This doctoral dissertation explores the complex food/nutrition, leisure physical activity (LPA) and mental health (MH) needs in Arab immigrants/refugees (AIR) in Ontario, Canada. The main goal is to improve the MH and well-being of AIR. The CAN-HEAL (Canadian Arab Nutrition, Health Education and Active Living) project used a collaborative community-based participatory research and integrated knowledge translation approach, and triangulated data from three different methods (qualitative interviews, Photovoice, and a questionnaire survey) to enhance study rigour. A primary finding of this research is that food/nutrition, LPA, and MH needs in AIR are multi-layered and vary considerably according to intersectional experiences, cross-cultural pressures, living conditions and racism. The research found an alarming prevalence of poor mental well-being (55%), food insecurity (65%) and low LPA levels (87%) in AIR participants (n=60). Among first-generation immigrant participants, 87% reported negative changes in MH since immigration. These negative changes are not straightforward; they are complex and dynamic, and mainly related to structural barriers, poor living conditions, and system failures to accommodate the distinct cultural needs of the AIR community. Intersections among different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion, immigration status), amplified the negative changes in MH, and played a considerable role in how nutrition, food security and LPA impacted AIR’s MH, exacerbating inequities within the AIR community. This research shows that the relationships among food/nutrition, LPA and MH among AIR are multi-faceted, and that there are various psycho-socio-cultural pathways and processes through which diet quality, cultural foods and LPA can contribute to shaping AIR’s MH. As part of this research, an upstream-downstream-based socio-political and community-level action plan was co-developed to thoroughly address the complex needs among AIR and to work towards health equity for this marginalized population. Collaboration between health and non-health sectors is required to effectively implement this action plan. / Thesis / Doctor of Philosophy (PhD) / This research explored the food, leisure time physical activity, and mental health (MH) experiences among Arab immigrants/refugees (AIR) in Ontario, Canada. The goal is to investigate pathways to promote the MH and well-being of the AIR community. The CAN-HEAL (Canadian Arab Nutrition, Health Education and Active Living) project was done in collaboration with the AIR community and used three different tools (interviews, photography, and a survey) to gain a better understanding of the community’s needs. In the survey of 60 AIR participants, we found high rates of poor mental well-being (55%), physical inactivity (87%), and poor reliable access to healthy and affordable food that meets one’s cultural preferences (65%). Eighty-seven percent of first-generation immigrant participants reported unfavorable changes in MH after immigration because of unfair opportunities, and poor living conditions and unjust systems. Interactions between different individual characteristics (e.g., gender, income, religion, immigration status) increased the unfavourable changes in MH, played a big role in how food and physical activity affected AIR’s MH, and led to unfair gaps in health and opportunities within the AIR community. The relationship between food, physical activity and MH among AIR is complex. For example, food quality, traditional foods and favourite physical activities play a large role in the feelings and well-being of AIR. As part of this project, a thoughtful plan has been produced with members of the AIR community in Ontario to allow their voices to be heard, to advocate for fair opportunities and treatment, and to promote their health and well-being.

More than seventy percent of Americans over the age of sixty are classified as overweight or obese, and the future incidence of these conditions is expected to rise. Although it is unclear why older adults are predisposed to weight gain, decreased total energy expenditure may contribute to positive energy balance. It is also possible that age-related impairments in energy intake regulation result in the inability to appropriately adjust food intake to meet energy requirements with advancing age. The purpose of these investigations was to determine the influence of age and habitual physical activity on acute regulation of energy intake. Secondary objectives were to determine if there are sex differences in energy intake regulation, and to determine if pre-meal water consumption decreases meal energy intake in young and older adults. To achieve these objectives, the ability to spontaneously adjust energy intake at a meal under "preloading" conditions in which a yogurt shake or water was consumed prior to the meal was determined. We hypothesized that older adults would demonstrate less accurate energy intake regulation than younger adults, but that energy intake dysregulation would be attenuated in physically active older adults. We also expected that young men would have higher accuracy of energy intake regulation compared to young women matched for dietary cognitive restraint and cardiorespiratory fitness, and that pre-meal water consumption would decrease meal energy intake in young and older adults. Our main finding was that energy intake regulation is significantly impaired in older compared to younger adults, and that habitual physical activity improves short-term, but not acute, energy intake regulation. We also found that young men demonstrate significantly higher accuracy of energy intake regulation compared to young women. Lastly, we determined that pre-meal water consumption significantly decreases meal energy intake in older, but not young, adults. Overall, these results indicate that acute energy intake regulation is less accurate with advancing age, but that regular physical activity improves short-term energy intake regulation. Additionally, sex appears to influence energy intake regulation, and water consumption is a potential strategy to reduce energy intake in older adults. / Ph. D.

Obesity in the United States has increased dramatically during the past 40 years. Women are more at risk than men to be obese; and, a lesbian sexual identity further increases a woman's likelihood of being overweight or obese. This dissertation includes the following components: 1) a review of factors influencing overweight and obesity in lesbians, 2) an ethnographic inquiry examining how lesbian culture and a lesbian sexual identity contribute to a woman's body weight, and 3) the development of a lesbian-specific tool based on factors identified during the ethnography that predicts eating, physical activity, and weight status. The literature review, informed by the Social Ecological Model, investigated potentially contributing factors of overweight and obesity in lesbians. This review revealed a small body of literature dedicated to lesbians' physical activity and eating behaviors; additionally, weight-influencing social-cultural elements of lesbian communities were identified. This body of literature suggests that specific personal, social, and environmental factors negatively influence lesbians' weight, although there is not much known about this community's PA and eating behaviors, as overall behavior-specific findings, were equivocal. However, the following gaps in the literature were identified: lesbians' self-efficacy in PA and healthy eating, and effects on these behaviors as determined by their membership in lesbian subcultures. An ethnographic inquiry examined how a lesbian sexual identity contributes to body weight, attempted to fill a need in the current literature, and was driven by the following questions: 1) How does this lesbian social community serve as a context for its lesbian members to understand body weight? 2) What is the relationship between women's lesbian identities and their body weight? 3) What sub-cultural customs exist that permit or prohibit healthy eating and physical activity by women in this lesbian community? Participant observation, the primary method of data collection, uncovered the following themes: 1) Valuing Weight, 2) Coping and Socializing Behavior, and 3) Living within an Inconsistent Environment. Social Cognitive Theory assisted in interpreting how and why lesbians create innovative ways to appreciate diverse body weights and provided directives for measurement domains when investigating overweight in this community. Informed by the previous projects, the Lesbian Overweight and Obesity Questionnaire (The LOOQ) was developed as a tool to measure potential influences on PA, fat intake, and dietary consumption, which assist in predicting body mass index (BMI) within the lesbian community. Internal consistency, test-retest reliability, and predictive validity demonstrated encouraging results; all but two (i.e., 2/27) subscales demonstrated adequate to high internal consistency (Cronbach's Alphas= 0.61-0.97) and reliable test-retest scores (r=0.61-0.92). The LOOQ displayed predictive validity with subscale scores predicting outcome behaviors, which predicted BMI scores. / Ph. D.

Physical Education Television (P.E.TV) is a curriculum supplement package, consisting of a series of 10-12 minute long videos and a teachers' support manual, for use in physical education and health classes in middle and high school. The program has been distributed to over 13,000 schools across the United States. The creators of P.E.TV have stated that they intend the program to influence adolescents' attitudes toward physical activity, and to encourage wellness. Reports from a national survey of educators have shown that teachers believe that their students' attitudes are being affected by the program. This experimental study examined if that is the case for 7th graders in a rural Southwestern Virginia Junior High School. Four intact 7th grade physical education/health classes were selected for the study. The students were randomly assigned to the classes by school administrators. The classes were randomly assigned to treatment and control groups. The treatment group (two 7th grade classes) viewed 10 P.E.TV shows over a period of 9 weeks. The same teacher taught all four classes. All participating students filled out a questionnaire consisting of the "Weekly Activity Checklist" and a television cultivation exposure questionnaire, at the beginning of the 9 weeks to determine their activity levels and viewing habits before the experiment. Students were categorized into groups based on activity level, amount of television normally viewed, and predominant type of television show viewed to allow for attribute-treatment-interaction analyses. A post-test only design was used to find out if P.E.TV influenced the students' attitudes toward physical activity. The Children's Attitudes Toward Physical Activity scale was used to assess the students' attitudes. Three hypotheses were tested using a one-way Analysis of Variance and two hypotheses concerning attribute-treatment-interactions were tested using a two-way Analysis of Variance for each. Levels of significance were set at .05. The analyses indicated that there were no statistically significant differences in attitudes toward physical activity between treatment and control groups as well as no statistically significant differences within the treatment groups concerning attribute-treatment-interactions. / Ph. D.

This study examined the relationship between the perceptions of physical competence and patterns of physical activity of 83 5th and 7th grade children in one school in rural southwest Virginia. Gender and grade level differences in perceptions of competence and physical activity patterns were also investigated. The Perceived Physical Competence Subscale for Children (PPCSC) (Harter, 1982) was modified to measure children's perceptions of physical competence (26 self-efficacy questions). Children's patterns of physical activity were measured by a modification to Sallis & McKenzie's Self Administered Physical Activity Checklist (SAPAC). Each item on the PPCSC was matched with an activity on the SAPAC scale. Modifications to both scales were made as a result of pilot testing performed with the sample population. A significant positive linear relationship was found between children's perceptions of competence and their amount of physical activity. Significant positive correlations were also found for a number of self-efficacy measures and the amount of time children chose to engage in these specific activities. Significant gender differences were found between boys and girls in overall perceptions of competence, as well as in a number of self-efficacy measures. Boys were typically higher is self-efficacy on most physical activities with the exception of gymnastics, dance, and jump rope. The 7th grade boys had the highest perceptions of competence, while 7th grade girls were the lowest of all four groups. These perceptions of competence were reflected in whether children chose to participate in an activity or not. Children generally chose to engage in activities that they perceived themselves competent . There also appear to be very powerful socio-cultural influences on the types of activities that boys and girls choose (Lirgg, 1992). Girls were significantly more active in health enhancing lifetime physical activities such as walking, jogging, and bicycling, and chose activities of a lower intensity level than boys. Contrary to the literature, this study found no significant differences in the total amount of physical activity between boys and girls. It was hypothesized that the rural setting in which this study was conducted may have influenced this outcome. No significant differences were found between grades in perceptions of competence or physical activity time. / Ph. D.

The purpose of this study was to design, pilot, and evaluate three alternative assessments that measured fourth and fifth grade student's understanding of physical activity guidelines as contained in the Surgeon General's Report (USDHHS, 1996). The alternative assessments were: 1. designing a booklet for a peer named Homer, 2. creating a Video Tape Advertisement for students at another school; and 3. coding the perceived intensity level for one minute intervals at an active aerobic type station (Perceived Intensity Level Assessment Task). Four research questions guided the evaluation of the assessment tasks. They were: 1. Do students who have been taught the physical activity guidelines score differently on the alternative assessment than those who have not been taught the guidelines? 2. Do content experts agree that scores can be used to describe what students have learned (content validity)? 3. Do students find the assessment task worthwhile, enjoyable, and meaningful? 4. Is the alternative assessment prototype "feasible" for a teacher to administer in a regular physical education setting? Student score results, student self-reflections, and student interview data were used to evaluate the first and third research questions. Teacher interview data and Content Expert validity score results were used to analyze the second and fourth research questions. Results from this study indicated that the Homer Booklet Assessment Task discriminated between those students who were taught (experienced group) and those who were not taught (inexperienced group). Furthermore, both the Content Experts and the teacher found this assessment to have high content validity and found it to be feasible to use in a regular physical education setting. Although the students enjoyed the Homer Booklet Task they found it to be the least enjoyable of the three assessment tasks. In contrast, students enjoyed the Video Tape Advertisement Task best. Although this assessment task did discriminate between those who were taught and not taught there were a couple of problems with this assessment. The teacher and Content Experts found this task to have feasibility problems and scores did not discriminate for style. Finally, the Perceived Intensity Level Assessment Task did not discriminate between students who were taught and not taught. / Ph. D.

This study examined the effects of Physical Education Television (P.E.TV) on 69 southwest Virginia middle school students' subjective norm, perceived behavioral control, and attitudes toward physical activity. Four intact 8th grade physical education/health classes were selected for the study. The students were randomly assigned to the classes by school administrators at the beginning of the school year. The classes were randomly assigned to treatment and control groups. The treatment group (two 8th grade classes) viewed 10 P.E.TV shows over a period of nine weeks. The control group (two 8th grade classes) had physical education/health class as normal. The same teacher taught all four classes. A pre-test post-test design was used. All students filled out a pre-test questionnaire at the beginning of the 9 weeks, and a post-test questionnaire at the end of the 9 weeks. The pre and post-test questionnaires included the "Children's Attitudes Toward Physical Activity" scale to assess the student's attitudes, and questions developed by Fishbein and Ajzen (1980, 1985) to assess subjective norm and perceived behavioral control. The pre-test questionnaire also included the "Weekly Activity Checklist", which was used to categorize students into groups based on their activity level. The first three hypotheses stated that P.E.TV would have a positive influence on the students' subjective norm, perceived behavioral control, and attitudes toward physical activity. These hypotheses were tested using Analysis of Covariance, and rejected at the .05 level of significance. The fourth hypothesis stated that P.E.TV would have more of a positive influence on students categorized as "moderate to low active" than on students categorized as "high active". This attribute-treatment-interaction hypothesis was tested using a two way Analysis of Variance, and was also rejected at the .05. level. Suggestions for future studies are included in the discussion section. / Ph. D.

This study tested an integrated social cognitive model of physical activity intention formation, onset, and maintenance among sedentary participants (N = 465) in a church-based, social cognitive, physical activity intervention. Three separate models were tested via structural equation modeling. Each model provided a good fit to the data. The models explained 28%, 19%, and 9% of the variance in intention formation, physical activity onset, and physical activity maintenance, respectively. Consistent with hypotheses, self-efficacy mediated the effect of positive outcome expectancy on behavioral intention, adoption of behavioral strategies mediated the effect of the intervention on physical activity onset, and maintenance of self-efficacy mediated the effect of the intervention on physical activity maintenance. Contrary to hypotheses, change in self-efficacy from baseline to post-assessment and perceived satisfaction with intervention outcomes did not have effects on physical activity onset or maintenance. The findings provide preliminary evidence that physical activity intention formation, onset, and maintenance are distinct processes driven by different determinants before, during, and following a social cognitive physical activity intervention. / Ph. D.

The use of group dynamics principles such as group goal-setting, distinctiveness and cohesion has been the basis of a burgeoning area of physical activity (PA) promotion. Recent reviews of literature suggest that these interventions are robust and increase PA in a wide variety of populations. Still, a number of questions remain unanswered in the areas of theory development, intervention implementation, and translation of research into practice. This dissertation includes a series of manuscripts that focus on research, theory, and practice of group dynamics interventions intended to promote PA. Within research, a systematic review of literature explores group dynamics-based PA interventions in terms of generalizability (through RE-AIM evaluation) and the degree to which the interventions use research techniques that are more pragmatic (reflect typical practice) or more explanatory (testing under optimal conditions). This exploration is based on an initial review of 17 interventions that employ group dynamics strategies to increase PA, fitness, and/or adherence. The results suggest that this body of literature includes a range of pragmatic and explanatory trials, but still has gaps in reporting related to external validity. Embedded within the context of a PA promotion program for minority women, the second manuscript addresses a theory-based question—to what degree do group-interaction variables (cooperation, communication, and competition) differentially predict group cohesion over time. The results suggest that friendly competition is the strongest and most consistent predictor of different dimensions of group cohesion while task and socially related communication are consistent predictors of task and socially related cohesion, respectively. Two manuscripts are included in addressing the use of group dynamics principles within practice settings. The first practice manuscript details a small pilot study in which obese, limited income women successfully (p<0.05) limited gestational weight gain to the Institute of Medicine (2009) recommendation of 11-20 pounds. This study attempted to integrate a group dynamics approach into a group visit model for pregnant women. The quantitative findings were promising, but qualitative findings indicated a number of difficulties in implementation. The purpose of the final manuscript was to determine the attributes of the program agents consider when deciding to adopt a PA and fruit and vegetable promotion program and their understanding of key strategies related to group dynamics theory. Delivery agents were able to identify key underlying principles and propose adaptations that align with those principles. / Ph. D.

Physical activity (PA) has been shown to be an important component in preventing a number of negative health outcomes and in improving cardio respiratory fitness. However, there is little consensus as to what mediates the relationship between PA interventions and PA behaviors. Numerous studies have identified self-regulation as a proximal mediator of PA interventions, but there appears to be little consensus as to what constitutes self-regulation and how it should be measured. The current study explores the theoretical underpinnings of self-regulation from several different theories and identifies several measures related to those theories. Overlapping factors are identified by combining the measures and conducting exploratory and confirmatory factor analyses in order to understand the components of self-regulation. The results of the factor analyses revealed a seven-factor model consisting of 96 items. The factors from the final model included Self-Regulation Self-Efficacy, Negative Affect, Goal Setting/Goal Planning, Goal Communications, Goal Setting/Outcome Expectancy, Self-Monitoring, and Goal Planning. Analyses reveal that Goal Setting/Goal Planning and Goal Setting/Outcome Expectancy significantly predicted PA behaviors. How these factors relate to the theories of self-regulation and how they relate to the original measures are discussed; however several factors derived from this study contained several theoretically distinct constructs which made interpretation of these factors difficult. Future directions for identifying and developing factors of self-regulation are discussed and special consideration is given to the process of self-regulation. / Ph. D.