Cultural Beliefs and Physical Activity among African-American Adolescents Herpreet Thind, PhD; TaShauna U. Goldsby, PhD; Akilah Dulin-Keita, PhD; Monica L. Baskin, PhD Objective: To examine the association of cultural beliefs with physical activity (PA) among African-American adolescents. Methods: For a list of 42 leisure-time physical activities, adolescents (N = 116) indicated whether they believed the activity was ‘Mostly a Black Thing’, ‘Equally a Black and White Thing’, or ‘Mostly a White Thing’. Moderate-to-vigorous physical activity was assessed using accelerometers. Results: Participants scoring in the highest quartile of Mostly Black score

P

hysical activity (PA) is associated with numerous positive health outcomes, including improvements in weight, cardio-metabolic health, bone mineral density, and depressive symptoms among adolescents.1 For these reasons, the Physical Activity Guidelines for Americans suggest that children and adolescents accumulate 60 minutes daily of moderate-to-vigorous intensity (MVPA) PA.2 PA may be especially important for African-American adolescents considering their high rates of obesity, diabetes, and cardiovascular disease.3,4 However, despite the known benefits, African-American youth do not engage in the recommended amount of PA.5 The 2013 Youth Risk Behavior Surveillance data indicate that only 37% of African-American boys were physically active for at least 60 minutes on 7 days. The level of physical inactivity is more alarming among African-American girls with only 16% engaging in 7 days of PA.5 Whereas these aforementioned rates are not much different from those of their white counterparts, more white youth are physically active for at least 60 minutes per day on 5 or more days per week Herpreet Thind, Postdoctoral Fellow, Centers for Behavioral and Preventive Medicine, Brown Alpert Medical School, Providence, RI. TaShauna U. Goldsby, Postdoctoral Scholar, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL. Akilah Dulin-Keita, Assistant Professor, Institute for Community Health Promotion, Brown University, Providence, RI. Monica L. Baskin, Professor, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL. Correspondence Dr Thind; [email protected]

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engaged in more PA and were less likely to be overweight or obese compared to those in lower quartiles. However, these findings were not statistically significant. Conclusion: Further research to validate the association of cultural beliefs with PA is needed to inform health-enhancing PA interventions for this population. Key words: African American; cultural beliefs; physical activity Am J Health Behav. 2015;39(2):284-293 DOI: http://dx.doi.org/10.5993/AJHB.39.2.15

compared to African-American youth (boys 59.6% vs 53.3%, and girls 40.5% vs 29.3% respectively).5 Taken together, these findings indicate the need to develop and implement PA promotion strategies for African-American adolescents to prevent and/ or delay the negative health consequences associated with physical inactivity. PA among adolescents is determined by multiple factors including self-efficacy, support from parents and peers,6-8 opportunities to exercise,9,10 attitudes toward PA, interests,11 and neighborhood disorder and lack of safety.12,13 In addition to these factors, cultural beliefs specific to African Americans may influence their participation in PA. Culture refers to the unique values, norms, and practices of a group that are usually learned or passed along from one generation to the next.14,15 Cultural beliefs are ideas and thoughts common to individuals belonging to the same culture.16 Cultural beliefs often are associated with health-related behaviors. For example, some cultural beliefs specific to African Americans that may affect their PA include greater acceptance of a larger body size among African-American girls,17 perception that exercise messes up their hair,18,19 and concerns about appearance when exercising.20,21 AfricanAmerican boys may not participate in leisure-time PA, because it is not considered a part of their family or community social activities, and often, it is viewed as unimportant or as a luxury.22 Similarly, cultural value for items that suggest economic sufficiency such as owning a car or having a television in a child’s bedroom may predispose African-

Thind et al American youth to sedentary behavior.23 Traditional PA interventions have not been effective in increasing PA among African-American children.24 There is a need for adoption of culturally-tailored interventions.24,25 However, understanding the cultural differences is crucial before developing health promotion interventions. One method of identifying cultural beliefs is through an ethnic mapping technique.26,27 This procedure involves sorting the target behavior along a continuum of ‘Mostly a Black thing → Equally Black and White thing → Mostly a White thing’. If individuals identify an activity as being most associated with their racial/ethnic group, they will be more likely to adopt it. Thus, this technique helps to capture preferences for the target behavior. Resnicow et al28 used this technique to identify food and PA preferences among African-American adults. However, less is known about the impact of cultural beliefs on PA among African-American adolescents. It also is unknown whether cultural preferences exist for different types of physical activities, ie, whether African-American adolescents identify certain activities as being part of their racial/ethnic group. Therefore, the purpose of this study was to use an ethnic mapping technique to: (1) identify cultural beliefs related to physical activities among AfricanAmerican adolescents; (2) examine whether cultural beliefs differ across participant characteristics; and (3) explore whether cultural beliefs are associated with MVPA and weight status among African-American adolescents. We anticipated that African-American adolescents might be less likely to engage in activities that are not popular in their culture or those considered as ‘Mostly a White thing.’ Moreover, we expected that African Americans who rated an activity as ‘Mostly a Black thing’ would be more likely to engage in it. It is possible that having more activities perceived as ‘Mostly a Black thing’ would provide increased opportunities to be physically active. Therefore, we hypothesized that adolescents who perceived more physical activities as ‘Mostly a Black thing’ would be likely to engage in greater MVPA, and therefore, be less predisposed to overweight or obesity; conversely, we hypothesized that perceiving the majority of activities as ‘Mostly a White thing’ would be associated with lower levels of PA.

for participation, and were invited for an in-person study meeting. Written informed consent was obtained from their parents; the adolescents themselves provided assent for the study. Adolescents and their parents completed self-administered paper-and-pencil surveys individually. All assessments were conducted in private conference rooms at the Division of Preventive Medicine at the University of Alabama at Birmingham. In addition, adolescents wore an accelerometer for one week. Parents received a $10 gift card for completing parental surveys. Adolescents received a $10 gift card for completing surveys and a $25 gift card for wearing and returning the accelerometer.

METHODS The study took place in metropolitan Birmingham, Alabama where 73.4% of residents are African Americans and 28.9% people are below poverty level.29 Data for this cross-sectional study were collected as part of a larger project examining the factors influencing PA among African-American adolescents.30,31 Recruitment efforts included posting flyers at community centers, churches, and recreational centers, and using newspaper and wordof-mouth advertising. Adolescents 12 to 16 years of age who self-identified as African-American and reported to be in general good health, were eligible

Measures Cultural beliefs. Cultural beliefs were assessed using the ethnic mapping technique identified above.26,27 Adolescents were given a list of 42 leisure-time physical activities. For each activity they were asked to indicate whether they believed the activity was ‘Mostly a Black thing’, ‘Equally a Black and White thing’, or ‘Mostly a White thing’. If more than 50% of participants rated a PA in one of the 3 categories, it was considered a consensus.27 The 50% consensus was used to be consistent with the studies conducted by Resnicow et al27,28 who developed this ethnic mapping technique. Using this majority consensus criterion, each PA was categorized as ‘Mostly a Black thing’, ‘Mostly a White thing’, or ‘Equally a Black and White thing’. To date, the ethnic mapping technique has been used only to categorize the target behavior to determine audience preferences. For example, Resnicow et al28 used it to examine food and PA preferences of African-American adults from a churchbased sample. However, to be able to assess the association of cultural beliefs with PA levels, we established a scoring strategy using an approach developed by Unger et al32 to score their Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA). Scores for 3 cultural belief subscales were calculated for each adolescent: (1) Mostly Black (total number of PAs rated as ‘Mostly a Black Thing’); (2) Mostly White (total number of PAs rated as ‘Mostly a White thing’); and (3) Equal (total number of PAs rated as ‘Equally a Black and White thing’). Because 42 physical activities were rated, each subscale has a potential range of 0 42. However, the sum of the 3 subscales is always 42; therefore, a total cultural belief score cannot be used. Summing the activities that were considered ‘Mostly a Black thing’, ‘Mostly a White thing’, or ‘Equally a Black and White thing’ gave a quantitative estimate of the respondent’s perception of the appropriateness of these activities based on race. Summing the number of items was considered the best method to examine whether participants who perceived more activities to be ‘Mostly a Black thing’ are in any ways different than those who perceived only a few activities to be ‘Mostly a Black thing’, and so on.

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Table 1 Demographic Characteristics of the Study Sample (N = 116) N (%) or Mean (SD) Age (years)

14.0 (1.4)

Male

54 (46.6)

Highest Education by Any Adult in Household High school or less Some college Graduate degree Postgraduate degree

14 (12.1) 45 (38.7) 42 (36.2) 14 (12.1)

Parent Marital Status Single, separated, divorced, or widowed Married or living together

53 (45.7) 63 (54.3)

Annual Household Income ($) < 30,000 30,001 – 60,000 > 60,000

27 (23.3) 50 (43.1) 34 (29.4)

Weight Status Underweight (BMI < 5th percentile) Normal (5th percentile >BMI < 85th percentile) Overweight (85th percentile >BMI 95th percentile)

3 (2.6) 63 (54.3) 24 (20.7) 26 (22.4)

Minutes of daily moderate-to-vigorous physical activity

Physical activity. Objective data on PA were collected using Actigraph uniaxial accelerometers (Model GT1M; Actigraph Manufacturing Technology Inc., Pensacola, FL, USA). We used the methods consistent with prior studies of adolescents.33Accelerometers were initialized with epoch length set at 60 seconds. Trained research staff demonstrated the use and purpose of the accelerometers to each participant at the study meeting. Adolescents were instructed to wear the accelerometers around their waist using an elastic belt for 7 consecutive days and nights. They were asked to take it off only for bathing or swimming purposes. To make sure that they wore the accelerometers, 2 reminders were sent through their desired methods of contact (ie, text message, email, phone call). At the end of the week, accelerometers were returned. Accelerometry data were uploaded and analyzed using ActiLife version 5.0 software. Data was considered valid if counts were present for at least 3 days with at least 8 hours of recording time per day. Accelerometry data were used to calculate metabolic equivalents of task (METs). The age-specific criteria of the Freedson group were calculated with thresholds of > 4 METs considered MVPA.33,34 Average daily minutes of time spent in MVPA were used in the analyses. Adolescents also were asked to record their PA in logs for 2 weekdays and one weekend day while wearing accelerometers. Each log was divided into 30-minute blocks and the adolescents recorded their main activity for each block using open-ended responses. Trained staff coded these open-end-

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40.4 (27.5)

ed responses to the 71 activities included in the 3-day Physical Activity Recall log (3d-PAR).35 Anthropometric variables. Height and weight were measured by trained research staff. Height was measured without shoes using a portable stadiometer (Seca 213) to the nearest 0.1 cm. Weight was measured without shoes and with light clothing to the nearest 0.1 kg using a digital scale (Seca 813). Two independent measures of weight were taken and an average of the 2 was used. Body mass index (BMI) was calculated using the formula weight (kg)/height (m2). Adolescent weight status was classified as underweight (BMI < 5th percentile), normal (5th percentile > = BMI < 85th percentile), overweight (85th percentile > = BMI < 95th percentile), or obese (> = 95th percentile) using the age-sex specific growth charts of the Centers for Disease Control and Prevention (CDC).36 Demographic information. Adolescents selfreported their age, sex, and grade. Parents selfreported their marital status, highest education attained by any adult in the household and total annual household income. Statistical Analysis Data were analyzed using IBM SPSS Statistics for Windows, Release 20.0.0 (©IBM Corp., 2011, Armonk, NY, http://www.ibm.com). Descriptive analyses for demographic variables were conducted to describe the sample. Frequencies were calculated to categorize each PA as ‘Mostly a Black thing’, ‘Mostly a White thing’ or ‘Equally a Black and White thing’ based on majority consensus.

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Table 2 Categorization of Physical Activities Using Ethnic Mapping Technique Mostly a Black thing (%)

Equally a Black and White thing (%)

Mostly a White thing (%)

Ballet

3.4a

55.2b

41.4b

Basketball

40.5a

56.9a

1.7b

Bicycling

3.4a

58.6b

37.9b

Boxing

24.1a

63.8b

11.2a

Dancing

25.0a

66.4b

7.8c

Fishing

0.8

70.7b

28.4c

Football

32.8

65.5

0.9c

0

Equally Black and White

Golf

a

b

a

52.6

47.4a

a

a

a

b

Gymnastics

1.7

60.3

37.9c

Jogging

2.6

81.0

b

14.7c

Jump rope

9.5

a

79.3

b

10.3a

Kickball

12.9

a

76.7

b

10.3a

Marching band

19.8

a

74.1

b

6.0c

Ping pong

1.7

a

53.4

b

44.0b

Pushups, sit-ups, pull-ups

13.8

a

85.3

0.9c

Roller skating

10.3

a

72.4

b

15.5a

Roller blading

6.0

a

60.3

b

32.8c

Running

12.9

77.6

b

8.6a

Soccer

1.7a

62.9b

35.3c

Swimming

4.3a

84.5b

11.2c

0

67.2a

31.0b

Track and field (high jump/long jump)

19.8a

75.9b

3.4c

Track and field (hurdles)

24.1a

69.8b

5.2c

Trampoline

12.1a

81.0b

6.9a

Walk for pleasure

4.3a

63.8b

31.9c

Water aerobics

0.9a

56.0b

42.2b

Weight-lifting

21.6a

77.6b

0.9c

Wrestling

7.8a

75.0b

17.2a

Beach Volleyball

1.7a

33.6b

63.8c

Frisbee

2.6

28.4

b

69.0c

Ice hockey

0.9a

16.4b

82.8c

Ice skating

2.6

a

34.5

b

62.9c

Horseback riding

0.9

a

24.1

b

75.0c

0

Tennis

b

a

Mostly a White thing

Racquetball Rock climbing Rowing

a

34.5

a

64.7b

1.7

42.2

b

55.2b

0

a

30.7

a

69.3b

b

b

Scuba diving

0.9

28.4

69.0c

Skateboarding

1.7

38.8

59.5b

Skiing

0.9

a

25.0

74.1c

Sky diving

0.9

a

28.4

Water polo

0

40.5

58.6a

Yoga

0

43.1

56.9a

a a

b b a a

69.8c

Note. Responses may not add to 100% due to missing values. a b c = Different superscripts in a row indicate significant differences based on one-way chi-square procedure and post hoc test with correction for alpha inflation (Bonferonni style).

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Table 3 Categorization of Physical Activities Included in the Cultural Beliefs Scale by Adolescents who Reported Engaging in these Activities in their Physical Activity Log N

Mostly a Black thing (%)

Equally Black and White thing (%)

Mostly a White thing (%)

Basketball

35

34.3

60.0

2.9

Football

13

38.5

53.8

7.7

Jogging

10

0

80.0

20.0

Running

10

30.0

70.0

0

Walking

22

4.8

76.2

19.0

Then, we used one-way chi-square procedures and post hoc tests with correction for alpha inflation (Bonferroni style) to examine significant differences for each physical activity by the 3 categories. Descriptive statistics were explored for the 3 cultural belief subscales. Because cultural belief subscale scores were not normally distributed, nonparametric statistical tests were used. Differences in cultural belief scores by participant characteristics were examined using nonparametric tests. The Wilcoxon Mann-Whitney test was used to examine differences in cultural beliefs by the adolescent’s age, sex, parent’s marital status, and education. The Kruskal-Wallis test was used to examine difference in cultural beliefs by income level. One-way ANOVA was conducted to assess whether there were differences in MVPA by quartiles of cultural belief scores. Chi-square was used to examine the relationship between adolescents’ weight status and quartiles of cultural belief scores. Statistical significance was set at α < .05. RESULTS Overall, 116 adolescents (62 girls and 54 boys) participated in this study (Mean age = 14 years; SD = 1.35). About 21% of adolescents were overweight and another 22% were obese. About 46% resided in a single-parent household, 48% lived with an adult with a graduate degree or higher, and 23% lived in families with an annual household income less than $30,000 (Table 1). Physical Activity Valid objective data on PA were obtained from 114 participants. On average, participants engaged in 40.39 (SD = 27.5) minutes of MVPA in a day (Table 1). Boys were significantly more active than girls (Mean = 55.43, SD = 27.87 vs Mean = 26.86, SD = 18.99, p < .001). The 3-day physical activity logs were completed by 96 participants. There were no significant differences in the demographic characteristics, levels of PA, or weight status between adolescents who completed the logs and those who did not complete

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the logs (p > .05). The most common leisure-time physical activities engaged in by participants were basketball (N = 35), football (N = 13), walking (N = 22), and running or jogging (N = 10). Participants also reported unstructured activities such as playing with young children (N = 10). Other sources of PA included Physical Education class in school (N = 44), travel by walking (N = 26), and household chores (N = 54). Cultural Beliefs The majority (N = 28) of the physical activities assessed were perceived to be ‘Equally a Black and White thing’ (Table 2). Fourteen activities were perceived to be ‘Mostly a White thing’. Ten of these activities, including Frisbee, ice skating, racquetball, rowing, and skiing, were perceived to be ‘Mostly a White thing’ by a statistically greater percentage of adolescents. There were no activities that were perceived to be ‘Mostly a Black thing’ by a majority of respondents. A significantly lesser percentage of adolescents rated ballet, bicycling, fishing, gymnastics, jogging, ping pong, roller blading, soccer, swimming, walking for pleasure, and water aerobics as ‘Mostly a Black thing’. The majority of the adolescents who reported engaging in basketball, football, walking or running in their PA logs perceived these activities as ‘Equally a Black and White thing’ (Table 3). The cultural belief subscale scores for adolescents were not normally distributed; non-parametric results are presented here. The median score for the Mostly Black subscale was 2.0 (IQR = 5, range 0-27). The median score for the Mostly White subscale was 15.0 (IQR = 9.75, range 0-33), and for Equal subscale, the median score was 24.0 (IQR = 12.75, range 4-42). The median is the value that represents the middle of the distribution and the interquartile range (IQR) is the range of values within which, reside the middle 50% of the scores. Table 4 presents differences in cultural belief scores and MVPA across demographic variables. Differences existed in cultural beliefs by participant age group. Older participants (14-16 years

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Table 4 Comparison of Cultural Belief Subscale Scores and MVPAa by Participant Characteristics Mostly Black

Equal

Mostly White

Median (IQR)

MVPA minutes/day Mean (SD)

Age (years) 12-13 14-16

2.0 (7.3) 2.0 (4.0)

26.0 (20.5) 23.0 (8.5)

10.5 (13.0)* 16.5 (6.8)*

43.78 (29.9) 38.34 (26.0)

Sex Male Female

3.0 (4.0) 2.0 (4.0)

22.0 (11.5) 25.0 (13.8)

16.0 (10.5) 14.5 (9.0)

55.43 (27.9)** 26.86 (19.0)**

Highest education by an adult in household Graduate or higher Less

2.0 (3.8) 2.0 (5.0)

24.0 (10.8) 25.0 (18.0)

17.5 (8.8) 15.0 (13.0)

40.10 (22.5) 40.45 (31.9)

Marital status Singleb Married or with partner

2.0 (4.0) 2.0 (4.0)

23.0 (11.5) 24.0 (14.0)

16.0 (11.0) 15.0 (9.0)

44.15 (31.0) 37.24 (24.1)

Income ($) < 30,000 30,001 – 60,000 > 60, 000

2.0 (5.0) 2.0 (4.3) 1.5 (5.0)

22.0 (15.0) 25.0 (13.3) 25.0 (10.3)

15.0 (13.0) 15.0 (11.3) 15.0 (6.5)

46.03 (31.6) 39.63 (28.7) 35.94 (22.5)

* p < .05 ** p < .001 Note. a = MVPA (Moderate-to-vigorous physical activity) b = Single (Single/separated/divorced/widowed)

old) had higher Mostly White scores (Mdn = 16.5 vs Mdn = 10.5, p < .01) compared to the younger participants (12-13 years old). Five activities (ie, Frisbee, rock climbing, skateboarding, water polo and yoga) that were considered to be ‘Equally a Black and White thing’ by 12-13 year-olds were considered ‘Mostly a White thing’ by youth in the 14-16 year-old age group. There were no significant differences in cultural beliefs by sex, household income, parents’ marital status, or education level of adults in household. MVPA and weight status were examined by quartiles of cultural belief scores, with higher quartiles indicating greater number of activities rated in that category by participants (Table 5). Though the findings were not statistically significant, participants who scored in the highest quartile of Mostly Black category averaged more minutes of daily MVPA compared to those in lower quartiles. Concurrently, the highest quartile of Mostly Black score had a lower percentage of overweight/obese adolescents, though not statistically significant (p > .05). There were no specific patterns in PA or weight status by quartiles of Mostly White or Equal scores. DISCUSSION This study examined the cultural beliefs related

to physical activities and participation in MVPA among African-American adolescents. A majority of the 42 physical activities were perceived to be an ‘Equally Black and White thing’. Whereas some activities were perceived as ‘Mostly a White thing’ (such as ice skating, racquetball, yoga, etc), no activity was perceived as ‘Mostly a Black thing’ based on a majority consensus. This finding differs from those of Resnicow et al27 with African-American adults from Atlanta, an urban area in the Southern US, and a geographic location similar to the current study with 54% of the population being African Americans.29 Participants in their study rated basketball (65%) and jump rope (72.4%) as ‘Mostly a Black thing’. A large proportion (40.5%) of adolescents in the current study perceived basketball to be ‘Mostly a Black thing’; however, it was considered to be ‘Equally a Black and White thing’ by the majority. However, only 9.5% adolescents in the current study perceived jump rope to be ‘Mostly a Black thing’ compared to 72% adults in the study by Resnicow et al.27 An activity that was considered ‘Mostly a White thing’ in the Resnicow et al27 study (ie, soccer) was perceived to be ‘Equally a Black and White thing’ in the current study. This indicates that there might have been shifts in cultural beliefs over the past decade with soccer be-

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Table 5 Daily MVPA and Weight Status by Quartiles of Cultural Belief Subscale Scores N

Daily MVPA Mean (SD)

Mostly Black Q1 Q2 Q3 Q4

32 31 31 20

35.8 (24.1) 39.0 (23.3) 42.4 (32.3) 46.9 (30.9)

Equal Q1 Q2 Q3 Q4

30 31 24 29

44.1 (30.7) 37.7 (23.7) 40.8 (31.5) 39.1 (25.3)

Mostly White Q1 Q2 Q3 Q4

29 29 30 26

44.9 (29.9) 42.2 (30.7) 34.2 (21.7) 40.5 (27.3)

p value a .525

.828

.497

OW/OB % 26 40 24 10 28 18 28 26 20 36 18 26

p value b .068

.232

.080

Note. a = F statistic, b = chi-square MVPA = moderate-to-vigorous physical activity OW/OB = percent overweight or obese Q = quartiles; higher quartiles indicate greater number of activities rated in that category by the participants

coming more acceptable to African-American adolescents and/or may reflect potential differences in beliefs of adults and youth. Three cultural belief scores were calculated, for each adolescent Mostly Black, Mostly White and Equal. Assuming the notion of ‘Acting White’ it was anticipated that African-American adolescents might be less likely to engage in activities that are not popular in their culture or those considered being a ‘White thing’. ‘Acting White’ is a term used in reference to Blacks who engage in activities traditionally considered to be a white cultural norm.37,38 Some attitudes and behaviors that are considered as ‘Acting White’ include listening to white music, talking proper English, and studying hard to get good grades.37,39-41 Therefore, in the current study it was expected that participants with high Mostly White scores would be less physically active and those with high Mostly Black scores would engage in more minutes of PA. Adolescents in the current study in the higher quartiles of Mostly Black score (ie, who perceived more activities as a ‘Black thing’) participated in more MVPA. However, the association was not statistically significant. Mostly White and Equal scores were not related with time spent in PA. However, it is noteworthy that PA reported by adolescents in the logs did not include any activity that was considered as ‘Mostly a White thing’. The most common leisure-time activities reported by boys were basketball, football, and walking. Girls reported engaging in walking, basketball, and dance. In addition, adolescents reported engaging in PE class and household chores, and traveled by

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walking, which contributed to their overall MVPA minutes. Some adolescents also reported engaging in sports such as baseball, volleyball, and calisthenics, activities not assessed in the cultural belief questionnaire. It is possible that because cultural beliefs were not assessed on some of the activities in which adolescents engaged, the cultural belief scores were not significantly associated with PA in this study. Also, some activities included in the questionnaire may have required greater differentiation. For example, the questionnaire only asked about ballet and dance in general. But not specifically about hip-hop or African/AfricanAmerican dance, which might be important activities for this population. Therefore, this association needs further testing in future studies. Cultural belief scores varied by age group. Older adolescents had higher Mostly White scores. Some activities that were considered an ‘Equally a Black and White thing’ by the 12-13 year-olds were considered to be ‘Mostly a White thing’ by the older participants. This suggests the possibility that cultural beliefs are developed over time, perhaps after exposure to community or societal beliefs. Older adolescents engaged in fewer minutes of daily MVPA compared to younger adolescents (38 minutes vs 44 minutes). This finding is similar to the national trend of lower PA among adolescents relative to younger children.42 PA among adolescents is influenced by individual, family, and environmental factors.6,8,9,13 For African Americans, their core social and cultural processes are fundamental aspects influencing

Thind et al their lifestyle behaviors.43 Therefore, interventions promoting PA among African-American adolescents are more likely to be successful if they include activities that are culturally acceptable to this audience. For example, the Stanford and the Memphis GEMS pilot studies included dancing (ie, traditional African-American, hip-hop aerobics) in their intervention to increase PA and reduce weight gain among African-American girls.44,45 Another student-centered after-school intervention included student-selected activities such as basketball, football, hip-hop dance, and Double Dutch jump rope in their program to increase PA among underserved adolescents.46 Intervention participants in that study showed greater increases in objectively measured time spent in PA compared to the control group.46 In the current study, sports such as basketball, football, boxing, dancing, and weight-lifting were considered to be either ‘Mostly a Black thing’ or ‘Equally a Black and White thing’ by almost all participants, and therefore, more likely to be acceptable among African-American adolescents. Also, the majority of the adolescents who reported engaging in these activities in their PA logs, perceived them to be an ‘Equally a Black and White thing’. Although not statistically significant in this study, participants who rated in the highest quartile of Mostly Black score averaged more minutes of daily MVPA compared to those who rated fewer activities as ‘Mostly a Black thing’. This suggests that if African-American youth perceive an activity to be related to their racial identity (ie, Mostly a Black thing or Equally a Black and White thing), they will be more likely to engage in it. If more activities are culturally acceptable, it will provide more options for adolescents to be active. On the other hand, if only a few types of activities are culturally acceptable, it reduces options for PA, especially if resources for that particular activity or sport are not available in their school or community. Due to limitations of this study, we cannot make any conclusive statements about activities that were perceived to be ‘Mostly a White thing’. Further research is needed to replicate and expand upon the current study for associations of these cultural beliefs with PA among African-American adolescents. This additional research could inform interventionists and health promotion planners who work with African-American adolescents. To our knowledge this is the first study to use an ethnic mapping technique to explore the cultural beliefs related to PA among African-American adolescents and examine its association with MVPA and weight status. This study is strengthened by the inclusion of both objective and subjective measures of PA: accelerometry, which is an objective measure of PA, and the PA log which is a subjective measure of PA. Additionally, the sample includes a varied distribution of MVPA levels among girls and boys, and includes a sample of youth with varying weight status (normal, overweight, obese). However, there are some limitations that need

consideration. Data used in this study are from a cross-sectional survey limiting its ability to assess any temporal relationships. We assessed cultural beliefs related to the 42 leisure-time physical activities; however, we did not specifically ask adolescents whether they participated in those 42 activities. Further, this study was conducted in an urban area in the Deep South region of the US. The findings from this study may not be generalizable to African-American adolescents in other regions or to more diverse Black populations (ie, African, Caribbean, Latino). However, the findings are interesting and informative of future research involving adolescents from the Deep South region of the US, a region with disproportionally high rates of physical inactivity and obesity.5,47 It is possible that these findings lay groundwork for identifying more salient mechanisms through which health behaviors may be affected by social factors such as cultural beliefs. We have explored only a limited subset of cultural beliefs. The technique we used only helps to determine cultural preferences for different types of physical activities. However, there are other cultural beliefs that could be important to understand and examine while planning PA interventions. For example, cultural beliefs related to the perception of ideal body image can influence participation in PA.17 Moreover, because we did not examine these cultural beliefs among adolescents from other racial/ethnic groups, we do not know how these beliefs and their association with PA differ for these groups. Nevertheless, this study is an important initial step in the examination of cultural beliefs related to PA among African-American adolescents using the ethnic mapping technique. Further research to validate the association of these cultural beliefs with PA in this population is needed to inform health-enhancing PA interventions.

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Human Subjects Statement This study was approved by the Institutional Review Board of the University of Alabama at Birmingham (IRB# X101013001). Conflict of Interest Statement The authors have no conflicts of interest to disclose. Acknowledgments We thank the study research participants and Research Assistants (Emily Godsey, Haley Heckman, Sh’Nese Townsend). This study was funded by Active Living Research (ALR)/Robert Wood Johnson Foundation (RWJF) Grant # 65659. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation. References

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Cultural beliefs and physical activity among African-American adolescents.

To examine the association of cultural beliefs with physical activity (PA) among African-American adolescents...
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