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P hysical activity (PA) is associated with nu- merous 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 sug- gest 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 cardiovascu- lar disease.3,4 However, despite the known benefits, African-American youth do not engage in the rec- ommended 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-Ameri- can 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

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 associ- ated with physical inactivity.

PA among adolescents is determined by mul- tiple factors including self-efficacy, support from parents and peers,6-8 opportunities to exercise,9,10

attitudes toward PA, interests,11 and neighbor- hood 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 Cul- tural beliefs often are associated with health-relat- ed 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 African- American boys may not participate in leisure-time PA, because it is not considered a part of their fam- ily or community social activities, and often, it is viewed as unimportant or as a luxury.22 Similarly, cultural value for items that suggest economic suf- ficiency such as owning a car or having a televi- sion in a child’s bedroom may predispose African-

Herpreet Thind, Postdoctoral Fellow, Centers for Behavior- al 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, Di- vision of Preventive Medicine, University of Alabama at Bir- mingham, Birmingham, AL. Correspondence Dr Thind; Herpreet_Thind@brown.edu

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 ac- tivity was ‘Mostly a Black Thing’, ‘Equal- ly a Black and White Thing’, or ‘Mostly a White Thing’. Moderate-to-vigorous phys- ical activity was assessed using acceler- ometers. Results: Participants scoring in the highest quartile of Mostly Black score

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

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Am J Health Behav.™ 2015;39(2):284-293 285 DOI: http://dx.doi.org/10.5993/AJHB.39.2.15

American youth to sedentary behavior.23 Traditional PA interventions have not been ef-

fective in increasing PA among African-American children.24 There is a need for adoption of cultur- ally-tailored interventions.24,25 However, under- standing 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 contin- uum 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 prefer- ences 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 ac- tivities 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 African- American adolescents; (2) examine whether cul- tural beliefs differ across participant characteris- tics; 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 Ameri- cans 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 ac- tivities as ‘Mostly a Black thing’ would be likely to engage in greater MVPA, and therefore, be less pre- disposed to overweight or obesity; conversely, we hypothesized that perceiving the majority of activi- ties as ‘Mostly a White thing’ would be associated with lower levels of PA.

METHODS The study took place in metropolitan Birming-

ham, Alabama where 73.4% of residents are Afri- can Americans and 28.9% people are below poverty level.29 Data for this cross-sectional study were col- lected as part of a larger project examining the fac- tors influencing PA among African-American ado- lescents.30,31 Recruitment efforts included posting flyers at community centers, churches, and recre- ational centers, and using newspaper and word- of-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

for participation, and were invited for an in-person study meeting. Written informed consent was ob- tained from their parents; the adolescents them- selves provided assent for the study. Adolescents and their parents completed self-administered paper-and-pencil surveys individually. All assess- ments were conducted in private conference rooms at the Division of Preventive Medicine at the Uni- versity 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.

Measures Cultural beliefs. Cultural beliefs were assessed

using the ethnic mapping technique identified above.26,27 Adolescents were given a list of 42 lei- sure-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 de- veloped this ethnic mapping technique. Using this majority consensus criterion, each PA was cat- egorized 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 de- termine audience preferences. For example, Resni- cow et al28 used it to examine food and PA prefer- ences of African-American adults from a church- based 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 Accultura- tion, 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 quantita- tive 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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Physical activity. Objective data on PA were collected using Actigraph uniaxial accelerom- eters (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 ac- celerometers to each participant at the study meet- ing. Adolescents were instructed to wear the accel- erometers 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 pur- poses. To make sure that they wore the accelerom- eters, 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-spe- cific 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-end- ed responses. Trained staff coded these open-end-

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 sta- diometer (Seca 213) to the nearest 0.1 cm. Weight was measured without shoes and with light cloth- ing 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 percen- tile), normal (5th percentile > = BMI < 85th percen- tile), 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 self- reported their age, sex, and grade. Parents self- reported 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 conduct- ed to describe the sample. Frequencies were cal- culated to categorize each PA as ‘Mostly a Black thing’, ‘Mostly a White thing’ or ‘Equally a Black and White thing’ based on majority consensus.

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) Obese (>95th percentile)

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

Minutes of daily moderate-to-vigorous physical activity 40.4 (27.5)

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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 (%)

Equally Black and White

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 0.8a 70.7b 28.4c

Football 32.8a 65.5b 0.9c

Golf 0 52.6a 47.4a

Gymnastics 1.7a 60.3b 37.9c

Jogging 2.6a 81.0b 14.7c

Jump rope 9.5a 79.3b 10.3a

Kickball 12.9a 76.7b 10.3a

Marching band 19.8a 74.1b 6.0c

Ping pong 1.7a 53.4b 44.0b

Pushups, sit-ups, pull-ups 13.8a 85.3b 0.9c

Roller skating 10.3a 72.4b 15.5a

Roller blading 6.0a 60.3b 32.8c

Running 12.9a 77.6b 8.6a

Soccer 1.7a 62.9b 35.3c

Swimming 4.3a 84.5b 11.2c

Tennis 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

Mostly a White thing

Beach Volleyball 1.7a 33.6b 63.8c

Frisbee 2.6a 28.4b 69.0c

Ice hockey 0.9a 16.4b 82.8c

Ice skating 2.6a 34.5b 62.9c

Horseback riding 0.9a 24.1b 75.0c

Racquetball 0 34.5a 64.7b

Rock climbing 1.7a 42.2b 55.2b

Rowing 0 30.7a 69.3b

Scuba diving 0.9a 28.4b 69.0c

Skateboarding 1.7a 38.8b 59.5b

Skiing 0.9a 25.0b 74.1c

Sky diving 0.9a 28.4b 69.8c

Water polo 0 40.5a 58.6a

Yoga 0 43.1a 56.9a

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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Then, we used one-way chi-square procedures and post hoc tests with correction for alpha inflation (Bonferroni style) to examine significant differenc- es for each physical activity by the 3 categories.

Descriptive statistics were explored for the 3 cul- tural belief subscales. Because cultural belief sub- scale scores were not normally distributed, non- parametric statistical tests were used. Differences in cultural belief scores by participant characteris- tics 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 dif- ference 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 en- gaged 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 dif- ferences in the demographic characteristics, levels of PA, or weight status between adolescents who completed the logs and those who did not complete

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 play- ing 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 per- ceived to be ‘Mostly a White thing’. Ten of these ac- tivities, 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 major- ity of respondents. A significantly lesser percent- age of adolescents rated ballet, bicycling, fishing, gymnastics, jogging, ping pong, roller blading, soc- cer, swimming, walking for pleasure, and water aerobics as ‘Mostly a Black thing’. The majority of the adolescents who reported engaging in basket- ball, 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 adoles- cents were not normally distributed; non-paramet- ric 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 partici- pant age group. Older participants (14-16 years

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

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old) had higher Mostly White scores (Mdn = 16.5 vs Mdn = 10.5, p < .01) compared to the younger par- ticipants (12-13 years old). Five activities (ie, Fris- bee, rock climbing, skateboarding, water polo and yoga) that were considered to be ‘Equally a Black and White thing’ by 12-13 year-olds were consid- ered ‘Mostly a White thing’ by youth in the 14-16 year-old age group. There were no significant dif- ferences in cultural beliefs by sex, household in- come, parents’ marital status, or education level of adults in household.

MVPA and weight status were examined by quar- tiles of cultural belief scores, with higher quartiles indicating greater number of activities rated in that category by participants (Table 5). Though the find- ings 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. Concurrent- ly, 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 ac- tivity 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 South- ern 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 bas- ketball 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 ‘Most- ly a Black thing’ compared to 72% adults in the study by Resnicow et al.27 An activity that was con- sidered ‘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 cul- tural beliefs over the past decade with soccer be-

Table 4 Comparison of Cultural Belief Subscale Scores and MVPAa by

Participant Characteristics Mostly Black Equal Mostly White MVPA minutes/day

Median (IQR) 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)

Cultural Beliefs and Physical Activity among African-American Adolescents

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coming more acceptable to African-American ado- lescents 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 be- ing a ‘White thing’. ‘Acting White’ is a term used in reference to Blacks who engage in activities tradi- tionally 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 associa- tion 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 ac- tivity 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

walking, which contributed to their overall MVPA minutes. Some adolescents also reported engaging in sports such as baseball, volleyball, and calis- thenics, activities not assessed in the cultural be- lief questionnaire. It is possible that because cul- tural beliefs were not assessed on some of the ac- tivities 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 dif- ferentiation. For example, the questionnaire only asked about ballet and dance in general. But not specifically about hip-hop or African/African- American dance, which might be important activi- ties 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 con- sidered to be ‘Mostly a White thing’ by the older participants. This suggests the possibility that cul- tural 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 min- utes vs 44 minutes). This finding is similar to the national trend of lower PA among adolescents rela- tive to younger children.42

PA among adolescents is influenced by individ- ual, family, and environmental factors.6,8,9,13 For African Americans, their core social and cultural processes are fundamental aspects influencing

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

N Daily MVPA Mean (SD) p value a OW/OB % p value b

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)

.525 26 40 24 10

.068

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)

.828 28 18 28 26

.232

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)

.497 20 36 18 26

.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

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their lifestyle behaviors.43 Therefore, interventions promoting PA among African-American adoles- cents are more likely to be successful if they in- clude 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 An- other student-centered after-school intervention included student-selected activities such as bas- ketball, football, hip-hop dance, and Double Dutch jump rope in their program to increase PA among underserved adolescents.46 Intervention partici- pants 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 signifi- cant 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 per- ceive 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 com- munity. 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 ado- lescents and examine its association with MVPA and weight status. This study is strengthened by the inclusion of both objective and subjective mea- sures 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 ac- tivities; however, we did not specifically ask ado- lescents whether they participated in those 42 ac- tivities. 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 in- teresting and informative of future research in- volving 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 cul- tural beliefs. The technique we used only helps to determine cultural preferences for different types of physical activities. However, there are other cul- tural 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 ra- cial/ethnic groups, we do not know how these be- liefs 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 re- search to validate the association of these cultural beliefs with PA in this population is needed to in- form health-enhancing PA interventions.

Human Subjects Statement This study was approved by the Institutional

Review Board of the University of Alabama at Bir- mingham (IRB# X101013001).

Conflict of Interest Statement The authors have no conflicts of interest to dis-

close.

Acknowledgments We thank the study research participants and Re-

search Assistants (Emily Godsey, Haley Heckman, Sh’Nese Townsend). This study was funded by Ac- tive 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 1. Janssen I, Leblanc AG. Systematic review of the health

benefits of physical activity and fitness in school-aged

Cultural Beliefs and Physical Activity among African-American Adolescents

292

children and youth. Int J Behav Nutr Phys Act. 2010;7:40. 2. Physical Activity Guidelines for Americans Midcourse

Report Subcommittee of the President’s Council on Fit- ness, Sports & Nutrition. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Phys- ical Activity among Youth. Washington, DC: US Depart- ment of Health and Human Services; 2012.

3. Mayer-Davis EJ, Beyer J, Bell RA, et al. Diabetes in Afri- can American youth: prevalence, incidence, and clinical characteristics: the search for diabetes in youth study. Diabetes Care. 2009;32(Suppl 2):S112-S122.

4. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: a report from the Ameri- can Heart Association. Circulation. 2013;127(1):e6-e245.

5. Kann L, Kinchen S, Shanklin SL, et al. Youth Risk Be- havior Surveillance - United States, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(Suppl 4):S1-S168.

6. Kelly EB, Parra-Medina D, Pfeiffer KA, et al. Correlates of physical activity in Black, Hispanic, and White middle school girls. J Phys Act Health. 2010;7(2):184-193.

7. Motl RW, Dishman RK, Ward DS, et al. Examining social- cognitive determinants of intention and physical activity among Black and White adolescent girls using structural equation modeling. Health Psychol. 2002;21(5):459-467.

8. Wilson DK, Lawman HG, Segal M, Chappell S. Neighbor- hood and parental supports for physical activity in mi- nority adolescents. Am J Prev Med. 2011;41(4):399-406.

9. Sallis JF, Prochaska JJ, Taylor WC. A review of corre- lates of physical activity of children and adolescents. Med Sci Sports Exerc. 2000;32(5):963-975.

10. Craggs C, Corder K, van Sluijs EM, Griffin SJ. Deter- minants of change in physical activity in children and adolescents: a systematic review. Am J Prev Med. 2011;40(6):645-658.

11. Butt J, Weinberg RS, Breckon JD, Claytor RP. Adolescent physical activity participation and motivational determi- nants across gender, age, and race. J Phys Act Health. 2011;8(8):1074-1083.

12. Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and ad- olescents. Am J Health Promot. 2004;18(5):378-386.

13. Davison KK, Lawson CT. Do attributes in the physi- cal environment influence children’s physical activity? A review of the literature. Int J Behav Nutr Phys Act. 2006;3:19.

14. Kreuter MW, Lukwago SN, Bucholtz RD, et al. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav. 2003;30(2):133-146.

15. Pasick R. Socioeconomic and cultural factors in the development and use of theory. In Glanz K, Lewis FM, Rimer BK, (Eds). Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jo- sey-Bass; 1997.

16. Greif A. Cultural beliefs and organization of society: a historical and theoretical reflection on collectivist and individualist societies. J Polit Econ. 1994;102(5):912-950

17. Mabry IR, Young DR, Cooper LA, et al. Physical activity attitudes of African American and White adolescent girls. Ambul Pediatr. 2003;3(6):312-316.

18. Airhihenbuwa CO, Kumanyika S, Agurs TD, Lowe A. Perceptions and beliefs about exercise, rest, and health among African Americans. Am J Health Promot. 1995;9(6):426-429.

19. Versey HS. Centering perspectives on Black women, hair politics, and physical activity. Am J Public Health. 2014;104(5):810-815.

20. Robbins LB, Pender NJ, Kazanis AS. Barriers to physical activity perceived by adolescent girls. J Midwifery Wom- ens Health. 2003;48(3):206-212.

21. Taylor WC, Yancey AK, Leslie J, et al. Physical activity

among African American and Latino middle school girls: consistent beliefs, expectations, and experiences across two sites. Women Health. 1999;30(2):67-82.

22. Griffith DM, Gunter K, Allen JO. Male gender role strain as a barrier to African American men’s physical activity. Health Educ Behav. 2011;38(5):482-491.

23. Kumanyika SK. Environmental influences on childhood obesity: ethnic and cultural influences in context. Physi- ol Behav. 2008;94(1):61-70.

24. Kumanyika S, Grier S. Targeting interventions for eth- nic minority and low-income populations. Future Child. 2006;16(1):187-207.

25. Kumanyika SK, Story M, Beech BM, et al. Collabora- tive planning for formative assessment and cultural ap- propriateness in the girls’ health enrichment multi-site studies (GEMS): a retrospection. Ethn Dis. 2003;13(1 Suppl 1):S15-S29.

26. Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and de- mystified. Ethn Dis. 1999;9(1):10-21.

27. Resnicow K, Braithwaite R. Cultural sensitivity in pub- lic health. In Braithwaite R, Taylor S, (Eds). Health Is- sues in Black Community. San Francisco: Jossey-Bass; 2001:516-542.

28. Resnicow K, Jackson A, Braithwaite R, et al. Healthy body/healthy spirit: a church-based nutrition and physical activity intervention. Health Educ Res. 2002;17(5):562-573.

29. US Census Bureau: American FactFinder. Available at: http://factfinder2.census.gov/, 2010. Accessed Septem- ber 2, 2014.

30. Baskin ML, Thind H, Affuso O, et al. Predictors of moderate-to-vigorous physical activity (MVPA) in African American young adolescents. Ann Behav Med. 2013;45(Suppl 1):S142-S150.

31. Dulin-Keita A, Thind H, Affuso O, Baskin ML. The asso- ciations of perceived neighborhood disorder and physi- cal activity with obesity among African American adoles- cents. BMC Public Health. 2013;13:440.

32. Unger JB, Gallaher P, Shakib S, et al. The AHIMSA Ac- culturation Scale: a new measure of acculturation for adolescents in a multicultural society. J Early Adoles- cence. 2002;22:225.

33. Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181-188.

34. Trost SG, Pate RR, Sallis JF, et al. Age and gender differ- ences in objectively measured physical activity in youth. Med Sci Sports Exerc. 2002;34(2):350-355.

35. Pate RR, Ross R, Dowda M, Trost SG. Validation of a 3-day physical activity recall instrument in female youth. Pediatr Exerc Sci. 2003;15(3):257-265.

36. Barlow SE. Expert committee recommendations regard- ing the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S164-S192.

37. Neal-Barnett A. Being black: new thoughts on the old phenomenon of acting white. In Neal-Barnett A, Contre- ras JM, Kerns KA, (Eds). Forging Links: African American Children: Clinical Developmental Perspectives. Westport, CT: Praeger; 2001:75-87.

38. Bergin DA, Cooks HC. High school students of color talk about accusations of “acting white.” The Urban Review. 2002;34(2):113-134.

39. Fordham S, Ogbu JU. Black students’ school success: coping with the “burden of ‘acting white.’” The Urban Re- view. 1986;18:176-206.

40. Fryer RG. “Acting white:” the social price paid by the best and brightest minority students. Education Next. 2006;6(1):52-59.

41. Neal-Barnett AM, Stadulis R, Singer N, et al. Assessing the effects of experiencing the acting white accusation.

Thind et al

Am J Health Behav.™ 2015;39(2):284-293 293 DOI: http://dx.doi.org/10.5993/AJHB.39.2.15

The Urban Review. 2009;42(2):102-122. 42. Belcher BR, Berrigan D, Dodd KW, et al. Physical activity

in US youth: effect of race/ethnicity, age, gender, and weight status. Med Sci Sports Exerc. 2010;42(12):2211- 2221.

43. Kumanyika SK, Whitt-Glover MC, Gary TL, et al. Expand- ing the obesity research paradigm to reach African Amer- ican communities. Prev Chronic Dis. 2007;4(4):A112.

44. Robinson TN, Killen JD, Kraemer HC, et al. Dance and reducing television viewing to prevent weight gain in Afri- can American girls: the Stanford GEMS pilot study. Ethn Dis. 2003;13(1 Suppl 1):S65-S77.

45. Beech BM, Klesges RC, Kumanyika SK, et al. Child- and parent-targeted interventions: the Memphis GEMS pilot study. Ethn Dis. 2003;13(1 Suppl 1):S40-S53.

46. Wilson DK, Evans AE, Williams J, et al. A preliminary test of a student-centered intervention on increasing physical activity in underserved adolescents. Ann Behav Med. 2005;30(2):119-124.

47. Springer AE, Hoelscher DM, Kelder SH. Prevalence of physical activity and sedentary behaviors in US high school students by metropolitan status and geographic region. J Phys Act Health. 2006;3:365.

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