Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 6, pp 1218–1227 | Cite as

Psychosocial Factors of Diet and Physical Activity among Rural, Hispanic Children: Findings from a Multilevel Health Intervention Study

  • Eileen Rillamas-SunEmail author
  • Sonia Bishop
  • Oralia Cisneros
  • Jason A. Mendoza
  • Mario Kratz
  • Linda K. Ko



To examine the relationship of psychosocial factors, such as self-efficacy, family role modeling, and perceptions of the environment, on diet, physical activity, and sedentary behavior in Hispanic children living in rural Washington State.


Gender, heights, and weights were obtained from Hispanic 8–12 year olds (n = 553) from two rural communities in Lower Yakima, Washington. A subsample of 179 children provided psychosocial measures, diet, and screen time via questionnaire and physical activity via accelerometer. Body mass index percentiles were used to calculate the prevalence of obesity. The association of demographic and psychosocial measures on the mean difference (95% confidence interval (CI)) of fruit, vegetable, and sugar consumption and minutes spent active was estimated using linear regression models.


Prevalence of obesity was 35%. Children with obesity consumed one-fifth (− 0.3, − 0.02) fewer cups of fruits, 2.2 (0.1, 4.2) more teaspoons of total added sugars, and spent 16.1 (− 22.0, − 10.2) fewer minutes in moderate-to-vigorous physical activity per day compared with children with healthy weights. Males consumed more added sugars and reported more screen time than females, but spent more daily minutes in moderate-to-vigorous physical activity. Higher fruit and vegetable self-efficacy scores were associated with more consumption of fruits and vegetables, more engagement in light physical activity, and less time spent sedentary per day.


Male gender and some psychosocial measures were associated with obesogenic behaviors. Insight about factors associated with obesity-related behaviors in rural, Hispanic children may help the development of successful and effective behavioral health interventions for this understudied population.


Rural Hispanic children Obesogenic behaviors Psychosocial factors Obesity 

List of Abbreviations


United States


National Health and Nutrition Examination Survey


moderate-to-vigorous physical activity


body mass index


Strategizing Together Relevant Intervention for Diet and Exercise


Centers for Disease Control


Dietary Screener Questionnaire


sugar-sweetened beverages


standard deviation


confidence interval



The authors wish to thank Beti Thompson and Norma (Mariscal) Alcala for their support on this project.

Funding Source

Funding was provided by the National Institutes of Health (U01 MD010540). The funding body had no role in the study’s design, collection, analysis, and interpretation of the data, or in the writing of this manuscript.

Availability of Data

The datasets analyzed in the current study are part of an ongoing longitudinal multi-intervention trial and are not publicly available, but are accessible from the corresponding author on reasonable request.

Authors’ Contributions

All authors contributed meaningfully to the development of this manuscript. LK and ERS designed and developed the study. LK and SB secured funding. LK, SB, and OC implemented the study and collected the data. ERS, LK, JM, and MK analyzed and interpreted the data and completed the literature search. All authors participated in the writing of the manuscript, accept responsibility for its content, and approved this submitted version.

Compliance with Ethical Standards

Conflict of Interest

The authors declare they have no conflict of interest.

Ethics Approval

All procedures performed were in accordance with the ethical standards of the Institutional Review Board at the Fred Hutchinson Cancer Research Center, Seattle, WA and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

Endorsement to conduct the study was obtained from the Lower Yakima Community Advisory Board and the school superintendents. All parents of children participating in the STRIDE study provided written informed consent and all children in the STRIDE study provided written assent to participate.


  1. 1.
    Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics. 2018;141:e20173459.CrossRefGoogle Scholar
  2. 2.
    Davis AM, Bennett KJ, Befort C, Nollen N. Obesity and related health behaviors among urban and rural children in the United States: data from the National Health and Nutrition Examination Survey 2003-2004 and 2005-2006. J Pediatr Psychol. 2011;36:669–76.CrossRefGoogle Scholar
  3. 3.
    Liu JH, Jones SJ, Sun H, Probst JC, Merchant AT, Cavicchia P. Diet, physical activity, and sedentary behaviors as risk factors for childhood obesity: an urban and rural comparison. Child Obes. 2012;8:440–8.CrossRefGoogle Scholar
  4. 4.
    U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The health and well-being of children in rural areas: a portrait of the nation, 2011-2012. Rockville, Maryland: U.S. Department of Health and Human Services. p. 2015.Google Scholar
  5. 5.
    U.S. Department of Heath and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans, 8th Edition. December 2015. Accessed April 2018.
  6. 6.
    Katzmarzyk PT, Denstel KD, Beals K, Bolling C, Wright C, Crouter SE, et al. Results from the United States of Americas 2016 report card on physical activity for children and youth. J Phys Act Health. 2016;13(11 Suppl 2):S307–13.CrossRefGoogle Scholar
  7. 7.
    Kim SA, Moore LV, Galuska D, Wright AP, Harris D, Grummer-Strawn LM, et al. Division of Nutrition PA et al. Vital signs: fruit and vegetable intake among children - United States, 2003–2010. MMWR Morb Mortal Wkly Rep. 2014;63:671–6.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Fakhouri TH, Hughes JP, Brody DJ, Kit BK, Ogden CL. Physical activity and screen-time viewing among elementary school-aged children in the United States from 2009 to 2010. JAMA Pediatr. 2013;167:223–9.CrossRefGoogle Scholar
  9. 9.
    Haughton CF, Wang ML, Lemon SC. Racial/ethnic disparities in meeting 5-2-1-0 recommendations among children and adolescents in the United States. J Pediatr. 2016;175:188–94 e181.CrossRefGoogle Scholar
  10. 10.
    Taverno SE, Rollins BY, Francis LA. Generation, language, body mass index, and activity patterns in Hispanic children. Am J Prev Med. 2010;38:145–53.CrossRefGoogle Scholar
  11. 11.
    Tovar A, Chui K, Hyatt RR, Kuder J, Kraak VI, Choumenkovitch SF, et al. Healthy-lifestyle behaviors associated with overweight and obesity in US rural children. BMC Pediatr. 2012;12:102.CrossRefGoogle Scholar
  12. 12.
    Ko LK, Rillamas-Sun E, Bishop S, Cisneros O, Holte S, Thompson B. Together We STRIDE: a quasi-experimental trial testing the effectiveness of a multi-level obesity intervention for Hispanic children in rural communities. Contemp Clin Trials 2018;67:81–86.CrossRefGoogle Scholar
  13. 13.
    Center for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. A SAS Program for the 2000 CDC growth charts (ages 0 to < 20 years). Last updated December 2016. Accessed April 2018.
  14. 14.
    Watson K, Baranowski T, Thompson D. Item response modeling: an evaluation of the children's fruit and vegetable self-efficacy questionnaire. Health Educ Res. 2006;21(Suppl 1):i47–57.CrossRefGoogle Scholar
  15. 15.
    Cullen KW, Baranowski T, Rittenberry L, Cosart C, Hebert D, de Moor C. Child-reported family and peer influences on fruit, juice and vegetable consumption: reliability and validity of measures. Health Educ Res. 2001;16:187–200.CrossRefGoogle Scholar
  16. 16.
    Saunders RP, Pate RR, Felton G, Dowda M, Weinrich MC, Ward DS, et al. Development of questionnaires to measure psychosocial influences on children’s physical activity. Prev Med. 1997;26:241–7.CrossRefGoogle Scholar
  17. 17.
    Ommundsen Y, Page A, Ku PW, Cooper AR. Cross-cultural, age and gender validation of a computerised questionnaire measuring personal, social and environmental associations with children's physical activity: the European youth heart study. Int J Behav Nutr Phys Act. 2008;5:29.CrossRefGoogle Scholar
  18. 18.
    Norman GJ, Schmid BA, Sallis JF, Calfas KJ, Patrick K. Psychosocial and environmental correlates of adolescent sedentary behaviors. Pediatrics. 2005;116:908–16.CrossRefGoogle Scholar
  19. 19.
    National Cancer Institute, Division of Cancer Control and Population Sciences. Dietary screener questionnaire in the NHANES 2009–10: background. Last Updated February 2018. Accessed April 2018.
  20. 20.
    Choi L, Ward SC, Schnelle JF, Buchowski MS. Assessment of wear/nonwear time classification algorithms for triaxial accelerometer. Med Sci Sports Exerc. 2012;44:2009–16.CrossRefGoogle Scholar
  21. 21.
    Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26:1557–65.CrossRefGoogle Scholar
  22. 22.
    Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561–7.CrossRefGoogle Scholar
  23. 23.
    Banfield EC, Liu Y, Davis JS, Chang S, Frazier-Wood AC. Poor adherence to US dietary guidelines for children and adolescents in the national health and nutrition examination survey population. J Acad Nutr Diet. 2016;116:21–7.CrossRefGoogle Scholar
  24. 24.
    National Cancer Institute, Division of Cancer Control and Population Sciences. Usual dietary intakes: food Intakes, US Population, 2007–10. Last updated April 2018. Accessed June 2018.
  25. 25.
    Di Noia J, Byrd-Bredbenner C. Determinants of fruit and vegetable intake in low-income children and adolescents. Nutr Rev. 2014;72:575–90.CrossRefGoogle Scholar
  26. 26.
    Yee AZ, Lwin MO, Ho SS. The influence of parental practices on child promotive and preventive food consumption behaviors: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2017;14:47.CrossRefGoogle Scholar
  27. 27.
    Slining MM, Popkin BM. Trends in intakes and sources of solid fats and added sugars among U.S. children and adolescents: 1994-2010. Pediatr Obes. 2013;8:307–24.CrossRefGoogle Scholar
  28. 28.
    Bogart LM, Elliott MN, Ober AJ, Klein DJ, Hawes-Dawson J, Cowgill BO, et al. Home sweet home: parent and home environmental factors in adolescent consumption of sugar-sweetened beverages. Acad Pediatr. 2017;17:529–36.CrossRefGoogle Scholar
  29. 29.
    Mazarello Paes V, Hesketh K, O'Malley C, Moore H, Summerbell C, Griffin S, et al. Determinants of sugar-sweetened beverage consumption in young children: a systematic review. Obes Rev. 2015;16:903–13.CrossRefGoogle Scholar
  30. 30.
    Belcher BR, Berrigan D, Dodd KW, Emken BA, Chou CP, Spruijt-Metz D. Physical activity in US youth: effect of race/ethnicity, age, gender, and weight status. Med Sci Sports Exerc. 2010;42:2211–21.CrossRefGoogle Scholar
  31. 31.
    Elmesmari R, Martin A, Reilly JJ, Paton JY. Comparison of accelerometer measured levels of physical activity and sedentary time between obese and non-obese children and adolescents: a systematic review. BMC Pediatr. 2018;18:106.CrossRefGoogle Scholar
  32. 32.
    Atkin AJ, Sharp SJ, Corder K, van Sluijs EM. Prevalence and correlates of screen time in youth: an international perspective. Am J Prev Med. 2014;47:803–7.CrossRefGoogle Scholar
  33. 33.
    Willett W. Nutritional epidemiology, third edition. Oxford ; New York: Oxford University Press; 2013.Google Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Sunnyside School DistrictSunnysideUSA
  3. 3.Department of PediatricsUniversity of Washington School of MedicineSeattleUSA
  4. 4.Department of Health ServicesUniversity of Washington School of Public HealthSeattleUSA

Personalised recommendations