Education and Activities to Improve Health and Quality of Life

Weight Watchers

Table of Contents

1. Specific Aims

1.          Description of Goals ……………………………………………………………….. 4
2.          Objectives ……………….…………………………………………………………….. 4
3.          Outcomes ……………………………………………………………………………….. 4
4.          Program …………………………………………………………………………………  4
5.          Population ……………………………………………………………………………… 6
6.          Sampling ……………………………………………………………………………….. 6
7.          Experimental design ……………………………………………………………….. 7

2. Background and Significance

1.          Importance of Topic ………………………………………………………………. 7
2.          Critical Review of the Research on Similar Programs .…………………………… 8
3.          Description of Program Components and Theoretical Relevance ………………… 12
4.          Statement of Hypotheses Being Examined   ………..………………………………. 14

3. Methods

1.          Description of the Population and Method of Sample Selection …………………. 15
2.          Design of Experimental Methodology…………………………………………….. 16
3.          Operationalization of Concepts ….. ………………………………………………. 18
4.          Formative Evaluation Methods …………………………………………………… 19
5.          Process Evaluation Methods ………………………………………………………. 20
6.          Rationale for Choice of Statistical Techniques…………………………………… 21

4. Timeline of Activities to be Accomplished …………………………………………….  23
5. Appendix

1.  The Weight Watchers Questionnaire (Pre/Post-Test) ……………………………..24
2.          Consent Form …………………………………..…………………………………. 28
3.          References …………………………………………….……………………..…… 29

SPECIFIC AIMS

Brief Description of Goal(s)

The main purpose of this program is to improve the health and quality of life through educational and physical activities as well as healthy eating to reduce the prevalence of obesity among low-income Hispanic/Latino middle school students (grades 6-8) residing in Long Beach, California.

Objectives

• Objective #1: By the end of the program, the Experimental Group will increase their knowledge about healthy nutrition by 30%, as measured at posttest through self-administered questionnaires (Question 6-15).
• Objective #2: By the end of the program, the Experimental Group will change attitudes regarding eating healthy by 20%, as measured at posttest through the self-administered a questions (Question 16-25).
• Objective #3: By the end of the program, the Experimental Group will reduce Body Mass Index (BMI) by 5% through physical activities, as measured at posttest through the clinical measurement (Question 26-30).

Outcome

A school year after the program implemented, this program will result in a significant difference in behavioral practices, which will gain the goal reducing BMI by 5% through educational and physical activities as well as healthy eating to prevent increase of obesity among low-income Hispanic/ Latino middle school students in Long Beach, California (grade 6-8).

Program

The Weight Watchers program is an intervention program designed with an educational and physical activity as well as healthy eating to prevent increase of obesity among middle school students in Long Beach, California. This program specifically targets students in low-income Hispanic/Latino attending at the middle schools (grades 6-8) in Long Beach Unified School District (LBUSD). Male and female students between grades 6 and 8 having signs and symptoms of obesity with the same socioeconomic status (SES) and ethnicity will be chosen to Weight Watchers program. Two schools – Hughes Middle and Lindsey Academy – will represent for the experimental group and control group randomly chosen in the middle schools in LBUSD Hughes Middle is as the experimental group; Lindsey Academy is as the control group.

Participants including students and their parents/ guardians are volunteers. Before taking participation in the intervention, parents/ guardians and their children will sign a consent form and children’s indices about health (BMI and blood pressure) will also be recorded for each participant. Instructors and nutritionists will provide guidance documents about nutrition as well as physical activities to parents/guardians for each education session. These documents are used for recording daily activities of participants, such as time for physical activity or quantity of vegetables or fruit consumption.

The Weight Watchers program will be put into 12 practice weeks from Monday to Friday during Fall semester and Spring semester of Long Beach Unified School District. The Weight Watchers program will be divided two parts: (1) The 45-minute activity a day is for physical activities and (2) the 45-minute activity a week is for educational guidance about choice of healthy food and preparation of meals. Physical instructors will organize and carry out 45-minute a day for physical activities; nutritionists will guide for parents/guardians about the understanding about choosing healthy foods and food processing properly. Parents/guardians’ participation into the sessions at school will help the students continue healthy behaviors at home as well as at school. Pretest and Posttest will be administered to determining effect of the program based on baseline and changes over the program.

Population

The Weight Watchers prevention program will focus on the target population among low income Hispanic/ Latino middle school students (grade 6-8) residing in Long Beach, California. The eligible students to participate into this program are at aged 11-13 that have signs and symptoms of overweight (> 85%) and obesity (>95%).

Sampling

The method of sampling used for this program is cluster sampling. The same characteristics are selected among Hispanic/Latino middle school students (grade 6-8) residing in Long Beach, California. The participants from two schools – Hughes Middle and Lindsey Academy – will represent for the experimental group and control group randomly chosen in the middle schools in LBUSD. Hughes Middle is as the experimental group; Lindsey Academy is as the control group.

Experimental Design

Non-experimental comparison through quasi-experimental design will be used to compare the control and experimental group. Both the control and experimental groups have the same characteristics based on the age, gender, SES, race, areas, and symptoms through randomization. Both groups will be provided and administered the same questionnaires, the same way, same questions, and same measurements at the pretest and posttest to assess to knowledge, attitudes and behavioral preventions of the prevalence of overweight and obesity in the beginning and at the end of program. Experimental group gets intervention; control group gets assessment of change.

BACKGROUND AND SIGNIFICANCE

1. Importance of the Topic

Obesity is no longer a disease in developed countries but it is also a common disease in the world (Centers for Disease Control and Prevention (CDC), 2012). Obesity is a public health problem, especially in children and adolescents. Obesity is becoming more and more serious in the United States, with 38% of adults and 17% of children and adolescents having obesity (CDC, 2017). According to data from the National Health and Nutrition Examination Survey, 2009-2010, overweight and obesity directly affected Hispanic/Latinos and their children.

“Since 1980, the obesity rate has more than doubled (from 5.0% to 12.4%) among children aged 2-5 years, almost tripled (6.5% to 17%) among children aged 6-11, and more than tripled (from 5.0% to 17.6%) in adolescents aged 12-19 years (Childhood Obesity in the United States, 2016).”

The consequences of obesity are directly related to mortality and risk factors associated with fatal chronic diseases such as type 2 diabetes, stroke, high blood pressure, and cardiovascular disease (CDC, 2017). The high rates of obesity among LBUSD adolescents indicate that addressing obesity and overweight through educational and physical activities as well as healthy eating is necessary (Crampon, Humphrey, John, 2011). If obesity among adolescents is not resolved thoroughly, long-term consequences for overweight or obese children will become higher risk of obesity in adulthood (Crampon et al, 2011)

Overweight and obesity cause leading to many negative effects to health and impacts directly to costs for diagnosis and treatment. Costs for childhood obesity in the United States are estimated at $ 14.3 billion a year (Hammond & Levine, 2010). Most obese children will become obese adults; the annual cost of treatment for obesity in adults is estimated about $147 billion, including prescription medications, emergency room, and personal care (Cawley, 2010). Therefore, the promotion of the use of preventative measures will reduce the costs of treating obesity and obesity-related diseases.

2. Critical Review on Similar Programs

The first program, implemented by Jackson et al., (2009) studied and compared diet and physical activity in two communities in Michigan: Ann Arbor and Ypsilanti. The program designed to middle-school students with five primary goals was to change for lifestyle through using of fresh fruit and vegetable, improving physical activity (150 minutes or per week), and reducing consumption of high sugar foods and fast foods. Through surveys and assessments, the results indicate that it is necessary for intervention by promoting healthy behavior among the middle school students in these areas. This program made significant changes in children’s awareness of healthy lifestyles. The second program intervention goal, by Padilla-Raygoza, Diaz-Guerrer & Ruiz-Paloalto (2013), is to apply an intervention program on education and physical activity to treat or prevent weight gain to reduce the incidence of obese syndrome among school-aged children (6-13 years old) in Celaya, Guanajuato, Mexico. There were four schools selected at random among 168 public schools. Students and parents were invited to participate voluntarily in this program. They were required to walk 15 per day around the school from Monday through Friday and attended 8 sessions in 4 months to learn about food choices and healthy food processing. The results after participating in the program showed that the number of children with high blood pressure decreased due to regular physical activity every day and how to choose and process food in the daily meals. In the third program, implemented by Wang et al., (2013), the authors gave a program that aimed to prevent children from gaining weight and reducing the risk of obesity. Prevention interventions are primarily focused on dietary modifications, and physical activity based on home-based and school-based interventions. The results after 6 months of activity showed that most results of BMI indices, obesity and overweight rates through physical activity interventions at school combined with family and community components are good when there was a combination of activities at school, in the family and in the community. In the fourth, Li et al.’s, (2014) program – “a non-randomized controlled trial with cluster sampling” – selected among 921 children aged 7 to 15 to participate in the 12-week program for physical education for obese students. Social ecological model was used as a “simple intervention.” Students in the intervention group participated in “a multi-component physical activity intervention” program and the students in the control group participated in regular school activities. The results showed that multi-component physical school activities significantly reduced indices BMI and these activities helped reduce obesity and significantly improved the health of students. The fifth program, implemented by Guerra et al. (2013), stated that most children are at school all days; so, the school environment should be advantageous to promoting healthy lifestyles and preventing overweight and obesity of children. This program focused on examining the effect of physical activity interventions at school for weight loss and obesity in children. The results showed that early participation in physical activities would lead to more efficacies in preventing to increase BMI.In the sixth program, Burke et al. (2014 also gave another program that promotes healthy eating and physical activity in elementary schools to improve the health of students. Theory of Behavioral Intention was used. “Paired two-sample T tests were used to compare continuous variables…., while chi-squared tests were used to assess categorical variables.” The results showed that the school staff became as the models for students to have positive changes in their activities and in combination with their families, the result also brought a positive improvement in children’s physical health and fitness. As for the seventh program, Pangani et al. in their study aimed to determine the prevalence of overweight and obesity among children aged 8-13 years in Dar es Salaam, Tanzania. A cross-sectional design study and a stratified random sample were used to select 1781 children for the target population. Weight and height are recorded according to WHO standards for children. The results of overweight and obesity in Dar es Salaam is high, so they need a strategy on how to lose weight to prevent overweight and obesity in schools. The Stephen Erfle’s (2012) next study focused on encouraging daily physical activity in middle schools using the Active School Program’s (ASP) fund in Pennsylvania. The target population was the middle-school students in State of Pennsylvania. The schools agreed to publish a physical moderate to vigorous program with minimum of thirty minutes per day at the beginning and the end of the 2009-2010 school years. The results showed that ASP was successful in helping students be conscious of daily physical exercise. The Story et al.’s (2009) last program focused on the role of schools in obesity prevention effort.  Program was organized with four main keys areas: food, physical activity, BMI measurements and wellness policies in school environment. After collecting data, the result showed that the students had some progress in choosing healthy food and creating some policies in providing food in schools.

In short, the entire program created some changes in attitude of middle school students in choosing healthy food and practicing daily physical activities. Social Cognitive Theory applying in Li et al.’s, (2014) program resolved all factors as the Weight Watchers program.

3. Program Components and Their Theoretical Relevance

The Weight Watchers program will be based on Social Cognitive Theory (SCT) to describe program components and their theoretical relevance. The main purpose of the Weight Watchers program concentrates to improve the health and quality of life through educational and physical activities as well as healthy eating and to reduce the prevalence of obesity among low-income Hispanic/Latino middle school students (grades 6-8) is residing in Long Beach, California. The Weight Watchers program will be put into 12 practice weeks from Monday to Friday during Fall semester and Spring semester of Long Beach Unified School District. The Weight Watchers program will be divided two parts: The 45-minute activity a day is for physical activities and the 45-minute activity a week is for educational guidance about choice of healthy food and preparation of meals. Physical instructors will organize and carry out 45-minute a day for physical activities; nutritionists will guide for parents/guardians about the understanding about choosing healthy foods and food processing properly. Parents/guardians’ participation into the sessions at school will help the students continue healthy behaviors at home as well as at school. Pretest and Posttest will be administered to determining effect of the program based on baseline and changes over the program.

The Social Cognitive Theory (SCT) “focuses on how people learn from individual experiences, the actions of others, and their interaction with their environment. ” (Rural Health Information Hub (RHIHub), 2017). The main components of SCT related to behavioral change include: “Self-efficacy, outcomes expectations, using observational learning and other reinforcements to achieve behavior change.” (RHIHub, 2017).

Self-efficacy. Self-efficacy is defined as “the belief that an individual has control over and is able to execute a behavior.” (RHIHub, 2017).The Weight Watchers addresses self-efficacy by applying control over students’ health habits through educational and physical activities as well as healthy eating. Physical education teachers will provide students with basic knowledge and skills for physical activity to promote healthy lifestyles. Through physical activities, students will create healthy relationships among their classmates to work together on the program. The combination of families, schools, and students who work together to pursue a preventive program will help students participate in the program to strengthen and maintain a healthy lifestyle. The Weight Watchers’ nutrition experts will provide students and parents/guardians knowledge about nutrition, how to choose safe and healthy foods to prevent developmental conditions of obesity. Nutrition education will help students and their parents understand the high risk of chronic diseases due to not doing a healthy diet. Maintaining unhealthy eating in childhood will be difficult to change as they become adults.

Outcome expectations. “Outcome expectations are defined as determining the outcomes of behavior change.” (RHIHub, 2017). The outcomes of the Weight Watchers program cooperated with an educational and physical activity as well as healthy eating will prevent increase of obesity among low-income Hispanic/Latino students attending at the middle schools (grades 6-8) in Long Beach Unified School District (LBUSD). Outcome expectations will be measured by various instruments before and after implementing the program. Strengthening physical activity and the knowledge gained during the Weight Watchers program participation will help students and parents/ guardians understand the risks of obesity and chronic disease related to obesity. In addition, parents/guardians’ knowledge about the use of healthy foods having rich in fiber such as fruits and vegetables can reduce the risk of obesity for their children. These results will help program participants reduce the cost of treating obesity and the diseases associated with it.

Observational learning and Reinforcements. Observational learning is defined as watching and observing outcomes of others performing desired behavior.” and “Reinforcement is defined as promoting incentives and rewards that encourage behavior change. (RHIHub, 2017). The Weight Watchers program addresses observational learning and reinforcements by Observational learning is defined as watching and observing outcomes of others performing desired behavior.” and “Reinforcement is defined as promoting incentives and rewards that encourage behavior change. (RHIHub, 2017). The Weight Watchers program addresses observational learning and reinforcements by making changes to the eating behavior of obese children. The intervention program consists two parts: (1) The 45-minute activity a day is for physical activities and (2) the 45-minute activity a week is for educational guidance about choice of healthy food and preparation of meals. In the education sessions, parents/guardians and students participate together in classroom activities on healthy food choices and sports activities. Parents are influential in their children’s lifestyles such as eating behavior and parenting physical activity behavior. The children thus form a positive lifestyle in order to avoid obesity during later adulthood.

4. Hypotheses to be Examined

1. The Experimental Group will increase their knowledge about healthy nutrition by 30%, as measured at posttest through self-administered questionnaires (Questions 6-15).
2. The Experimental Group will change attitudes regarding eating healthy by 20%, as measured at posttest through the self-administered a questions (Questions 16-25).
3. TheExperimental Group will reduce Body Mass Index (BMI) by 5% through physical activities, as measured at posttest through the clinical measurement (Question 25-30).

METHODS

1. Description of Sample Population and Method of Sample Selection

The Weight Watchers prevention program will focus on the middle school students in Long Beach, California. This program specifically targets students in low-income Hispanic/Latino attending at the middle schools (grades 6-8) in Long Beach Unified School District (LBUSD). Hughes Middle and Lindsey Academy schools’ students have signs and symptoms of obesity with the same socioeconomic status (SES) and ethnicity will be chosen to Weight Watchers program. Two schools – Hughes Middle and Lindsey Academy – will represent for the experimental group and control group randomly chosen in the middle schools in LBUSD Hughes Middle is as the experimental group; Lindsey Academy is as the control group. The eligible students to participate into this program are at aged 11-13 that have signs and symptoms of overweight (> 85%) and obesity (>95%).

The cluster sampling method will be selected as a representative sample and not having a population list. Both schools – Hughes Middle and Lindsey Academy – are located in the Hispanic / Latino area, making them the perfect cluster for the program. Both schools will be required to provide a list of their students and their demographics. Featured samples include low-income Hispanic / Latino students studying in grades 6-8 who are living in Long Beach City and have symptoms of overweight (> 85%) and obesity (> 95%). To recruit participants, the program will focus on receiving students with the information featured above through the flyers distributed on campus, via email and phone calls.

The Weight Watchers is a program involving behavior so the program’s Type 1 error will have alpha (a) level set up equal 0.05 and beta (b) level will be worked out as 1-4(a) when a=0.05 to account for Type 2 error with the consequence b=.80. Due the objective # 2 will change behavior regarding eating healthy by 20%, the effective size will be .2. When using proportion chart with two tailed test, the effect size will give the minimum number to be 219 participants to obtain a significant for this test. Having two groups, this number will be doubled to be equal 438 and there is an addition 20% of the participants, who will drop out or refuse to participate. The sample size (n) of the total number of participants will include 526.

2. Design of Experimental Methodology

The Weight Watchers will take a quasi-experimental design that is a type of the non-equivalent comparison group. Two schools – Hughes Middle and Lindsey Academy are divided into two groups: an experimental group and a comparison group. Hughes Middle is as the experimental group that will get intervention of the Weight Watchers program; Lindsey Academy is as the control group that will get standard protocol currently in school. Pretest and posttest will administer the same way at the same time for both groups at both times. Because there is lack random assignment, so it is not equivalent.

Non-equivalent comparison group will control the threats of internal validity – history, maturation, testing, and instrumentation – for two groups.

The threat of history. This design can control the threat of history because any event outside of the program may have an impact on the outcome. If external factors are showing the knowledge to the problem at the posttest, both the experiment and the comparison groups are exposed and attributed to the program.

The threat of maturation. Maturation is controlled in this design through the use of two comparative groups. In Weight Watchers program, both the experimental and control group are selected with same age through randomization and are expected to loose their fat at the same rate. If the experimental group is showing a decrease in BMI at posttest, it is due to the program.

The threat of testing. Testing can be controlled by learning through testing. The experiment group is compared to the control group that reveal significant program efficient regardless of test learning effect in control group.

The threat of instrumentation. Instrumentation is controlled by changing of measuring instruments over time. Two groups are measured in the same way with pretest and posttest, regardless of instrumentation change.

The threat regression to the mean effect. Regression to the mean effect is only through randomization. Randomization should equally distribute outliers to both groups and have equal characteristics. It has tendency of outliers (extreme case) to improve or stay the same. Most commonly extreme cases are tested from the statistical analysis. The Weight Watchers can recruit more participants at the beginning of the program and allow for sufficient sample size after removing extreme cases.

The threat of selection. There is no randomization of the experimental and control group for the threat of selection. Participants are self-selected into the experimental and control group to create bias and similarities in group. Randomization assignment prevents participant selection and ensures equal characteristics distribute in both groups.

 The threat of attrition. Attrition cannot be controlled for under this design. Randomization ensures equal characteristics which would yield same drop out and attrition rates between the experimental and control group. Barriers should be identified and addressed early to reduce attrition. Larger sample size is recruited to account for any dropout or rejection of the program.

The threat of interaction. Interaction is controlled by randomization among two groups. Two or more of the threats operate at the same time. If design can control both of threats individually, it can control for the interaction of the two.

Compensation, diffusion, compensatory rivalry, and demoralization. Threats to internal validity are not controlled by any design. Compensation will be controlled by staff training of important of equal treatment to have pure results. Staff of the control group gives the standard treatment to end up feeling sorry for them because they are withholding potential treatment for them.  Next, diffusion will be controlled through separate the groups geographically so they don’t interact together. Then, compensatory rivalry will be controlled when the staff of control group gets competitive with experimental group. Training of persons who implement the standard treatment makes them aware not to change the standard treatment.

3. Operationalization of Concepts

The Weight Watchers program will collect data by giving a pretest/posttest to the participants through a self-administered questionnaire. The same pretest at the beginning of the program and the same posttest at the end of program will be completed by the groups at school. Students and their parents/guardians will answer the questions together. The purpose of the pretest is baseline assessment about knowledge, attitudes, and beliefs of the participants and their parents/guardians and the posttest is assessment of change with same contents. All questionnaires will be administered the same way, same questions, same measurements for both groups at both times.

The questionnaire consists of many questions with the contents about demographics, knowledge, attitude, and behavior questions. The knowledge questions are based on a Likert scale for nominal data under T/F questions, Y/N questions, multi-choice questions or fill in the blank to measure knowledge; the attitude questions are based on a Likert scale for ordinal data to assess change. Questions 1-10 will be used to measure knowledge; questions 11-20 used to measure attitude; question 21 used to measure behavior.

Children’s indices about health (BMI, weight, body fat percentage, or blood pressure) will also be recorded for each participant at pretest and posttest. Weight scale and calipers will be used as the tools for measurement for both groups.

4. Formative Evaluation Methods

Each program must conduct a pilot test to assess feasibility whether can be implemented or overcome any issues that are inconsistencies with the program not. The Weight Watchers program will be piloted through the use of small scale groups to make the program more effective and avoid problems that may be encountered before the widespread implementation of the larger population. The program will receive feedback from highly trained professionals in the area the program is pursuing. These professionals include many areas such as nutritionists, fitness professionals, and Hispanic / Latinos public health professionals who are living in the Long Beach area. In addition, the program will receive feedback from participants to adjust to the specific population living in the same environment that the program will perform.

Feedback from experts and participants will be used to recruit and retain individuals from the target populations. The mode of recruitment and retention based on the target populations will look at ways to make people come to the program voluntarily. The implementation method will focus on how to promote the program so that children with obesity along with their parents participate in the program. The tools needed to measure change will depend on the target population. Focus groups will be conducted with children who have race, economic status, and in the area where the program will be conducted. Brochures or flyers will popularize in the community to recruit potential audiences; the asked questions were based on the ability to understand obesity, healthy eating preferences as well as physical activity to improve their health.

5. Process Evaluation Methods

Process Evaluation is a program monitoring and solve the barriers that the program faces. It is a very important process for carrying out intervention programs. Programs with an inadequate process evaluation often lead to failure. The purpose of the process evaluation is to monitor or oversee the entire program to ensure that all components of the program are being implemented smoothly. To run an effective program, it is necessary to reach the target population for the program and this will be maintained through program monitoring. To determine whether the prevention program is operating according to the plan of the program or not, participants will be offered pretest and posttest. These tests will also be recorded for follow-up.

Sign-in sheets are used to track attendance or absences with participants. If a participant misses half of the interactions without contact, the participant will be discarded to avoid deviation. Knowledge of obesity will be recognized through questions from 10 to 20 in both pretest and posttest. Focus groups will be given both pretest and posttest to determine the effectiveness of the program based on the data from the test. The pretest test measures background knowledge; the posttest measures change in the group that receives the intervention. The budget of the program will be monitored closely to ensure that program activities are properly allocated. Teaching materials, tools for measurement, staff costs, and administrative materials will be spent by the budget. Formative evaluation focus on the quality and implantation of the program; it includes a pretest of program component and pilot testing purpose. Process evaluation measures the degree to which program was successfully implemented and may apply lessons learned to future implementation of the program.

6. Rationale for Choice of Statistical Techniques

“Descriptive Statistics – Univariate Analysis”

The statistical techniques utilized by Weight Watchers will use both univariate and bivariate analysis. Univariate analysis is a simple descriptive analysis that is used to analyze one variable collected at a time through pre- and post-test. Univariate analysis consists of nominal data, such as age and gender and is reported by graphs, pie charts or frequency tables. The measurement of central tendency for most frequency occurring value is based on mode, median and mean in which mean is added the number of value and divided by the number of cases. This will be assessed in the pre- and post-test.

Inferential Statistics – Bivariate Analysis

Bivariate analysis is not only a simple descriptive analysis but also it is used to identify cause and effect. Its process is used to identify relationship between the cause and effect. It will be conducted to determine program effectiveness. The dependent variables will be obtained through questions from measuring objective. The independent variables will be obtained the group membership of the program through the experimental group or control group.

Object outcome

Active # 1: The Experimental Group will increase their knowledge about healthy nutrition by 30% as measured by self-administered post-test (Questions # 1-10). A summative index will be established based on questions # 1-10 assigned a score of 1 for each correct answer and a score of 0 for incorrect answers. Summative index will range from 0-10. The higher score will indicate the more understanding of the subject matter, the lower score will indicate the less understanding of the subject matter.  A Chi-square test will be preferred using group members at the independent variable and Chi-square (1 nominal) dependent variable. The Chi-square test will be determined at a significant level of .05. Diagrams, scatterplots or line graphs will be used to show the data.

Active # 2: The Experimental Group will change attitudes regarding eating healthy by 20%, as measured at posttest through the self-administered a questions (Question #11-20). The dependent variables are ordinary data with 30 nominal and independent variables are the group membership, a nominal level with 2 categories. The Summative Index will be created by assigning to score of 1 and to the correct answer a score of 0. The Summative Index will be the knowledge score for each participants raging between 0-30 considered an interval level variable. Likert scale is used to assess the attitudes. There will be 3 answer choices. A code of 2 is designed as the most desired answer “Strongly Agree”; code of 1 used for an answer “Agree”; code of 0 used for the least desired answer “Disagree.” Score will be input into database and computerized after the posttest. The experimental and comparison group will be compared about the knowledge at the median scores. Showing data about the changing the attitude is via graphs, charts or frequency table.

Active # 3: The Experimental Group will reduce Body Mass Index (BMI) by 5% through physical activities, as measured by a self-administered questionnaire by posttest through the clinical measurement (Question #21-25). The summative index will be created by assigning the desired answer the highest and abstract 1 for consecutive category. The dependent variable is shown as daily physical activities; the summative index is an interval level variable indicating the attitude score. The summative index ranges from [0, # of questions and highest score]. 

VII.  Timeline of Activities to be Accomplished

Activity	Jun 2017	July 2017	Aug   2017	Sept   2017	Oct   2017	Nov 2017	Dec2017	Jan   2018	Feb   2018	Mar   2018
Needs Assessment	
Draft of Program			
Pilot Test				
Revisions				
Recruitment								
Pretest								
Program   Implementation										
Process Evaluation									
Post test										
Data Analysis										
Report writing										

APPENDIX A

Pre/Post-Test Questionnaire

Name of participant: ___________________________________

Directions

• Use a #2 pencil only
• Make dark marks
• Example:   Agree  Disagree

Demographics

1. What is your gender? (Circle to which apply)

 Male

 Female

 Other: _________

2. How old are you?

 11

 12

 13

 14

3. Are you Hispanic?

 Yes

 No

4. In what grade are you?

 Grade 6^th   Grade 7^th    Grade 8^th

5. What is your ethnicity? (Circle all that apply)

 Hispanic

 Black/African American

 American Indian/Alaska Native

 Asian

 White/Caucasian

 Native Hawaiian/Other Pacific Islander

 

KNOWLEDGE

6. An obese person has excess weight including muscle, bone, fat, and water.

True  False  I don’t know

7. A person becomes obese because he or she practices exercising too much.

True  False  I don’t know

8. Determination of obesity may be to use key measurements including the body mass index (BMI).

True  False  I don’t know

9. If a person has close relatives with heart disease or diabetes, they are at the risk to increase obesity.

True  False  I don’t know

10. High cholesterol, high blood sugar, and heart disease are the disease concerning to obesity.

True  False  I don’t know

11. Female weighing 174lb or more is overweight and weighing 209lb or more is obese.

True  False  I don’t know

12. Organizing your daily routine reasonably is a way to weight loss.

True  False  I don’t know

13. Eating plenty of fruits and vegetables is good for your health

True  False  I don’t know

14. Obesity in young children often occurs due to parental lack of nutritional knowledge.

True  False  I don’t know

15. Weight-loss diets are based on eating fewer dietary carbohydrates.

True  False  I don’t know

ATTITUDES

How much do you agree or disagree with each statement?

 (Mark one answer for each question.)

When I am physically active, …	Strongly disagree	Agree	Strongly agree
I enjoy it			
I find fun			
it gives me energy			
my body feels good			
I don’t feel good

How much do you agree or disagree with each statement?

 (Mark one answer for each question.)

Do you think …	Strongly disagree	Agree	Strongly agree
obesity is good for you?			
you should practice exercise 60 minutes every day?			
obesity is a chronic illness?			
obesity is increasing in your community?			
your BMI is a high risk to become obese?			

BEHAVIOR

(Mark one answer for each question.)

During the past 7 days, …	0 days	1 days	2 days	3 days	4 days	5 days	6 days	7 days
on how many days were you physically active?								
on how many days did you walk or ride when you were at school?								
on how many days did you eat fruit or vegetables in your meals?								
on how many days did you drink Coke or Pepsi? (Do not count diet Coke or Pepsi)								
on how many days did you have breakfast?								

Consent Form

Obesity is a public health problem, especially in children and adolescents in Long Beach, California. Your child has been selected to participate in the Weight Watchers program. The main purpose of this program is to improve the health and quality of life through educational and physical activities as well as healthy eating to reduce the prevalence of obesity.

This is an entirely voluntary program to increase knowledge and prevention measures to reduce the signs and symptoms of obesity. This program lasts from Fall 2017 to Spring 2018. Your child will be provided the materials relating to the Weight Watchers program.

Through this consent form, personal information is confidential. Your signature is used to approve or disapprove the participation of your child.

_____________________________________

Participant’s Printed Name

_____________________________________                                  __________________

Guardian’s signature                                                               Date

 

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Childhood Obesity in the United States. (,,,,). National Collaborative on Childhood Obesity Research. Retrieved from http://www.nccor.org/downloads/ChildhoodObesity_020509.pdf

Crampon, William J., Humphrey, John W., Norman, Alex J. (2011). Body Mass Index Within Long Beach Public Schools: A Longitudinal Study. Retrieved from http://www.rethinklongbeach.org/resources/Body+Mass+Index+Within+LBUSD.pdf

Erfle, Stephen. (2012). Does Daily Physical Activity Reduce Obesity in Middle School Students? Active Living Research Annual Conference. Retrieved from http://activelivingresearch.org/does-daily-physical-activity-reduce-obesity-middle-school-students

Guerra P.H, Nobre, M.R.C., Silveira, Jonas, A.C. & Taddei, J.A, Aguiar C. (2013). The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials. Clinics, 68(9), 1263-1273. https://dx.doi.org/10.6061/clinics/2013(09)

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holistic school-based intervention for improving health-related knowledge, body composition, and fitness in elementary school students: an evaluation of the

Padilla-Raygoza, N., Diaz-Guerrero, R., & Ruiz-Paloalto, M. (2013). Lifestyle intervention as a treatment for obesity in school-age-children in Celaya, Guanajuato: An experimental study. Central Asian Journal of Global Health, 2(1). doi:https://doi.org/10.5195/cajgh.2013.21

Parks, Joanna, Alston, Julian M., and Okrent, Abigail M. (2013). The External Health-Care Cost of Obesity in the United States. Retrieved from http://vinecon.ucdavis.edu/publications/cwe1304.pdf

Rural Health Information Hub (RHIHub). (2017). Social Cognitive Theory (SCT). Retrieved from https://www.ruralhealthinfo.org/community-health/health-promotion/2/theories-and-models/social-cognitive

Story, M., Nanney, M. S., & Schwartz, M. B. (2009). Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity. The Milbank Quarterly, 87(1), 71–100. http://doi.org/10.1111/j.1468-0009.2009.00548.x

Wang, Y., Wu, Y., Wilson, R.F., Bleich, S., Cheskin, L., Weston, C., Showell, N., Fawole, O., Lau, B., Segal, J. (2013). Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis. Agency for Healthcare researcher and Quality. Retrieved from http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1523