Parent and Friend Influences on the Multiple Health Behaviors of Adolescents in Hawaii

14 Pages·2014·0.17 MB·English

Geller, K.S., Alvarez, A.R., Nigg,C.R., Oasay, A., Timbobolan, J. / Californian Journal of Health Promotion 2014, Volume 12, Issue
2, 55-68.

Parent and Friend Influences on the Multiple Health Behaviors of Adolescents in
Hawai`i

Karly S. Geller1, Antonia R. Alvarez2, 3, Claudio R. Nigg3, 4, Aaron Oasay2, and Jerson
Timbobolan2

1Miami University, Department of Kinesiology & 2University of Hawai`i Cancer Center,
Prevention and Control
3Mental Health America of Hawai`i
4University of Hawai`i at Mānoa, Public Health Sciences

Abstract
Background and Purpose: The prevalence of youth obesity has increased dramatically in the United
States, becoming a severe concern in Hawai`i and disproportionally impacting Filipino youth. The main
study objective was to describe the influence of parents and friends on adolescents’ dietary, physical
activity, and sedentary behaviors. Methods: We collected quantitative and qualitative data from two
classrooms in Hawai`i, from ethnic minority adolescents (N=42; 11th and 12th graders) and their parents
(N=31). Participating adolescents were 86% female with a mean age of 16.5 + .6 years, and their parents
were 77% female with a mean age of 45.9 + 6.9 years. The majority of participants described themselves
as Filipino American. Self-report data were collected via adolescent surveys and follow-up group
discussion, as well as individual adolescent-led parent interviews. Quantitative data were descriptive, and
qualitative data were conceptualized into underlying themes based on the targeted health behavior and the
source of influence (parents and friends). Results: The majority of students reported parents as the
dominant influence on their dietary and sedentary behaviors; however, friends were reported as the
principal influence on adolescents’ physical activity levels. Parents’ reported a strong dietary influence
via home availability, but minimal influence on adolescents’ physical activity. Conclusion: Home food
availability and reduced television time are prime targets for family-based interventions among ethnic
minority Hawai`ian populations.

© 2014 Californian Journal of Health Promotion. All rights reserved.
Keywords: Adolescents, Hawai`ian, Filipino, obesity, physical activity, nutrition

Introduction Baranowski, Zakeri, & Berenson, 2003),
physical activity, and sedentary behavior
There has been a dramatic rise in the prevalence (Berkey, Rockett, Gillman, & Colditz, 2003;
of youth obesity in the United States (US) Janssen, Katzmarzyk, Boyce, Vereecken,
(Ogden, Carroll, Curtin, Lamb, & Flegal, 2010), Mulvihill, et al., 2005). Similar to mainland
demonstrating strong association with adverse populations, Hawai`ian and Pacific Islander
health outcomes (Daniels, 2006) and health- youth typically report high fat intake and low
related costs. Specifically, annual obesity-related fruit and vegetable consumption (Moy, Sallis, &
hospital costs increased from $35 million (1979– David, 2010). Research targeting all US
1981) to $127 million (1997–1999) (Wang & adolescents reported only 8% perform enough
Dietz, 2002). physical activity to experience health benefits
(Troiano, Berrigan, Dodd, Masse, Tilert, et al.,
Obesity is largely a consequence of energy 2008), and inactivity rates are lowest among
imbalance generating from increased energy ethnic minority youth (Javier, Huffman, &
intake and/or decreased energy expenditure, Mendoza, 2007; Tudor-Locke, Ainsworth,
with relation to dietary habits (Nicklas, Yang, Adair, & Popkin, 2003). Although less than two
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Geller, K.S., Alvarez, A.R., Nigg,C.R., Oasay, A., Timbobolan, J. / Californian Journal of Health Promotion 2014, Volume 12, Issue
2, 55-68.

daily hours of screen time is recommended Spruijt-Metz, 2009; O’Dea, 2003; Pugliese &
(American Academy of Pediatrics, 2011), 32% Tinsley, 2007; Prochaska, Rodgers, & Sallis,
of youth reported watching television for three 2002). However, evidence regarding the relative
or more hours on a regular school day and 31% influences of parents and peers on adolescent
used the computer for three or more hours behaviors are inconsistent. Recent research
(Eaton, Kann, Kinchen, Shanklin, Flint, et al., suggests friends are more influential than
2012). parents on youth physical activity (Finnerty,
Reeves, Dabinett, Jeanes, & Vogele, 2009;
Obesity-related Disparities in Hawai’i Heitzler, Lytle, Erickson, Barr-Anderson, Sirard
Using multiple anthropometric assessments, & Story, 2010). In another study of adolescent
approximately 24% of adolescents residing in females, parents support for physical activity
Hawai`i (aged 12-17 years) were classified as decreased, while friends’ support increased over
obese; compared to 11% of adolescents (aged time (Davison & Jago, 2009). Furthermore,
12-19 years) reported via NHANES III statistics family involvement with youth was negatively
(Chai, Kaluhiokalani, Little, Hetzler, Zhang, et associated with youth television time, relative to
al., 2003). Asian-Americans are among the friend involvement (Springer, Kelder, &
fastest growing ethnic minority population in the Hoelscher, 2006); another study reported similar
US (United States Census Bureau, 2009), associations (Richards, McGee, Williams,
representing a multitude of diverse subgroups Welch, & Hancox, 2010). In their review of
(e.g., Japanese, Filipinos). Although Asians are dietary-related influences, Geller and
traditionally identified as a homogeneous Dzewaltowski (2009) found peers having an
population (Ye, Rust, Baltrus, & Daniels, 2009), additive influence on adolescents’ fruit and
the health disparities encountered across Asian vegetable intake rather than a parent
origins are highly variable. For example, replacement, suggesting a significant parental
Filipino individuals are more likely to develop influence that continues across adolescent
hypertension compared to their Asian development.
counterparts, and Filipino youth demonstrate
greater risk of developing obesity and related The Present Study
illnesses (Baruffi, Hardy, Waslien, Uyehara, & The current study was a quantitative and
Krupitsky, 2004; Grandinetti, Chang, Theriault, qualitative inquiry of the obesity-related health
& Mor, 2005; Ye et al., 2009). behaviors shared between Hawai`i residing
adolescents and their parent. Self-report data
Effective health promotion for diverse youth were collected via adolescent surveys and
requires initial knowledge of valued cultural follow-up group discussion, as well as
components of virtue (e.g., food, social individual adolescent-led parent interviews. The
relationships, etc.) (Braun & Nichols, 1997; general objective was to explore the perceived
Finucane & McMullen, 2008); yet, few influence of parents and friends on adolescents’
interventions do more than add cultural obesity-related behaviors; specifically assessing
references to existing curricula (McGrath & adolescents’ reported shared time with parents
Ka'ili, 2010). To inform appropriately tailored and friends and their motivation to change their
intervention efforts for youth residing in obesity-related behaviors. The predominantly
Hawai`i, in-depth examinations are a necessary Filipino youth sample provided the opportunity
preliminary step to better understand existing to generate initial understanding of certain social
enablers and barriers to healthy lifestyles. factors influencing the multiple health behaviors
of an understudied Asian-American population
Parent and Peer Influences on Adolescent living in Hawai`i.
Obesity-related Behaviors
Research suggests that both parents and friends Given high variability in parent supervision and
influence youth eating and physical activity monitoring of youth across cultures and levels of
(Duncan, Duncan, & Strycker, 2005; McClain, socioeconomic status and education (Li,
Chappius, Nguyen-Rodriquez, Yaroch, & Feigelman, & Stanton, 2000), data collection
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2, 55-68.

also included parents’ perceived influence on 2010). During the 2010/11 school year, the high
their adolescents’ obesity-related behavior. In school student population was primarily
addition to serving as a potential catalyst for Filipino-American (65.5%) followed by Samoan
future health conversations, this youth-led (9.3%), part-Hawai`ian (6.5%), and other or
research approach facilitated a gateway to the mixed ethnicities (18.7%). Forty-nine percent of
home environment. Such youth involvement students were included in the free/reduced
contributes to tailored intervention efforts while school lunch program during that same year,
simultaneously expanding participating which was slightly higher than the average
adolescents’ knowledge and skills, increasing Hawai`i public high school at 47 % (Hawai`i
their capacity to engage in healthy behaviors State Department of Education, 2010).
(Suleiman, Soleimanpour, & London, 2006).
Youth-led research has been published Procedure
previously among Native Hawai`ian adolescents Student Survey and Interview. Adolescent
(Geller, Hendricks, Alvarez, Braceros, & Nigg, data were derived via self-reported surveys with
2013). Participating adolescents were expected follow-up class-level discussions. Adolescent
to report both parent and friend shared time; and, self-report surveys included quantitative
given youth remain dependent on the resources questions, as well as open-ended (i.e.,
within their home environment, a strong parental qualitative) questions; which assessed
influence was expected to emerge for all demographic characteristics and certain health
targeted health behaviors. behaviors shared with their parent and friends.
Following survey completion, a trained focus
Methods group moderator led participating adolescents in
a follow-up classroom discussion to review each
Participants and Setting survey question. All adolescents who completed
Informed consent preceded all study procedures, the student survey also participated in the
which were approved by the University follow-up group discussion, which was
Institutional Review Board and the State of implemented in each classroom separately (n=20
Hawai`i Department of Education. Participating and n=22). This qualitative follow-up approach
adolescents (N=42) were 11th and 12th grade supported clarity of survey questions, allowing
high school students residing in Oahu, Hawai`i. adolescents to elucidate their initial answers
Through a university-teacher partnership, further when appropriate.
students were recruited from two separate high
school classrooms. Participating students elicited Adolescent Interview of Parents. In
the participation of one of their parents, resulting preparation for subsequent adolescent-led parent
in a 74% parent response rate (N=31 parent interviews, adolescents participated in a 30-
participants); which is comparable to research minute training session that covered general
among similar youth populations (e.g., Geller, et research interview techniques. Specifically,
al., 2013). All participating adolescents were adolescents were trained to distinguish between
born in the US, majority in Hawai`i. The divergent and convergent questions; led through
immigrant status of adolescents’ parents was a brief discussion of each parent interview
variable, with most born in Hawai`i. Given question; and organized into small groups to
limited classroom time, this information was practice asking questions aloud, summarizing
collected unsystematically via hand count of answers, and capturing direct quotes. Similar to
participating adolescents. adolescent surveys, parents were asked to self-
report certain demographic and health
The school was located in a highly populated information, including personal behavior, shared
city with a predominantly Filipino-American behavior, and perceived parental influence.
population and a median household income of Specifically, adolescents led their mother or
$49,444; which is comparable to national levels father through open-ended questions,
($51, 914), but considerably lower than the state summarized their parents’ responses, and
of Hawai`i ($63, 030) (US Census Bureau, recorded enriching quotations. Parent interviews
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Geller, K.S., Alvarez, A.R., Nigg,C.R., Oasay, A., Timbobolan, J. / Californian Journal of Health Promotion 2014, Volume 12, Issue
2, 55-68.

were mostly performed at home (98%), lasting interviews (minutes). Parents were first asked to
approximately 24 minutes (± 14 minutes) and report their gender, birthdate, ethnicity, and
ranging from 8 to 63 minutes. relationship to the adolescent interviewer. Using
the physical activity definition, participating
Measures adolescents defined physical activity for their
Adolescent Survey. Participating adolescents parent and asked them to report their personal
reported their gender, birthdate, and ethnicity. weekly frequency (“Aside from work and/or
Quantitatively, adolescents also self-reported house chores, how many times per week do you
shared health-related time with their engage in physical activity, like exercise or
participating parent and friends, including sports?”). Parents then reported their daily
shared meals (“How many meals per day do you sedentary time (“How many hours per day do
eat with your parent? How about with your you do activities that are sedentary or not
friends?”), shared television time (“How many active?”). Finally, participating parents reported
times hours per day do you watch television or their perceived influence on their adolescent’s
movies with your parent? How about with your physical activity (“Do you influence the physical
friends?”), and shared computer time (“How activities I do? How, why not?”), and dietary
many hours per day do you play video games or behaviors (“Do you influence the foods I eat?
surf the Internet (e.g., Facebook) with your How, why not?”).
parent? How about with your friends?”).
Adolescents were also asked to report weekly Data Analysis
physical activity shared with their parent and Quantitative data from both adolescents and
friends (“How many times per week do you do parents were analyzed descriptively, including
physical activity (e.g., sports, gym workouts) calculations of means and percentages.
with your parent? How about with your Adolescents’ report of health-related time spent
friends?”). Physical activity was initially defined with parents and friends were averaged across
to participating adolescents as an activity in the sample by gender, as was parents’ self-report
which “you are moving your arms and legs fast of personal health behavior. Participants’
enough to sweat or get your heart rate up. responses to open-ended questions were
Physical activities include time spent walking, analyzed qualitatively, including the
running, swimming, sports, surfing, mowing the conceptualization of common themes by
lawn, etc.” question and/or health behavior. Given the
directive nature of open-ended questions, a
Adolescents also reported shared time content analysis approach was used to
qualitatively via open-ended survey questions. systematically analyze the content of
For parents and friends, participating participants’ qualitative responses (Duncan,
adolescents reported the types of foods shared 1989). A color-coded key was used to categorize
(“What foods do you usually eat with your participants’ open-ended reports into common
parents? How about with your friends?”), as themes, which were then rank-ordered by
well as types of physical activities shared frequency. Response frequencies were then used
(“What physical activities do you usually share to calculate the proportion of adolescent
with your parents? How about with your responses within common themes via the ratio
friends?). Finally, adolescents were asked about nT/np, where nT = the number of participants
previous changes to their physical activity reporting within the common theme and np = the
(“Have you previously changed your level of number of participants who offered a qualitative
physical activity? Why, Why not?”), and dietary response.
behaviors (“Have you previously changed your
diet? Why, Why not?”). Results

Parent Interview. Parent interview start and Participants’ demographic characteristics are
stop times were recorded by adolescents and provided in Table 1. Participating adolescents
summarized as the average length of parent (N=42) were 86% female with a mean age of
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2, 55-68.

16.5 (± 0.6), and their parents (N=31) were 77% (n=1), and 2% White (n=1). Parents were 82%
female (i.e., mothers) with a mean age of 45.9 (± Filipino (n=26), 10% Japanese (n=3), 3% White
6.9). Similar to the high school population at the (n=1), and 3% Samoan (n=1). Aside from one
time of data collection, adolescents were 86% father and son, all participating adolescents self-
Filipino (n=36), 5% Japanese (n=2), 2% other identified as the same ethnicity as their parent.
Asian (n=1), 2% Tongan (n=1), 2% Samoan

Table 1.

Demographic and Adolescents’ Shared Health Behavior
Adolescents Parents
Males Female Fathers Mothers

n=6 (17%) n=35 (83%) n=7 (30%) n=24 (70%)
Ethnicity n (%) n (%) n (%) n (%)
Filipino American 4 (66%) 32 (89%) 5 (71%) 21 (88%)
Japanese American 1 (17%) 1 (3%) 2 (29%) 1 (4%)
Caucasian -- 1 (3%) 1 (4%)
Samoan - 1 (3%) - 1 (4%)
Tongan 1 (17%) - - -
Mean Age, Years (SD) 16.50 (0.55) 16.47 (0.56) 48.86 (8.59) 45.05 (6.24)
Male Adolescents Female Adolescents
Parent- Friend- Parent- Friend-

shared shared shared shared
Mean SD Mean SD Mean SD Mean SD
Daily Meals 1.67 0.82 1.17 0.75 1.77 0.94 1.33 0.93
Weekly Physical
0.00 0.00 4.00 2.37 0.50 1.03 1.97 1.61
Activity Bouts
Daily Computer Hours 0.00 0.00 2.00 2.28 0.63 1.21 2.37 2.50
Daily TELEVISION
2.40 2.88 1.20 1.10 2.70 2.59 0.82 1.02
hours
Note. N = number of participants; SD = standard deviation; % = percentage of total
sample; TELEVISION = television.
Adolescent Quantitative Outcomes shared physical activity or computer time;
Overall, most time was sedentary, while friend- however, they shared just under 2 ½ hours of
shared time was more conducive to physical daily television time with their parents. Limited
activity. The average daily television hours parent-shared time was also reported among
shared with parents was threefold that shared female adolescents; specifically, physical
with friends. Conversely, computer time with activity was shared less than once per week and
friends was more than double that shared with daily shared computer time was reported under
parents, generally including Internet-based one hour. Similar to male reports, participating
networking (e.g., Facebook, Myspace). females reported over 2 ½ hours of shared
Adolescents reported sharing approximately two television time their parent each day. Both
meals each day with their parent and one shared genders watched considerably less television
daily meal with their friends. with friends than parents, sharing approximately
one hour each day with their friends.
Quantitative results were interpreted more Adolescents also shared more physical activity
specifically by adolescent gender (see Table 1). time with friends than with their parent; male
Participating males reported no parent-shared and female adolescents reported four and two
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2, 55-68.

friend-shared weekly bouts, respectively. the friend-shared meals reported (e.g., fruit and
vegetables versus fast food). All participants
Adolescent Qualitative Outcomes reported eating “Filipino food” at home with
Table 2 summarizes adolescents’ reports to their parents. Two commonly reported
open-ended survey questions, including common traditional Filipino dishes were Pinakbet and
themes, response frequencies, and response Adobo, containing vegetables and occasional
proportions. Outcomes are organized in the meat. The majority of adolescents also reported
following sections by each adolescent survey parent-shared meals that typically included meat
question. (pork, beef, chicken, and fish) and starch foods
(mostly rice), as well as meals high in fruits and
What foods do you usually eat with your vegetables. Alternatively, adolescents reported
parents/friends? In general, parent-shared eating mostly fast food/junk food with their
meals were more healthful and nutritious than friends and minimum fruit and vegetable intake.

Table 2.

Adolescent Survey Questions, Themes, and Quotes
Frequency
Question Common Theme Adolescent Quotes
nT/nP* (%)
Weight
25/34 (74%) “I wanted to lose weight, I started cutting on sweets”
Management
“Stay healthy, I added more vegetables & fruit in my diet”
“I don’t want to get diabetes like my grandpa”
Health & “My doctor told me to”
8/34 (24%)
Knowledge “I quit soda because I learned it was bad”
Diet
“I found out what it was made of”
Changes
“To be healthy, & my mom is on a diet”
Fitness & Sports 1/34 (3%) “Improve my running for sports”
Barriers to “Because of work & homework”
3/38 (8%)
Change
“I’m kind of lazy”
“I felt like it was getting hard for me to do normal stuff, like
climb the stairs”
Weight “Preventing me from being overweight”
16/29 (55%)
Management “To stop gaining weight”
“To lose weight”
“I was gaining pounds & I started becoming bigger”
“Build stamina”
“Have muscles”
Fitness & Sports 7/29 (24%) “Prevent injury”
Physical
Activity “Prepare for soccer season”
Changes
“Encourage my friends to lose weight”
Social 3/29 (10%)
“To have fun with friends”
“To get out more with fresh air”
Lifestyle 3/29 (10%)
“To avoid laziness”
“No time or transportation”
“I just tend to stop devoting my time to exercise because I have
Barriers 9/40 (23%)
homework”
“I do not have time because of work”
*Frequency is the number of participants who reported within the common theme (nT) / the number of participants
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2, 55-68.

who responded (nP).
What physical activities do you usually share fathers reported close to 4 hours of daily
with your parents/friends? The most sedentary time (M=3.90 ± 2.54).
frequently reported activities shared with parents
were “nothing” and/or television watching. Parent Qualitative Outcomes
Adolescents reported a considerably larger Table 3 summarizes participating parents’ open-
variety of physical activity with their friends, ended responses regarding their perceived
most frequently reporting sport involvement and influence on adolescent health behavior,
leisure activity (e.g., hanging out, walking to reporting frequencies and themes. Outcomes are
school, etc.). organized in the following sections by each
parent interview question.
Have you previously changed your diet? Why
or Why not? Ninety percent of adolescents Do you influence the foods I eat? How or why
reported a previous change to their dietary not? Eighty six percent of parents reported
behavior. Table 2 reports common themes and having an impact on their adolescent’s dietary
frequencies of qualitative reports. Participating behavior, exclusively reporting food availability
adolescents most frequently reported weight loss and accessibility as the mechanism of their
and/or weight management motives for their influence. Among the 14% who did not
previous diet-related change(s) (n=25, 74%); recognize themselves as a dietary influence,
which was followed by motivations related to 12% (n=4) reported adolescent consumption of
health and knowledge (n=8, 24%). Among meals outside of the home (e.g., “you always eat
adolescents who did not report previous changes out”).
to their diet (10%), 8% (n=3) reported being
“too lazy” or busy with school-related work. Do you influence the physical activities I do?
How or why not? Sixty-one percent of parents
Have you previously changed your level of believed they influence their adolescent’s
physical activity? Why or Why not? The physical activity. Of those recognizing their
majority of adolescents (77%) had previously influence, 64% (n=7) perceived themselves as a
changed their physical activity. Common themes positive or negative role model. Thirty six
and frequencies from qualitative reports are percent of participating parents (n=4) reported
shown in Table 2. Similar to dietary changes, influencing their adolescent’s physical activity
weight loss/management was the most through shared time ("We do mostly everything
commonly reported motive for previous changes as a family”). Among parents who did not report
to activity levels (n=16, 55%). The second having an influence (39%), all reported time
leading motive involved fitness and/or sport and/or fatigue related barriers.
related goals (n=7, 24%), stating body image
reasoning that echoed the nutrition context. Discussion
Unique to physical activity were motivations for
social interactions (e.g., “to have fun with The current study aimed to distinguish between
friends”) and lifestyle (e.g., “to be outside”). parent and friend influences on adolescents’
Among the 23% adolescents reporting no prior dietary, sedentary, and physical activity
change, all reported a lack of time for physical behaviors. In general, results demonstrated
activity due work and/or school. variability between parent and friend influences
on adolescent’s obesity-related behavior. Similar
Parent Quantitative Outcomes to mainstream research, the meals shared
Specific to parent-reported health behavior, between participating adolescents and their
mothers participated in a bout of physical parent included more fruits and vegetables and
activity just over once per week (M=1.57 ± less junk food than meals shared with friends.
1.62) and fathers twice per week (M=2.00 ± The healthier parent-shared meal supports
2.83). Mothers reported just over 3 hours of evidence of healthier dietary patterns among
daily sedentary time (M=3.14 ± 2.65), while youth exposed to more family meals (Berge,
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2, 55-68.

2009; Geller & Dzewaltowski, 2009; Haapalahti, among mainland American youth (McClain et
Mykkanen, Tikkanen, & Kokkonen, 2003), and al., 2009; Wansink, 2006) and family-based
reports of increased snacking and fatty food research among ethnic minority youth in
intake when meals are shared with friends Hawai`i (Guerrero, Nishimura, Chang, Ona,
(Feunekes, de Graaf., Meyboom, & van Cunanan et al., 2010; McGrath & Ka’ili, 2010).
Staveren, 1998; Monge-Rojas, Nunez, Garita, & Taken together, home food availability and
Chen-Mok, 2002). The strong parent influence accessibility are leading influences on
was evident (“you got to eat what’s there, you adolescents’ dietary behaviors and should be
don’t have a choice”), similar to evidence prioritized in future intervention efforts.

Table 3.

Parent Interview Survey Questions, Themes, and Quotes
Frequency
Question Common Theme Adolescent Quotes
[nT/nP] (%)
“Whenever you’re home, you got to eat what’s there,
you don’t have a choice”
“I buy everything you eat”
“You got to eat what’s there, you don’t have a
choice”
Availability &
22/22 (100%) “You eat what I give you, no complaining”
Accessibility
Diet
“Whatever I cook, you eat”
“We eat together as a family”
“Because I told you it tastes good, & you eat it”
“You eat whatever I cook”
“You always eat out”
Barriers to Influence 4/34 (12%)
“You bring junk food, & eat out a lot”
“I think you want to be active so you won’t be
overweight like me”
Role modeling 7/11 (64%) “I show what to do & you do it”
“I don’t do it [physical activity] myself”
“You come running with me”
Physical Shared Activity 4/11 (36%) “We do mostly everything as a family”
Activity
“You take me along with you”
“Since I work 5 days a week, I’m too tired to go out
for a walk with you”
“I’m usually busy”
Barriers to Influence 14/31 (45%)
“You’re barely home”
“I’m not always home, I couldn’t influence you
unless I was home”
*Frequency is the number of participants who reported within the common theme (nT) / the number of
participants who responded (nP).
Adolescents’ dependency on parent food direction for future promotional efforts. As
purchases and preparation was obvious in the dietary gatekeepers, parents contribute greatly to
current sample, which may be an effective youth nutritional patterns by controlling food
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2, 55-68.

purchases and meal preparation. One strategic with activities that incorporate physical activity,
approach to promoting healthy food availability such as after dinner family walks or sport
changes within the home environment is to drive activities.
intervention efforts through the participating Future research and promotional efforts among
youth (i.e., program action agents or vehicles to similar youth are advised to consider the shared
change). For example, research has examined time adolescents spend watching television and
empowerment strategies targeting youth efficacy being active with their parents and friends. For
to request healthier food options from their example, time management strategies can guide
parents (Geller & Dzewaltowski, 2010; the substitution of shared family television with
Middlestadt, Lederer, Smith, Doss, Hung et al., activities incorporating physical activity (e.g.,
2013). Furthermore, previous intervention family walks, active games, etc.), which can be
research has successfully promoted proxy incorporated within the contextual nature of the
efficacy to increase children’s physical activity home environment. For instance, the average US
and related opportunities (Dzewaltowski, child lives in a home with access to a variety of
Estabrooks, & Johnston, 2002; Dzewaltowski, screen time facilitators (televisions, video/DVD
Estabrooks, Welk, Hill, Milliken et al., 2009). players, etc.) (Rideout, Vandewater, &
Future investigations that build on these findings Wartella, 2003), which has been the most
by evaluating similar efforts among youth in consistent correlate of adolescent television
Hawai`i are recommended. viewing (Gorely, Marshall, & Biddle, 2004).
Alternatively, the home environment can be
Current results illuminated distinctions between adjusted to foster decreased television time via
the parent and friend influences on adolescents’ parental attitude (Meizi et al. 2009) and
physical activity and sedentary behaviors. Alike consistent parental rules (Norman, Schmid,
to several previous examinations, friend-related Sallis, Calfas, & Patrick, 2005).
influences appeared to be more relevant to
current adolescents’ physical activity behavior Current adolescent also reported a commanding
(Finnerty et al., 2009; Heitzler et al., 2010). In a friend influence on their physical activity, which
specific examination, youth biked a greater may be an advantageous avenue for future
distance and demonstrated greater motivation to interventions. Specifically, promotional efforts
be physically active when a friend was present targeting late-adolescent populations should
compared to when they were alone (Salvy, capitalize on their motivations for autonomy by
Roemmich, Bowker, Romero, Stadler et al., facilitating interactive physical activity
2009); which parallels the high frequency of opportunities among friend groups (e.g., sport
friend-shared physical activity bouts reported teams, walking and jogging clubs, etc.).
within the current adolescent sample. Participating adolescents’ concern about their
future health suggests the potential to promote
On the other hand, parent-shared physical health by increasing knowledge. Educating
activity was rarely reported within the current youth about the components and behaviors of a
sample and many parents did not perceive healthy diet is a collective responsibility
themselves as an influence on their adolescent’s (researchers, teachers, policy makers, etc.) and
activity. Parents consistently reported work and should be an educational priority. Considering
time as barriers to their involvement; however, most participating adolescents expressed body
participating adolescents reported sharing image concerns, it is strongly suggested that
approximately 2 ½ hours of television with their future interventions emphasize health-related
parent each day. This excessive parent-shared outcomes, rather than motivations related to
television time parallels previous research weight loss.
among conventional youth populations (Meizi,
Harris, Piche´, & Beynon, 2009), and may be a Limitations
prime target for future interventions. Future Certain study limitations and strengths are
interventions are advised to target the noteworthy. The youth sample was relatively
substitution of shared family television time small, mostly female, and predominantly
63
Geller, K.S., Alvarez, A.R., Nigg,C.R., Oasay, A., Timbobolan, J. / Californian Journal of Health Promotion 2014, Volume 12, Issue
2, 55-68.

Filipino-American, limiting generalizability of The current study is a preliminary step toward
study outcomes. In addition, study outcomes developing culturally appropriate interventions
were based on participant self-report, that aim to advance the health of similar ethnic
introducing the risk for social desirability bias. minority populations. Similar to the current
Even so, this study is among the first multiple youth sample, television viewing represents the
health behavior investigations among youth in single greatest source of physical inactivity
Hawai`i, providing valuable knowledge to among US youth (Dietz & Strasburger, 1991)
advance future research among similar and has a larger effect on obesity than activity
populations. and dietary behaviors alone (Saelens, Sallis,
Nader, Broyles, Berry et al., 2002). Television
Conclusion has been shown to displace physical activity
(Carlson, Fulton, Lee, Foley, Heitzler et al.,
The social and physical environments 2010), facilitating an obesogenic home food
surrounding 2nd/3rd generation mainland youth environment comprised of mindless eating and
are dramatically distinct from alike youth increased energy intake (Rosenkranz &
residing in Hawai`i, an island thousands of miles Dzewaltowski, 2008). Reducing family-shared
from mainland America. The current manuscript television time may create increased
is the first investigation of multiple health opportunities for physical activity and decreased
behaviors among Filipino-American youth, a risk of excessive energy consumption. A strong
population that will inevitably be designated friend influence on adolescents’ physical activity
high priority for public health research in the also emerged in the current study. Future
future (see US 2050 Census projections). One interventions should target interactive physical
goal of Healthy People 2010 was to eliminate activity opportunities between adolescents and
health disparities (USDHHS, 2000); however, their friends.
evidence-based, culturally adapted interventions
among Filipino youth in Hawai`i remain Acknowledgements
severely warranted. This study was funded by the National Cancer
Institute, R25 CA90956 & CURE Supplement,
P30 CA071789

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