American Journal of Health Promotion

The purpose of this research was to investigate how well Theory of Planned Behavior (TPB) predicted frequency of consumption of fruits and vegetables among seventh graders and to investigate whether gender or socioeconomic status (SES) had moderating effects on the relationships between the constructs in the model.

Two identical self-administered paper and pencil surveys were distributed 6 months apart. Path analyses of the TPB models by gender and SES were performed with AMOS software.

The study occurred in eight middle schools from school districts in the Minneapolis—St.Paul metropolitan area, where a minimum of 20% of the students qualified for free or reduced-price meals.

Of the invited seventh graders, 1406 (74%) completed data for the model constructs at baseline and for behavior at interim data collection.

We assessed frequency of consumption of fruits and vegetables and attitudes, subjective norms, barriers, and intentions related to this behavior. Three levels of SES were created based on questions about free lunch, parents' education, and work.

No significant direct effects of attitudes and subjective norms on behavior were found, but for barriers, both indirect effects through intentions and direct effects on behavior were significant. Seven percent of the variation in the frequency of fruit and vegetable consumption and 31% of the variation in intention to eat more fruits and vegetables were explained by the model. Gender appeared to have moderating effects on the relationships between attitudes and intention and between intentions and behavior in the model. There were no moderator effects of SES, but the larger dropout rates from the low-SES group could have caused the groups to become more homogeneous.

The data fit the model well; still, large proportions of the variance in the frequency of consumption of fruits and vegetables were unexplained. This may be related to the operationalization of the model constructs or to missing important factors in the model. Furthermore, there appeared to be strong relationships between subjective norms or barriers and intentions as well as gender differences in the strengths of the relationships in the model that may have implications for intervention methods or messages.

To examine the effects of 10 youth developmental assets on adolescent tobacco use.

Survey of a randomly selected sample using in-home interviewing methodology.

Inner-city areas of two midsized Midwestern cities.

The researchers studied 1,350 teen-parent pairs.

Demographic information, adolescent self-reported tobacco use, eight developmental asset Likert scales, and two one-item developmental asset measures.

The response rate was 51%. Logistic regression results indicate that youth who possess nine of 10 developmental assets examined are significantly less likely to report tobacco use than youth with low levels of assets. Adjusting for youth age, race, gender, parental income and education, and family structure, significant odds ratios include the following: nonparental adult role model, 2.09 (95% confidence interval [CI] = 1.45, 3.02); peer role models, 2.48 (95% CI = 1.87, 3.29); family communication, 1.73 (95% CI = 1.29, 2.31); use of time (organized groups), 1.77 (95% CI = 1.28, 2.44); use of time (religion), 2.49 (95% CI = 1.86, 3.33); good health practices (exercise/nutrition), 1.61 (95% CI = 1.21, 2.14); community involvement, 1.66 (95% CI = 1.07, 2.58); future aspirations, 2.06 (95% CI = 1.42, 2.99); and responsible choices, 2.21 (95% CI = 1.55, 3.15).

The findings of this study support the view that certain developmental assets may serve to protect youth from risk-taking behaviors, particularly tobacco use. Limitations include cross-sectional data and three scales with alphas below .7.

This study examined the relationship between lifestyle-related health risks and health care costs and utilization in adults.

A 2-year prospective study with no intervention was used to compare health care utilization and costs in employees with different levels of health risks.

Data were collected at a primarily white-collar worksite during 1994 and 1995.

Subjects included 982 employees and spouses, mean age 32.1 ± 10.1 years.

Employee medical claims obtained from a third-party administrator were analyzed with respect to health care expenses and utilization. Exercise habits, stress, and overall wellness were assessed by self-report and obesity by the body mass index (BMI). Regression, regression with outliers removed, and odds ratios were used to analyze the associations.

Employees who were at high risk for overall wellness (2.4 times), stress (1.9 times), and obesity (1.7 times) were more likely to have high health care costs (>$5,000) than subjects not at high risk. Mean total medical costs also were greater for high-risk subjects compared to lower risk subjects for overall wellness (difference = $1,973; F = 10.65, p = .001), stress (difference = $1,137; F = 7.35, p = .007), and obesity (difference = $1,092; F = 9.09, p = .003). The exercise habits measure was not significantly associated with health care costs or utilization.

Results indicate that health risks, particularly obesity, stress, and general lifestyle, are significant predictors of health care costs and utilization in employed young adults.