Adolescents demonstrate improvement in obesity risk behaviors after completion of choice, control & change, a curriculum addressing personal agency and autonomous motivation

Abstract

Background: The rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts.

Objective: To examine the impact of a curriculum intervention, Choice, Control & Change, on the adoption of the energy balance-related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors.

Design: Ten middle schools were randomly assigned within matched pairs to either intervention or comparison/delayed control conditions during the 2006-2007 school year.

Subjects/setting: Students were from low-income New York City neighborhoods; 562 were in the intervention condition, and 574 in the comparison condition.

Intervention: Students received the 24 Choice, Control & Change lessons that used science inquiry investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action.

Main outcome measures: Self-report instruments to measure energy balance-related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors.

Statistical analyses: Analysis of covariance with group (intervention/control) as a fixed factor and pretest as covariate.

Results: Students in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen time, but showed no increases in their intakes of water, fruits, and vegetables. They showed substantial increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy.

Conclusions: The Choice, Control & Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach.

Choice, Control & Change (C3) middle school curriculum theoretical model1 ¹The C3 curriculum is based on Social Cognitive Theory and Self-Determination Theory (28,30). It uses educational strategies to address the potential motivational mediators of outcome expectations, goal intentions, and self-efficacy/perceived barriers as well as behavior change mediators of knowledge and skills and self-regulation processes. Together these increase personal agency/autonomous motivation in order to achieve the targeted obesity risk reducing behaviors shown, with the long term goal of improving health and preventing obesity.