When it comes to researching the physical activity levels of college students, there seem to be very few studies that truly depict and show the ranges of physical activity throughout a college student’s life. This statement has helped propelled me to collect and analyze data in order to see what the physical activity is like for an undergraduate college student at the University of Texas. Researchers have discovered that many college students have reported understanding the benefits of physical activity, but that they report that there are many barriers in their daily life that thrust physical activity into the backseat as a priority (Lopez, Gallegos, & Extremera, 2010). Knowing that some college students will ignore physical activity, regardless of the health-related benefits, urges us to further discover the attitude of college students towards physical activity and what factors seem to have the most affect, whether positively or negatively, when it comes to their decisions on physical activity. Many university students decrease their PA levels (Gyurcsik, Bray, & Brittain, 2004; Keating et al., 2005; McArthur & Raedeke, 2009). Knowing this, I seek to answer the question, “What happens to the levels of physical activity throughout an undergraduate student’s life and what are the contributing factors to their level of physical activity?” Researchers noted that a healthy college-aged student should be participating in at least 30 minutes of moderate physical activity at least 5 days per week (Nelson, 2007). My thesis is an analysis of daily and weekly activity, as well as what kinds of physical activity college students like and do not, the way in which they participate, either independently or with friends, as well as where they partake in physical activity. My subjects answered questions based on their physical activity levels throughout their college years. The subjects ranged between first and fifth year undergraduate students, which allowed me to get some insight as to how their physical activity levels have changed throughout the duration of their college careers. / text

Adolescents are usually considered to be in good health, but their wellbeing tend to decrease from primary school to high school. When youth participate in at least 60 min of physical activity every day several health benefits accrue: healthy bones and muscles, improved muscular strength and endurance, reduced risk of developing chronic disease risk factors, improved self-esteem, as well as reduced stress and anxiety. Most youth, however, are not engaging in the recommended level of physical activity. Several studies report that adolescents’ general perception of health includes immediate issues like body awareness and not other health risks like osteoporosis, cholesterol and high blood pressure. The aim of this study was to firstly establish from the literature the main perceptions of physical activity for adolescents, and secondly to establish from the literature the main perceptions of physical activity in health enhancement for adolescents. The systematic review was, where possible, undertaken in line with the recommendations of the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The researchers independently reviewed the title and abstract of each reference to assess its eligibility. The full article was obtained for all potentially eligible references. After a review of the full article, 29 fulfilled the inclusion criteria for article 1 (chapter 2) and 17 articles for article 2 (chapter 3). From the results of the study it seemed that the main perceptions of physical activity for adolescents are influenced by cultural and social factors as well as parents’ beliefs. Perceptions youth have about physical activity will influence their participation in physical activity. Lastly, the results of this study demonstrate that there is a low level of knowledge and awareness regarding physical activity and health. The need to increase physical activity is a public health priority and therefore it is necessary to understand the factors that may influence their participation in order to promote physical activity among youth more effectively. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

Adolescents are usually considered to be in good health, but their wellbeing tend to decrease from primary school to high school. When youth participate in at least 60 min of physical activity every day several health benefits accrue: healthy bones and muscles, improved muscular strength and endurance, reduced risk of developing chronic disease risk factors, improved self-esteem, as well as reduced stress and anxiety. Most youth, however, are not engaging in the recommended level of physical activity. Several studies report that adolescents’ general perception of health includes immediate issues like body awareness and not other health risks like osteoporosis, cholesterol and high blood pressure. The aim of this study was to firstly establish from the literature the main perceptions of physical activity for adolescents, and secondly to establish from the literature the main perceptions of physical activity in health enhancement for adolescents. The systematic review was, where possible, undertaken in line with the recommendations of the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The researchers independently reviewed the title and abstract of each reference to assess its eligibility. The full article was obtained for all potentially eligible references. After a review of the full article, 29 fulfilled the inclusion criteria for article 1 (chapter 2) and 17 articles for article 2 (chapter 3). From the results of the study it seemed that the main perceptions of physical activity for adolescents are influenced by cultural and social factors as well as parents’ beliefs. Perceptions youth have about physical activity will influence their participation in physical activity. Lastly, the results of this study demonstrate that there is a low level of knowledge and awareness regarding physical activity and health. The need to increase physical activity is a public health priority and therefore it is necessary to understand the factors that may influence their participation in order to promote physical activity among youth more effectively. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

In South Africa a remarkable weight gain is found in black adolescent girls during mid-adolescence, which is not necessarily the case among boys (Kalk, 2001:577) . Anthropometry is one of the most basic methods for determining over-nutrition and malnutrition status. A considerable amount of research is indeed done on obesity, and quite an amount on growth stunting (OS), but few interventions exist for prevention and treatment of OS. The World Health Organization (WHO) has determined that approximately 230 million children world wide are growth stunted (OS) (WHO working group, 1986). Physical activity in children is affected by average or serious malnutrition and influences adolescents' body build and body composition (BC) because they are in a period of development. Hoffman et al. (2006), Mantsena et al. (2005) and Monyeki et al. (2005) have all found that OS children/adolescents are shorter in length and lighter in mass than adolescents that grow normally. But most OS adolescents have shown a higher skin fold-fat percentage as well as a higher body mass index (BMI). Intra-abdominal fat storage is also found in OS adolescents and children, which is a health risk. Cross sectional studies show that physical activity (p A) decrease with up to 50% during adolescence, which influences body composition. Research has indicated that a P A participation peak is reached between aged 13 and 14 years, when boys are more active than girls. What is less clear is how the pattern of adolescent obesity differs in terms of race, gender and age (Popkin & Udry, 1998). Firstly, the aim of this study was to determine what the nature of research is that has been undertaken regarding body composition (BC) of OS and malnourished adolescents in Africa and South America, by means of a literature study. The second aim was to determine which body composition variables best describe changes in BC in adolescents (13-18 years) after participation in a physical activity intervention. Thirdly, the aim was to determine which BC, relations and maturation differences are found between OS and non growth stunted (NOS) adolescents between ages 13 and 18 years. Finally, the aim was to establish whether the physical activity levels and physical activity patterns of adolescents (13 to 18 years) change congruent to age increase. The study was compiled by means of an availability sample by making use of two secondary black schools in Ikageng (Potchefstroom) in the North West Province. The availability sample comprised a control group and an experimental group of black learners each. The study was of a longitudinal study design nature which stretched from March 2004 to September 2006. Adolescents (N=309) in the North West Province (Potchefstroom, South Africa (158 boys, 211 girls) between ages 13 and 18 years were used in this study. All the learners were in grade 8 at the onset of the study 2004. The experimental group participated in a physical activity intervention programme for practically one hour, two days per week after school hours for twenty-three weeks in 2004 and in 2005 they practised three times per week for nineteen weeks (July school holiday excluded). Attendance percentage of the PA programme was noted according to attendance registers with the experimental group split into three categories, namely low (0%-30% attended), average (30%-60%) and high (60% and higher). The control group (N=87) attended no intervention program. BC, middle-to-hip ratio (MHR), body mass index (BMI), percentage body fat (% LV) and skin folds were measured for baseline and again after completion of the intervention programme. Maturation phase was determined by means of two gender specific questionnaires (Tanner Questionnaires). The Previous Physical Activity Recall (PDPAR), compiled by Trost et al. (1999), was used for the study to analyse the PA levels. Statistica (Statsoft Inc 9) and SAS (SAS Institute Inc, edition 8, Cary NC) computer processing packages were used to process the data collected. Descriptive statistics were used to represent BC components and participants. A Repeated measurements co-variance analysis (ANCOVA) (corrected for attendance percentage and gender) variance analysis (ANOVA) over time, with a Bonferroni post hoc analysis to establish how the different variables differ from each other over the various test period in months. The significance of differences found was set on p<0.05. Next the Mann-Whitney U test was applied to calculate the significant differences of certain variables between the GS and non-growth stunted (NGS) adolescents. The Chi-square test was also used to determine the categorical variables, namely differences in the distribution within the five Tanner phases, as well as the differences between the GS and NGS girls and boys separately, with regard to the distribution between the groups with a body fat percentage lower or higher than the median. The technique of multilevel modelling was used for analysing the change in PA data over time. The result gained from the literature clearly indicates that GS generally occurs in adolescents and children in developing countries. It was also found that physical activity is. beneficial to the adolescents in terms of body composition, especially for the boys. According to the body mass index (BM!) values, a small percentage of children are classified as overweight, whilst with methods such as the sum of skin folds calculation of skin fold fat percentage and %BF measured by means of air transfer pletismografie (ADP), a larger percentage of children was classified as "over fat". It has also been found that significant differences occurred between the mass, length, length-for-age-z-score (LOZ) , arm span, middle circumference, hip circumference and lean body mass of the GS (28 girls and 28 boys) and NGS (113 girls and 90 boys) groups. The results also indicated a difference in PA levels of boys in the experimental and control groups after participation in the P A programme. With increase in age and over time there was a decrease in weekend physical activity patterns in both groups (experimental and control) for both genders. The experimental group ended at higher PA level than that of the control group of boys over the 30.75 months period. Opposed to this the girls (152 and 59 subjects respectively) did indeed show significant differences during the week as well as during the weekend with the baseline measurements, whereas the experimental group initially showed higher PA levels. These differences were, however, not more significant during end measurements. Both groups of girls further showed a lower curve of PA than that of the boys. The experimental group of boys and girls, as well as the control groups displayed a decrease in PA over the 30.75 months period. With increase in age and over time, a decrease was observed in PA patterns in both groups for both genders, although the last two measurements showed a slight upward inclination, especially in the experimental group of boys. The results showed a difference in PA patterns in the boys in the experimental and control groups, which can be attributed to the PA intervention. From the literature overview the conclusion can be drawn that African countries and other developing countries, where food scarcity is more common, experience a larger extent of problems with GS. The occurrence of GS in South Africa is average. Hence it can be deduced that growth and development need to be taken into consideration when BC is determined in adolescents. Fat percentage is more sensitive measure of obesity than BMI following participation in a PA intervention programme in town community adolescents. Determining BF percentage by means of skin folds and air replacement pletismografie (ADP) is more accurate than BMI in this specific group of experimental subjects. From this study the conclusion can be drawn that differences occur between GS and NGS adolescents of both genders in certain BC and body proportion components, without a difference in sexual development. With regard to the girls in terms of PA levels, it had another effect as with the boys with the intervention. The experimental group of boys, after 3 years (of which they underwent a PA intervention for 2 years) showed a higher PA level than the control group of boys that did not participate in a PA intervention. From this it can be deduced that this intervention did indeed contribute to differences in PA of boys that participate in physical activity programmes in deprived environments, while strategies different from these will need to be developed for girls from these communities. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2010.

In South Africa a remarkable weight gain is found in black adolescent girls during mid-adolescence, which is not necessarily the case among boys (Kalk, 2001:577) . Anthropometry is one of the most basic methods for determining over-nutrition and malnutrition status. A considerable amount of research is indeed done on obesity, and quite an amount on growth stunting (OS), but few interventions exist for prevention and treatment of OS. The World Health Organization (WHO) has determined that approximately 230 million children world wide are growth stunted (OS) (WHO working group, 1986). Physical activity in children is affected by average or serious malnutrition and influences adolescents' body build and body composition (BC) because they are in a period of development. Hoffman et al. (2006), Mantsena et al. (2005) and Monyeki et al. (2005) have all found that OS children/adolescents are shorter in length and lighter in mass than adolescents that grow normally. But most OS adolescents have shown a higher skin fold-fat percentage as well as a higher body mass index (BMI). Intra-abdominal fat storage is also found in OS adolescents and children, which is a health risk. Cross sectional studies show that physical activity (p A) decrease with up to 50% during adolescence, which influences body composition. Research has indicated that a P A participation peak is reached between aged 13 and 14 years, when boys are more active than girls. What is less clear is how the pattern of adolescent obesity differs in terms of race, gender and age (Popkin & Udry, 1998). Firstly, the aim of this study was to determine what the nature of research is that has been undertaken regarding body composition (BC) of OS and malnourished adolescents in Africa and South America, by means of a literature study. The second aim was to determine which body composition variables best describe changes in BC in adolescents (13-18 years) after participation in a physical activity intervention. Thirdly, the aim was to determine which BC, relations and maturation differences are found between OS and non growth stunted (NOS) adolescents between ages 13 and 18 years. Finally, the aim was to establish whether the physical activity levels and physical activity patterns of adolescents (13 to 18 years) change congruent to age increase. The study was compiled by means of an availability sample by making use of two secondary black schools in Ikageng (Potchefstroom) in the North West Province. The availability sample comprised a control group and an experimental group of black learners each. The study was of a longitudinal study design nature which stretched from March 2004 to September 2006. Adolescents (N=309) in the North West Province (Potchefstroom, South Africa (158 boys, 211 girls) between ages 13 and 18 years were used in this study. All the learners were in grade 8 at the onset of the study 2004. The experimental group participated in a physical activity intervention programme for practically one hour, two days per week after school hours for twenty-three weeks in 2004 and in 2005 they practised three times per week for nineteen weeks (July school holiday excluded). Attendance percentage of the PA programme was noted according to attendance registers with the experimental group split into three categories, namely low (0%-30% attended), average (30%-60%) and high (60% and higher). The control group (N=87) attended no intervention program. BC, middle-to-hip ratio (MHR), body mass index (BMI), percentage body fat (% LV) and skin folds were measured for baseline and again after completion of the intervention programme. Maturation phase was determined by means of two gender specific questionnaires (Tanner Questionnaires). The Previous Physical Activity Recall (PDPAR), compiled by Trost et al. (1999), was used for the study to analyse the PA levels. Statistica (Statsoft Inc 9) and SAS (SAS Institute Inc, edition 8, Cary NC) computer processing packages were used to process the data collected. Descriptive statistics were used to represent BC components and participants. A Repeated measurements co-variance analysis (ANCOVA) (corrected for attendance percentage and gender) variance analysis (ANOVA) over time, with a Bonferroni post hoc analysis to establish how the different variables differ from each other over the various test period in months. The significance of differences found was set on p<0.05. Next the Mann-Whitney U test was applied to calculate the significant differences of certain variables between the GS and non-growth stunted (NGS) adolescents. The Chi-square test was also used to determine the categorical variables, namely differences in the distribution within the five Tanner phases, as well as the differences between the GS and NGS girls and boys separately, with regard to the distribution between the groups with a body fat percentage lower or higher than the median. The technique of multilevel modelling was used for analysing the change in PA data over time. The result gained from the literature clearly indicates that GS generally occurs in adolescents and children in developing countries. It was also found that physical activity is. beneficial to the adolescents in terms of body composition, especially for the boys. According to the body mass index (BM!) values, a small percentage of children are classified as overweight, whilst with methods such as the sum of skin folds calculation of skin fold fat percentage and %BF measured by means of air transfer pletismografie (ADP), a larger percentage of children was classified as "over fat". It has also been found that significant differences occurred between the mass, length, length-for-age-z-score (LOZ) , arm span, middle circumference, hip circumference and lean body mass of the GS (28 girls and 28 boys) and NGS (113 girls and 90 boys) groups. The results also indicated a difference in PA levels of boys in the experimental and control groups after participation in the P A programme. With increase in age and over time there was a decrease in weekend physical activity patterns in both groups (experimental and control) for both genders. The experimental group ended at higher PA level than that of the control group of boys over the 30.75 months period. Opposed to this the girls (152 and 59 subjects respectively) did indeed show significant differences during the week as well as during the weekend with the baseline measurements, whereas the experimental group initially showed higher PA levels. These differences were, however, not more significant during end measurements. Both groups of girls further showed a lower curve of PA than that of the boys. The experimental group of boys and girls, as well as the control groups displayed a decrease in PA over the 30.75 months period. With increase in age and over time, a decrease was observed in PA patterns in both groups for both genders, although the last two measurements showed a slight upward inclination, especially in the experimental group of boys. The results showed a difference in PA patterns in the boys in the experimental and control groups, which can be attributed to the PA intervention. From the literature overview the conclusion can be drawn that African countries and other developing countries, where food scarcity is more common, experience a larger extent of problems with GS. The occurrence of GS in South Africa is average. Hence it can be deduced that growth and development need to be taken into consideration when BC is determined in adolescents. Fat percentage is more sensitive measure of obesity than BMI following participation in a PA intervention programme in town community adolescents. Determining BF percentage by means of skin folds and air replacement pletismografie (ADP) is more accurate than BMI in this specific group of experimental subjects. From this study the conclusion can be drawn that differences occur between GS and NGS adolescents of both genders in certain BC and body proportion components, without a difference in sexual development. With regard to the girls in terms of PA levels, it had another effect as with the boys with the intervention. The experimental group of boys, after 3 years (of which they underwent a PA intervention for 2 years) showed a higher PA level than the control group of boys that did not participate in a PA intervention. From this it can be deduced that this intervention did indeed contribute to differences in PA of boys that participate in physical activity programmes in deprived environments, while strategies different from these will need to be developed for girls from these communities. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2010.

This thesis aims to determine energy compensation following exercise induced energy expenditure (ExEE). The specific objectives were: I) to determine the impact of the time spent performing physical activity (PA) of varying intensities on body weight and composition (Study 1); II) to determine the overall energy compensation and the major predictors of energy compensation through the systematic review approach (Study 2); III) to develop new methods to measure energy intake (EI) (Study 3) and time spent performing different activities (Study 4); IV) to determine the effects of a lower (LI) and higher intensity (HI) ExEE intervention on energy compensation (Study 5); and V) to investigate the inter-individual variability regarding exercise induced energy compensation (Study 6). In Study 1, women spending more time performing light-intensity PA were shown to have lower adiposity compared to women spending more time performing moderate- and high-intensity PA. Results from Study 2 (systematic review) show an overall energy compensation of 25% following exercise interventions and that fat mass (FM), exercise intensity and duration of the intervention are the main predictors of energy compensation. To better capture energy compensation (i.e., EI and EE), new methods to measure EI and time spent performing activities were developed (Studies 3 and 4) and used in the following studies. In Study 5, overweight/obese women training at HI displayed higher energy compensation when compared to women training at LI, which was accompanied by a reduction of NSPA (non-structured physical activity) and a greater amount of time spent lying down. Results from Study 6 showed that complete compensators (CC) had higher EI, fat and carbohydrate intake at the onset of the ExEE intervention when compared to incomplete compensators (IC). However, the results also showed that dietary disinhibition was increased, whereas NSPA was decreased at the end of the intervention in IC. Taken together, these studies emphasize that weight loss following exercise is impeded by energy compensation. In addition to the impact of FM, exercise intensity and duration of the intervention on energy compensation, NSPA and cognitive factors also seem to modify energy compensation that occurs as a result of exercise.

Yes / This paper explores why teachers adopt physically active learning (PAL). Data were collected through ‘go-alongs’ supplemented by individual interviews with 13 teachers in seven Norwegian lower secondary schools. Data were then analysed thematically. Results indicated that as well as to enhance their teaching and pupils' learning, teachers adopt PAL to adhere to school policy (The Conforming Teacher), to be an innovative educator (The Innovating Teacher), and, because it matches past positive personal experiences (The Connecting Teacher). The findings can be used to shape PAL teacher training programs to increase the likelihood of adoption.

Master of Public Health / Department of Kinesiology / Brandon Irwin / Purpose: Face-to-face group dynamics-based (GDB) programs have been shown to be effective in promoting group cohesion and physical activity (PA). Recent evidence suggests that GDB principles can be successfully translated to web-based applications to impact group cohesion. The social nature of such applications allows for interactions to occur between friends and strangers alike, potentially moderating the effects of such GDB applications. Optimal group composition within GDB web applications has yet to be determined. The present study examines the moderating effects of group composition in a GDB application on group cohesion and PA. Methods: Participants (n = 166) were randomized into same-sex pairs and then randomly assigned to an experimental condition: stranger (no app), stranger (using app), friend (using app) or individual control. Participants in all conditions performed two sets of planking exercises. In between sets, those in partnered conditions interacted with their partner using a GDB social media app, where they participated in a series of team-building activities. The main dependent variables were group cohesion and physical activity, calculated as the total persistence during Block 2, controlling for Block 1 persistence. Results: Results indicate that the group integration dimensions of cohesion were higher in groups that used the application than those that did not (GI-T: p= .001; GI-S: p= .004). Friends that used the app reported greater cohesion across all dimensions than strangers that did the same (ATG-T: p= .006; ATG-S: p= .003; GI-T: p= .001; GI-S: p< .001). There was also a significant difference in PA (p=.004) between the two app-using conditions. However, there was no significant difference in PA between app using conditions and strangers that did not use the app (p= .495). Conclusions: Group cohesion can be enhanced through the use of an online GDB application. Using an online GDB application with a friend is associated with higher levels of cohesion. Further research is necessary to identify effective online GDB applications for impacting physical activity and cohesion in field settings.

Research has highlighted that adolescent girls are insufficiently active which has serious implications for their current and future health. Walking is recognised as an effective way of implementing regular, health enhancing physical activity (PA) into the daily routine of the general population and in an adolescent population walking is a convenient alternative to active play and sports participation. However it is currently difficult to promote walking and walking initiatives with adolescent girls due to lack of well-established evidence regarding both the quantity and quality of walking that might be advocated to promote PA and health. Therefore the aim of this thesis was to provide step based guidelines with regard to both the quantity and quality of walking required for health and thus inform walking interventions in adolescent girls. In order to achieve this aim four studies were undertaken. Study one explored the most appropriate way to assess walking activity, specifically whether walking on a treadmill accurately replicates walking overground in adolescent girls. Treadmill walking was found to overestimate the metabolic cost of walking in this population. This indicated that studies with the aim of exploring or promoting moderate intensity walking should focus on overground walking. Study 2 explored the quality of walking (steps·min-¹) required to achieve moderate intensity physical activity (MPA) overground. The influence of different anthropometric measures on step rate (steps·min-¹) equating to MVPA were also compared. Results suggest that a generic step rate of 120 steps·min-¹ and 7200 steps in 60 minutes may be advocated to achieve MPA in adolescent girls. However inter-individual variation in step rate associated intensity was observed and it was suggested that a step rate range based on the girl’s body mass may be beneficial for use with adolescent girls. Study 3 considered the most appropriate step measurement instrument to assess free-living walking. Five commercially available instruments (activPAL™ and pedometers; Omron HJ-720-ITC, Omron HJ-304-E, New Lifestyles NL-1000, Yamax CW-701) were compared to direct observation hand-tally step counts, during continuous (study 3a) and incidental (study 3b) walking overground. The New lifestyles NL-1000 was most consistently accurate in quantifying steps and ‘activity time’ during continuous walking, but not during incidental walking. However due to the ease of use and additional youth friendly design features, the New Lifestyles NL- 1000 was utilised in study 4. Study 4 explored the quantity of walking (steps·day-¹) required for health in adolescent girls. The results indicated that in terms of walking activity, ‘healthy’ adolescent girls do not walk significantly more in term of steps∙day⁻¹ or time spent in activity than girls classified as at ‘health risk’. Therefore specific thresholds for quantity and quality of walking required for health could not be defined for this population. Overall findings of this thesis highlight, that walking should be assessed overground with an appropriate measurement instrument. A step rate of 120 steps·min-¹ and 7200 steps in 60 minutes may be advocated to achieve MPA in adolescent girls. However further research is required to explore the relationship between walking and health in this population before we can promote an appropriate threshold of walking that is conducive to good health in adolescent girls.

Physical activity (PA) is beneficial for older women, yet, many older women are physically inactive. One way to motivate older women to become physically active is through physically active identity development. This study tested an intervention to see if physically active identity development could be facilitated, and if a facilitated physically active identity resulted in increased PA. A quasi-experimental pre-test post-test design was used with a convenience sample of 43 older women. Data analyses compared those who completed the study versus those who did not complete the study and those assigned to the intervention versus the attention-control group. Those who did not complete the study (N=22) had significantly higher walking frequency (p=.023) and significantly lower duration of sitting (p=.000). Among those who participated in the intervention (N=12) or attention-control (N=9) activities, there were no significant differences in physically active identities or PA at the end of the nine-week study period. Therefore, the study's two hypotheses were not supported. Significant associations were noted between physically active identity measures and health status (p=.039), ego-resiliency (p=.040, p=.016), general fear of performing PA (p=.024), and access to PA (p=.017). Limitations of the study include the high risk of error in the statistical conclusions due to low statistical power, the limitations of the sample, limitations of the intervention itself, and the failure to track subjects longitudinally. Implications for nursing education, practice, and research are discussed. Recommendations for future studies were suggested.