributed to participants thinking that exercises would be considered “right” answers in this setting. Overall, the participant group seemed to be fairly active with the majority reporting active leisure-time physical activities during free time rather than sedentary.
As BMI percentile increased among participants, self-concept decreased. This could be attributed to social and body image pressures that are prevalent in adolescent girls . Self-concept fell within the positive range for each participant despite BMI percentile. This suggests that these participants may have not yet entered the vulnerable phase when self-concept starts to play a major role in their everyday lives. The group dynamic may have also played a role in these results. Participants were very supportive of their peers throughout the camp week, which could have positively influenced self-concept through social support.
The questionnaire results indicating that body weight and sport were the most important factors to participants indicate that these may be the most prevalent factors among adolescent girls. Adolescent girls may deal directly with the pressures of sport and weight more often than specific aspects, such as strength and flexibility, which were rated as less important. The results of strength, flexibility, healthy eating, and exercise being reported as least important factors indicates that the participant group may not be aware of the relationship between individual factors of physical activity and performance in sport, which was rated as one of the most important factors. There is also a gap in realizing the connection between exercise, healthy eating, and weight. Whereas weight was named one of the most important factors, exercise and healthy eating were least important. Additionally, the majority of participants found appearance to be important. The combination of these results could indicate that appearance is more important to adolescent girls than physical health at this age.
Trends in stratification
The trends seen in stratified results may have been compromised by the fact that there were only 3 participants in each of the BMI percentile stratifications. Results based on stratifications, however, did provide valuable evidence for the idea that BMI percentile is not an all-encompassing indicator of health. The participant with the highest BMI percentile exhibited the greatest flexibility at above the 85th percentile for her age group. This was a source of confidence building for this participant and indicates the importance of finding strengths within each individual. On the contrary, some of the participants in the lowest BMI group scored below the 50th percentile in the V-sit test just as those in the highest BMI did showing that BMI does not necessarily determine other factors.
There were notable differences in factors participants in the highest and lowest BMI percentiles rated as important. Appearance was more important to those in the highest BMI percentile group than to the participants in the lowest BMI percentile group. This could be because there is more pressure or attention placed on body image in those who are overweight or obese causing them to be more self-conscious and aware of it. Endurance and sport were also more important to those in the highest BMI percentile group. This could be due to difficulties that they may experience in these areas of physical performance. Sports and everyday tasks involving endurance could be made more difficult by a higher BMI status, leading it to be a more prominent concern among this group. More specific components of physical activity were of higher importance in those in the lowest BMI group. This may suggest that those falling within lower BMI percentiles could be more focused on the details of physical activity rather than the difficulty of sport in general since this may be less of an issue for them. Body weight was also ranked at high importance in the lowest BMI percentile group which could suggest that placing weight at a higher priority caused these participants to keep their weight at a lower range. Although the participant with the highest BMI maintained a positive self-concept score of 3.9 out of 6, this was the lowest score among the participant group. This raises concern about the body images and self-esteem of adolescent girls who are struggling with their weight and provides evidence that higher BMI may influence self-concept.
This study was limited by the small sample size of only 10 participants. While valuable insight was gained regarding the reception of curriculum and importance of some measures, more significant results may have been possible with a larger participant pool. In addition, the inability to collect post-data prevented analysis of the effectiveness of the intervention. Re-administering questionnaires and physical testing at the end of the summer would have allowed for assessment of both the intervention’s effectiveness and progress related to the participants’ self-made goals. The baseline measures alone did, however, allow the researchers to determine which areas are most important to target in future research.
Despite its limitations, this study provided valuable information for further research. Based on the results, the participant group seemed to be at an important age range where self-concept was still positive and beginning to be shaped. This suggests that adolescence is a good time to intervene and promote positive self-concept. The subjective feedback throughout the study week suggests that designing interventions that pinpoint individual strengths and create a sense of social support are important to creating a positive experience and interest among this population. There also seemed to be a great need for information regarding what constitutes quality nutrition, indicating a gap in health education among adolescent girls that could be addressed in further intervention curriculums. The concept of living an active lifestyle versus exercising seemed to be another important area for further interventions. The results and implications for further research that were gained from this study will be utilized in modifying the current intervention curriculum for implementation in the summer of 2013.
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