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PHYSICAL ACTIVITY IN RURAL OVERWEIGHT YOUTH: A SOCIAL APPROACH

By

SHANA L. SCHUMAN

A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE

UNIVERSITY OF FLORIDA

2011

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© 2011 Shana L. Schuman

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ACKNOWLEDGMENTS

I would like to thank my family for continuing to support my academic endeavors

with love and encouragement. I thank my mentor and the members of the Pediatric

Psychology Lab for providing the guidance that allowed me to reach this milestone.

Finally, I’d like to thank the children and families who have inspired me to pursue a

career in pediatric psychology.

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TABLE OF CONTENTS page

ACKNOWLEDGMENTS .................................................................................................. 3

LIST OF TABLES ............................................................................................................ 5

ABSTRACT ..................................................................................................................... 6

CHAPTER

1 INTRODUCTION ...................................................................................................... 8

2 METHODS .............................................................................................................. 19

Participants ............................................................................................................. 19 Procedures ............................................................................................................. 19

Measures ................................................................................................................ 20 Social Experience Questionnaire ..................................................................... 20 Social Skills Improvement System- Rating Scales (SSIS-RS) (Student

Report) .......................................................................................................... 20 Weight Status ................................................................................................... 21

Physical Activity ................................................................................................ 21 Demographic Questionnaire ............................................................................. 22

Data Analysis .......................................................................................................... 23

3 RESULTS ............................................................................................................... 24

4 DISCUSSION ......................................................................................................... 36

LIST OF REFERENCES ............................................................................................... 44

BIOGRAPHICAL SKETCH ............................................................................................ 54

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LIST OF TABLES

Table page 3-1 Demographic Characteristics of the Sample ...................................................... 29

3-2 Child Report of Social Skills................................................................................ 30

3-3 Behavior Levels Corresponding to Total Standard and Subscale Raw Scores for the SSIS Student Form ................................................................................. 30

3-4 Mean Differences in Social Skills (Total and Subscale Scores) Among Child Gender and Race ............................................................................................... 31

3-5 Associations of Child Age and BMI-z with Social Skills (Total and Subscale Scores) ............................................................................................................... 32

3-6 Physical Activity Descriptive Data ....................................................................... 32

3-7 Mean Differences in Sedentary and Physical Activity (PA) among Child Gender and Race ............................................................................................... 33

3-8 Associations of Child Age and BMI-z with Physical Activity at Different Levels of Intensity .......................................................................................................... 33

3-9 Social Skills in Relation to Average Daily Minutes Spent in Physical Activity ..... 34

3-10 Child Report of Peer victimization and Prosocial Support (Social Experience Questionnaire) .................................................................................................... 34

3-11 Interaction Between Peer Victimization (PV) and Social Skills in Relation to Average Daily Minutes Spent in Physical Activity ............................................... 35

3-12 Interaction Between Peer Victimization (PV) and Peer Social Support in Relation to Average Daily Minutes Spent in Physical Activity ............................. 35

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Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science

PHYSICAL ACTIVITY IN RURAL OVERWEIGHT YOUTH:

A SOCIAL APPROACH

By

Shana L. Schuman

May 2011

Chair: David M. Janicke Major: Psychology

Participation in physical activity during childhood and adolescence is crucial as

the rates of childhood obesity continue to rise. It is imperative to identify modifiable

correlates of physical activity in order to appropriately design intervention programs for

at-risk populations of youth. Although several correlates of physical activity have been

documented, the association between social skills and physical activity in overweight

children has not yet been studied.

The aims of the current study were to: (1) describe social skills in a sample of

rural, overweight youth, (2) determine if social skills are associated with participation in

physical activity, and (3) examine whether social skills and social support moderate the

relationship between peer victimization and physical activity. Participants were 89

overweight or obese youths, ages 8 to 12, and their parents enrolled in the E-FLIP for

Kids Program, a treatment outcome study that addresses overweight in rural children.

Children filled out questionnaires regarding social skills, social support, and peer

victimization, while parents completed a demographic form. Youth physical activity data

was gathered using SenseWear® accelerometers. Social skills of the current sample

were not significantly different from those of a normative group of same-age peers.

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Total social skills were not significantly associated with average daily time spent in

physical activity. Additionally, both social skills and social support did not moderate the

relationship between peer victimization and physical activity. Future research should

continue to examine relationships between social skills and weight-related behaviors in

overweight children, including those who are not seeking treatment for weight

management. It is important to also consider possible mediating variables, such as

depression and social support, which may better explain the association between social

skills and physical activity. Thus, longitudinal research is warranted in this area.

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CHAPTER 1 INTRODUCTION

The prevalence of high body mass index (BMI) among children and adolescents

continues to be a major public health concern in the United States, with recent data

showing that approximately 31.7% of youth ages 2 to19 years are classified as

overweight or obese (body mass index above the 85th percentile for age and gender),

while 16.9% are obese (body mass index above the 95th percentile for age and gender)

(Ogden, Carroll, Curtin, Lamb, & Flegal, 2010). These statistics are particularly

troubling, as childhood overweight is associated with a myriad of medical complications,

including type 2 diabetes, asthma, and orthopedic abnormalities (Ebbling, Pawlak, &

Ludwig, 2002). Of even greater concern is the more immediate development of

metabolic risk factors associated with overweight, such as insulin resistance, elevated

blood lipid levels, increased blood pressure, and impaired glucose tolerance (Sinha et

al., 2002; Freedman, Srinivasan, & Berensen, 2007; Cook, Weitzman, Auinger, Nguyen,

& Dietz, 2003; Weiss et al., 2004; Dietz, 1998; Figueroa-Colon, Franklin, Lee, Aldridge,

& Alexander, 1997), all which may enhance the risk for cardiovascular disease.

Furthermore, short-term morbidities associated with childhood overweight are often

psychosocial in nature, and may include social marginalization, low self esteem, peer

victimization, and poor quality of life (Dietz, 1998; French, Story, & Perry, 1995; Strauss,

2000; Strauss & Pollack, 2003). As peer appearance norms, body image, and physical

fitness are becoming increasingly prevalent topics among youth populations, obesity

may have lasting implications for child and adolescent well-being (Strauss & Pollack,

2003).

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The literature cites several factors that contribute to childhood obesity, with the

simplest explanation being an imbalance between excess energy intake and energy

expenditure in the form of physical activity (Hill, 2005). Thus, recommendations for the

management of childhood overweight often include safely reducing energy intake

usually in combination with an increase of energy expenditure, which is achieved by

increasing physical activity and reducing sedentary behavior (Kirk, Scott, & Daniels,

2005; Krebs, Jacobson, & American Academy of Pediatrics Committee on Nutrition,

2003). Although reducing energy intake and maintaining adequate nutrition are

necessary components of achieving a healthy weight status, participation in physical

activity during childhood and adolescence is especially crucial as lifetime physical

activity habits are established during this period.

There are several documented health benefits associated with participation in

regular physical activity, including improvements in cholesterol, glucose, and blood

pressure levels, as well as increased heart and lung functioning, lower body adiposity,

and improved cardiovascular fitness and strength. In addition, moderate physical activity

can improve self-esteem and body image, enhance sleep quality, and contribute to

better psychosocial well-being (Huang, Sallis, & Patrick, 2009; Strauss, Rodzilsky,

Burack, & Colin, 2001; Sothern, Loftin, Suskind, Udall, & Blecker, 1999; United States

Department of Health and Human Services, 1999). On the other hand, physical

inactivity has been linked to hypertension, hyperlipidemia, and clustered metabolic risk

in children (Andersen et al., 2006; Brage, et al., 2004; Ekelund et al., 2007).

Furthermore, studies shows that physical activity is inversely associated with

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depression, anxiety, and shyness in children and adolescents (Page & Tucker, 1994;

Steptoe & Butler, 1996; Kirkcaldy, Shephard, & Siefen, 2002).

Physical activity in children can be assessed using both subjective and objective

methods. Subjective methods include questionnaires, interviews, activity diaries (logs),

and direct observation, while objective methods include the use of pedometry,

accelerometry, heart rate (HR) monitoring, and combined sensors (e.g., HR and

movement sensors) (Corder, Ekelund, Steele, Wareham, & Brage, 2008). Electronic

monitoring has been indicated as the best method for detecting and assessing patterns

of physical activity over extended periods of time, especially among young children who

often have difficulty accurately recalling frequency, duration, and type of physical activity

via self-report methods (Kohl, Fulton, & Caspersen, 2000). Corder and colleagues

(2008) suggest that accelerometers with physiological parameters like heart rate or

temperature have the greatest potential for increasing the accuracy of energy

expenditure prediction of habitual physical activity in youth.

At least 60 minutes of moderate-intensity physical activity daily is recommended

for youth in the United States (Strong et al., 2005); however, the majority of youth do not

meet this recommendation. Physical activity data compiled from the 2003-2004 National

Health and Nutrition Examination Survey revealed that the estimated prevalence of

achievement of physical activity recommendations varied and ranged from 2% among

12 to15-year-old non-Hispanic White girls to 61% among normal weight 6 to 11-year-old

non-Hispanic Blacks (Centers for Disease Control, NHANES 2003-2004).

Given these statistics, and considering the myriad of negative health

consequences associated with physical inactivity, it is necessary to recognize and

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understand modifiable correlates of physical activity in order to appropriately design

intervention programs for identified at-risk populations of youth. Kohl and Hobbs (1998)

proposed that determinants of physical activity fall into three broad categories:

psychological/social/demographic, environmental, and physiologic/developmental.

Psychological factors have also been considered as distinct from those at the socio-

demographic level (Lindquist, Reynolds, & Goran, 1999), so taking this view one could

state that there are four broad categories.

The role of demographic factors (e.g., age, gender, and socioeconomic status) in

physical activity has been widely studied. Data from the NHANES 2003-2004 survey

revealed a significant decline in physical activity as age increased, regardless of

race/ethnicity, gender, SES, or weight status (Centers for Disease Control, NHANES

2003-2004). Using accelerometry in a sample of children in grades 1 to12, Trost and

colleagues (2002) found the greatest age-related differences to occur in elementary

school, more specifically between grades 1 to 3 and grades 4 to 6. However, the largest

disparities have been observed among gender, such that boys engage in more physical

activity than girls (Eaton et al., 2010; Heath, Pratt, Warren, & Kahn, 1994). Indeed, the

magnitude of gender differences may be highly dependent on the method used to

assess physical activity. Trost et al. (2002) used uniaxial accelerometers to assess

physical activity and reported a magnitude of gender differences that was noticeably

smaller than that reported by studies using self-report methods to assess physical

activity, except at the level of vigorous-intensity activities. Also, greater participation in

physical activity by boys may be explained by a number of other mechanisms, including

differential development of motor skills (Thomas & French, 1985), differences in body

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composition during growth and maturation (Nogueira & Macedo da Costa, 2009) and

gender role expectations (Slater & Tiggemann, 2010).

In addition, higher levels of physical activity are reported in white compared with

minority populations and in children from more affluent backgrounds (Andersen,

Crespo, Bartlett, Cheskin, & Pratt, 1998; Bradley, McMurray, Harrell, & Deng, 2000).

These findings are not surprising, as low income youth typically have less access to

recreational facilities including parks, fitness clubs, sports fields, and trails (Estabrooks,

Lee, & Gyurcsik, 2004; Powell, Slater, & Chaloupka, 2004). In fact, literature has

suggested that children and adolescents who live in areas with more direct access to

recreational facilities and programs are more active than those who do not have such

access (Sallis, Prochaska, & Taylor, 2000). Low levels of physical activity have been

observed in rural youth compared with their urban counterparts, as many of the

identified environmental supports for physical activity in urban areas such as sidewalks,

street connectivity, population density, and diversity of land use (Kirtland et al., 2003;

Saelens, Sallis, & Frank, 2003) are not applicable to rural residents.

Finally, physical activity is positively associated with self-efficacy and attitudes

toward exercise and negatively associated with perceived barriers, including time

constraints, a lack of resources, lack of support from parents, and self-consciousness

when exercising (Gray, Janicke, Ingerski, & Silverstein, 2008), with females and older

children reporting higher levels of barriers (Allison, Dwyer, & Makin, 1999; Zabinski,

Saelens, Stein, Hayden-Wade, & Wilfley, 2003). Regardless of weight status, children

who report more barriers are less likely to be physically active (Sallis, Prochaska, &

Taylor, 2000; Allison, Dwyer, & Makin, 1999; Garcia et al., 1995).

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Along with the recent emergence of group-based weight management programs,

there has been increased attention on the role of social functioning as it relates to

healthy lifestyle behaviors among overweight youth, more specifically physical activity

participation. Social functioning is a fairly vague term that is best defined as an index of

children’s interest and performance across several areas, including peer relations,

social competence, and social-emotional adjustment (Adams, Streisand, Zawacki, &

Joseph, 2002). Research suggests that social functioning in children predicts changes

in adiposity (Lemeshow et al., 2008) and other weight-related behaviors over time (e.g.,

television viewing and sports participation) (Strauss & Pollack, 2003), with much of the

literature emphasizing the role of social support in physical activity. Social support

provided by either parents or peers has been positively associated with youth

involvement in physical activity (Sallis et al., 2000). However, as children age an

increasing amount of time is spent with friends rather than family, highlighting the

importance of peer influence on physical activity. Peer support offers opportunities for

companionship, social integration, and the development of physical abilities and socio-

emotional competencies (Salvy et al., 2008). In addition, emotional support from peers

may enhance self-worth, thereby increasing self-efficacy to perform a variety of physical

activities and to overcome perceived barriers (Duncan, Duncan, & Strycker, 2005;

Duncan, 1993).

In contrast, impaired social functioning may exacerbate overweight by promoting

sedentary activities or increasing unhealthy eating behaviors (e.g., overeating to cope

with loneliness) (Braet & Van Strein, 1997; Salvy, Coelho, Kieffer, & Epstein, 2007).

Studies have found that high social problems are associated with less participation in

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physical activity (Kirkcaldy, Shephard, & Seifen, 2002). Of particular concern, research

has shown that socially impaired youth may be less successful in weight control

interventions (Epstein, Wisniewski, & Weng, 1994). Wilfley and colleagues (2007)

recently conducted a randomized control trial comparing different family-based weight

maintenance approaches, including one intervention that targeted factors identified as

barriers to overweight children’s physical activity (e.g., teasing and body image). They

found that children with low social problems in this intervention achieved the best weight

change outcomes from baseline to two-year follow-up, while no condition-based

differences were found among children with high social problems. These results are

concerning, given that overweight children are at increased risk for a variety of

psychosocial problems, including peer victimization, social isolation, and poor self-

esteem (Schwimmer, Burwinkle, & Varni, 2003; Strauss & Pollack, 2003; Zametkin,

Zoon, Klein, & Munson, 2004). However, certain indices of social functioning, including

social support and social skills, may allow children to overcome these problems. For

instance, social skills can be used to limit negative aspects of social relationships and

mobilize social support for engaging in healthy lifestyle behaviors (Dierk et al., 2006).

While social functioning is a broad concept, social skills are a set of specific

behaviors that are often included in this domain. Gresham and Elliott (2008) define

social skills as ―learned behaviors that promote positive interactions while

simultaneously discouraging negative interactions when applied to appropriate social

situations.‖ Social skills allow an individual to successfully complete social tasks,

including peer group entry, initiating and sustaining a conversation, making friends, and

playing a game with peers (Gresham, Elliott, Cook, Vance, & Kettler, 2010). Research

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has shown that social skills deficits in children are associated with poor academic

performance, later social adjustment problems, as well as a variety of negative

psychological outcomes, including peer victimization and depressive symptoms

(Cowen, Pederson, Babigian, Izzo, & Trost, 1973; Deater-Deckard, 2001; Hay, Payne,

& Chadwick, 2004; Masten, 2005; Segrin, 2000); however, there is a paucity of research

examining the relationship between social skills and physical activity in overweight

youth.

Prior research has primarily utilized broadband measures, such as the Child

Behavior Checklist, as a screener for general social problems (Goldschmidt et al., 2010;

Wilfley et al., 2007; deNiet, Timman, Jongejan, Passchier, & van den Akker, 2010).

While somewhat informative, these broadband measures are often limited. For

example, the Social Problems subscale on the Child Behavior Checklist includes items,

such as, ―Gets teased a lot,‖ ―Complains of loneliness,‖ and ―Prefers being with younger

kids.‖ These items seem to tap outcomes, as opposed to specific skills and behaviors.

Thus, these measures are limited in informing researchers as to why certain children

exhibit or experience problematic outcomes, and in providing specific targets for

intervention. On the other hand, a widely used measure that specifically assesses social

skills is the Social Skills Rating System (SSRS; Gresham & Elliott, 1990). The SSRS

has been used in studies of children with epilepsy, high-functioning autism, attention-

deficit disorder and 22q11 deletion (Tse, Hamiwka, Sherman, & Wirrell, 2007;

Macintosh & Dissanayake, 2006; Mulhern et al., 2004; Kiley-Brabeck & Sobin, 2006).

Given that overweight children have been shown to experience more

interpersonal difficulties, it is necessary to identify modifiable ways to reduce these

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problems. While a focus on negative behaviors initiated by peers (e.g., bullying, teasing,

and ostracization from activities) is necessary, it is also imperative to identify social

skills that may serve to reduce these negative social experiences and promote

participation in more positive health behaviors. For example, the ability to engage in

conversation, assert oneself, join an activity already in progress, and control one’s

emotions when feeling angry or upset, may be important tools for a child to have when

confronted with barriers to physical activity, including lack of support or peer

victimization. For children who are overweight, these social skills may be taught and

consolidated within a group-based weight management program, especially considering

that children with social problems may lack the basic skills needed to enlist social

support for engaging in healthy behaviors (Wilfley et al., 2007).

Moreover, it is unclear to what extent children who are overweight experience

social skills deficits. Only one study has used a standardized measure specific to social

skills to assess social skills in an overweight population (Lumeng et al., 2010). While

this study found social skills to be generally within the average range, further research

describing social skills in overweight youth is clearly warranted.

Thus, the first aim of the current study is to describe social skills in a treatment-

seeking sample of rural overweight and obese youth as they vary by age, gender, race,

and weight status. Given that children who are overweight experience more weight-

related victimization and social marginalization, it is hypothesized that children will

report lower social skills than a normative sample of same-age peers. Based on

previous findings, it is expected that there will be a significant gender difference in social

skills, such that on average, females will have higher social skills ratings than males.

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Adding to the literature on social problems in overweight youth, this study seeks to use

a standardized measure, the Social Skills Improvement System-Rating Scales, to

gather information specific to social skills behaviors. The social skills domain of this

questionnaire assesses behaviors within the following seven sub-domains:

communication, cooperation, assertion, responsibility, empathy, engagement, and self-

control, and also provides a total social skills score (Gresham & Elliott, 2008).

Using physical activity data from accelerometers, the current study also seeks to

investigate the association between social skills and average daily minutes spent in

physical activity. Overweight children who have social problems may be at a

disadvantage if they lack the appropriate social skills needed to enlist support for

engaging in healthy behaviors, such as physical activity. Thus, it is expected that

children who report higher social skills will spend more time in physical activity.

The third aim of the study is to determine if social support and social skills

moderate the relationship between peer victimization and average daily minutes spent

in physical activity. Peer victimization has been positively associated with barriers to

physical activity and inversely associated with child-reported physical activity in a

sample of treatment-seeking overweight youth (Gray et al., 2008). However, given that

social support provided by peers has been positively associated with youth involvement

in physical activity (Sallis et al., 2000), is expected that peer social support will

moderate the relationship between peer victimization and physical activity. Likewise,

children who are able to use social skills (e.g., asserting oneself and exhibiting self-

control when teased) may be less likely to withdraw from social situations, including

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physical activity. Thus, it is hypothesized that social skills will also moderate the

relationship between peer victimization and physical activity.

Aims and Hypotheses Aim 1: To describe social skills in a treatment-seeking sample of overweight and obese

youth as they vary by age, gender, race, and weight status.

Hypothesis 1a: Overweight children will report lower social skills than a normative

sample of same-age peers.

Hypothesis 1b: Females will report higher total social skills scores than males.

Aim 2: To examine the association between child-reported social skills and average

daily time spent in physical activity.

Hypothesis 2: Children who report higher total social skills will engage in more

average daily minutes of physical activity.

Aim 3: To examine peer social support and social skills as separate moderating

variables in the relationship between peer victimization and average daily time spent in

physical activity.

Hypothesis 3a: Peer social support will moderate the relationship between peer

victimization and physical activity.

Hypothesis 3b: Social skills will moderate the relationship between peer

victimization and physical activity.

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CHAPTER 2 METHODS

Participants

One-hundred and seventy-one children between the ages of 8 and 12 were

recruited from six different rural counties for a family-based healthy lifestyle treatment

outcome program. Children were eligible to participate if they were between the ages of

8 and 12, accompanied by a parent or legal guardian, resided in a designated rural

county, and had a BMI above the 85th percentile for age and gender. Individuals who

had a severe developmental delay, were enrolled in another weight-loss program, or

had a serious medical condition that would limit participation in physical activity were

excluded from the study.

Procedures

Children were recruited using direct solicitation methods, including mailing

brochures to households using commercially available mailing lists, as well as

distributing information through local schools, libraries, churches, health-care providers,

and community organizations. Finally, press releases were made via local radio stations

and newspapers. Interested families were asked to call a toll-free number to receive

more information about the program and complete an initial phone screen. Eligible

families then completed an in-person screening visit at their local University of Florida

IFAS Extension office. After families were provided with a complete study description,

informed consent and assent were obtained from the both the child and parent prior to

the administration of questionnaires. These initial in-person screening visits occurred

approximately one to two months prior to the start of treatment. Families also completed

a ―baseline‖ visit just prior to the start of treatment. Those who had scheduling conflicts,

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or signed up after initial screening visits were already completed attended a ―combined

screening/baseline‖ appointment. With the exception of the accelerometry data, all

measures were completed during the initial in-person screening visit. Families who

attended combined appointments were not asked to complete a select number of

questionnaires, due to time constraints. Physical activity data was collected via

accelerometry during the first week of treatment.

Measures

Children completed the following measures:

Social Experience Questionnaire

Child self-report of peer victimization and peer social support was obtained using

the Social Experience Questionnaire (Crick & Grotpeter, 1996). This 15-item measure

consists of three subscales (i.e. relational victimization, overt victimization, and receipt

of prosocial behavior) consisting of five items each. For the purpose of this study, the

relational and overt victimization subscales were combined to form a total victimization

scale. The prosocial behavior scale was used to describe peer social support. Children

rate items on a 5-point Likert scale, ranging from 1 = never to 5 = all the time, with

higher scores indicating increased frequency of behavior. Cronbach’s alpha for the total

victimization scale (α = .89) and prosocial support scale (α = .85) indicated moderate to

good internal consistency.

Social Skills Improvement System- Rating Scales (SSIS-RS) (Student Report)

Children also completed a shortened Student Form of the Social Skills

Improvement System- Rating Scales (SSIS-RS; Gresham & Elliott, 2008). The SSIS-RS

student form assesses three domains including social skills, problem behaviors, and

academic competence. Children answered 75 questions related to both social skills and

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problem behaviors; however, for the purpose of this study, only social skills behaviors

were included in analyses. This domain includes common social skills behaviors in the

following sub-domains: communication, cooperation, assertion, responsibility, empathy,

engagement, and self-control. Each statement on the SSIS is answered on a 4-point

Likert scale that requires the respondent to indicate to what degree a statement is true

for him or her (1= not true to 4= very true). Cronbach’s alpha was .88 for the current

sample. High internal consistency (.94) and test-retest reliability (.81) have also been

reported in the SSIS normative sample of same-age peers. This measure has also

demonstrated good criterion-related and construct validity (Gresham & Elliott, 2008).

Weight Status

Child height and weight were obtained by the project nurse or health technician.

Height was measured using a Harpendon stadiometer, and weight was assessed using

a Tanita® BWB-800 Digital Medical Scale. These data were used to calculate Body

Mass Index (kg/m2). Body Mass Index z-score (BMI-z) values were then calculated for

children using age in months, gender-specific median, standard deviation, and the Box-

Cox transformation according to Center for Disease Control national norms (Kuczmarski

et al., 2002).

Physical Activity

Time spent in physical activity was assessed using the SenseWear® Armband

(BodyMedia, Inc., Pittsburgh, PA). Children were instructed in proper usage of the

SenseWear® Armband, and members of the research team assisted children in

attaching the SWA body monitor to the back of the left arm, over the triceps muscle.

Children were asked to wear the device 24 hours a day, for seven consecutive days in

between the first and second treatment sessions. Families were asked to not make any

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changes to typical physical activity patterns until after session two. The SenseWear®

armband technology includes a two-axis accelerometer device that measures motion

generated from both the upper and lower body. In addition to motion detection, this

device uses heat-related sensors that allow for the assessment of complex, non-

ambulatory activities. These sensors can also detect the increased work required to

walk up a grade or to carry a load (McClain, Welk, Wickel, & Eisenmann, 2005). This

instrument has been shown to accurately estimate energy expenditure for most

activities in children (Calabro, Welk, & Eisenmann, 2009; Arivdsson, Slinde, & Hulthen,

2009). For the purpose of the current study, physical activity data was analyzed if

children had at least 16 hours of wear time per day, for at least four days (three

weekdays and one weekend day). Data was obtained using SenseWear Professional

Software, Version 7.0. Time spent in physical activity was reported in average minutes

per day. The intensity of physical activity was described as metabolic equivalents

(METs). Time spent in activity that rated as 3 to 5.9 METs was classified as moderate

physical activity, and time spent in activity rated as above 6 METs was classified as

vigorous physical activity.

Parents or guardians completed the following questionnaire:

Demographic Questionnaire

Parents and guardians completed a self-report demographic questionnaire.

Information on parent and child age, gender, and race, as well as parent marital status,

income, occupational status, and highest level of education was obtained. Parents also

completed this form at the screening assessment.

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Data Analysis

Descriptive statistics (means, SDs) were calculated for demographic variables,

child-reported social skills, social support, and peer victimization, as well as total time

spent at various levels of sedentary and physical activity. Next, a one sample t-test was

calculated to investigate whether child reported total social skills were significantly

different from those of a same-age normative sample. Independent samples t-tests

were conducted to determine differences in social skills between males and females,

and also among Caucasian and minority racial groups. Correlation analyses were then

used to examine the relationship between child characteristics (age and weight status),

and social skills. A separate set of correlations and independent samples t-test analyses

were run to determine any differences in physical activity by child age, weight status,

gender, and race/ethnicity. The association among social skills and physical activity was

then assessed using hierarchical regression analyses. Demographic variables that were

correlated with total time spent in physical activity were entered in block 1, while the

child-reported total social skills standard score was entered in block 2. Multiple

regression using centered main effects was conducted to test social skills and social

support as moderating variables in the relationship between peer victimization and

physical activity.

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CHAPTER 3 RESULTS

Overall, a total of 171 children completed questionnaires at their initial in-person

screening visit. Unfortunately, 25 participants withdrew from the program or were

assumed to be no longer interested prior to the first treatment session. Thus, 146

children began treatment.

Accelerometers were provided to children at the first group treatment session,

and returned to researchers one week later at the second treatment session. Of the 146

children who initiated treatment, 44 did not have sufficient physical activity data. Eight

children did not return the accelerometer, while 36 did not wear the accelerometer for at

least 16 hours per day on at least three weekdays and one weekend day. An additional

12 children did not complete the Social Skills Improvement System, because they only

were required to attend a combined screening and baseline assessment due to signing

up for the program within two weeks of the treatment start date. Thus, a total of 90

children had sufficient physical activity data and completed the Social Skills

Improvement System.

Finally, one participant was considered to be an outlier with regard to total time

spent in moderate physical activity. Because this individual participated in an

exceptionally high amount of moderate physical activity, their average daily minutes

spent in total physical activity (≥ 3 METs) was more than three standard deviations

above the sample mean. Thus, this participant was subsequently removed from

analyses. The remainder of participants (N = 89) had both sufficient physical activity and

social skills data and were included in analyses.

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Children were aged 8 to 12 years (M = 10.57, SD = 1.40), with 60.7% of

participants identifying as Caucasian, and a smaller percentage of children identifying

as African American (14.6%), Bi- or Multi-Racial (9.0%), and Hispanic (6.7%).

Approximately 89% of the children were obese and 11% were overweight. Slightly more

than half (53.9%) of the participants were female. Median family income was reported to

be between $40,000 and $59,000. Demographic information is displayed in Table 3-1.

The first aim of the study was to describe social skills in a sample of treatment-

seeking overweight and obese youth. Results from the Student Form of the Social Skills

Improvement System (SSIS) showed that, on average, children reported total social

skills in the average range (M = 100.51, SD = 15.80), based on the normative

distribution from the SSIS (see Table 3-2 for means and standard deviations of total

social skills and subscale scores). Approximately 16% of children reported total social

skills standard scores in the ―below average‖ range (-1 to -2 SD below the normative

mean), while 3.4% of children reported total social skills standard scores in the ―well-

below average‖ range (≤ -2 SD below the normative mean). Table 3-3 displays behavior

levels (e.g., below average, average, and above average) corresponding to total and

subscale raw scores for the Student Form of the Social Skills Improvement System.

Results from a one-sample t-test revealed that mean total social skills were not

significantly different from those of the same-age SSIS normative sample, [t(88) = .302,

p = .763]. Additional t-tests did not reveal any significant differences in subscale scores

between this sample and the normative sample. Next, independent-samples t-tests

were run to determine if there were gender differences in social skills. While total social

skills did not differ by gender (p =.280), males reported significantly lower scores on the

26

Cooperation (p = .032) and Responsibility (p = .045) subscales. The Cooperation

subscale assesses one’s ability to help others, share materials, and comply with rules

and directions, while the Responsibility subscale includes behaviors such as doing

one’s part in a group, being well-behaved, and showing regard for property or work. To

determine if there were differences in social skills by race, an independent samples t-

test was conducted, using Caucasian and racial/ethnic minority subsamples. Results did

not reveal any significant differences in social skills by race. Finally, bivariate

correlations were conducted to determine differences in social skills by age and BMI-z

score. Again, using child-reported total social skills, findings revealed that older children

reported lower total social skills (r = -.225, p < .05). There was no significant association

between BMI-z and total social skills. These results are shown in Tables 3-4 and 3-5.

The second aim of the study was to examine the relationship between child-

reported social skills and average daily minutes spent in physical activity. Prior to

examining this relationship, descriptive analyses were run to obtain average total time

spent in daily physical activity, as well as average daily time spent in moderate (3 to 6

METs) and vigorous (>6 METs) physical activity. This data is displayed in Table 3-6. In

addition, analyses were run to determine if any characteristics of the child (e.g., age,

gender, race, and BMI-z) were significantly related to time spent in physical activity.

Independent-sample t-tests revealed that on average, males spent significantly more

time in total, moderate, and vigorous physical activity, while females spent significantly

more time in sedentary activity. A second independent samples t-test did not reveal

significant differences in physical activity by race, and bivariate correlations did not

reveal any significant differences in physical activity by child age or BMI-z score (see

27

Tables 3-7 and 3-8). Thus, only child gender was entered as a covariate in subsequent

multiple regression analyses. Lastly, a square root transformation was applied to total

time spent in physical activity, as the data were significantly and positively skewed (z =

3.65).

Findings from a multiple regression analysis revealed that although the overall

model was significant, (F(2, 87) = 5.00, p=.009), the main effect of social skills was not

associated with average daily time spent in physical activity t(86) = .702, p = .485. Child

gender accounted for 9.9% of the variance in this model, while child-reported social

skills only added to 0.5% of the total variance. These results are presented in Table 3-9.

Although not initially proposed as an aim of the study, post-hoc analyses were

conducted to determine if social skills were associated with physical activity at different

levels of intensity. Two separate multiple regression analyses were run, controlling for

gender, with moderate physical activity and vigorous physical activity as dependent

variables. There was no significant association between social skills and average daily

minutes spent in moderate physical activity (p = .520); however, the relationship

between social skills and average daily minutes spent in vigorous physical activity was

trending toward significance (p = .090). There was no association between social skills

and sedentary activity (p = .878).

The third aim of the study was to determine if social skills or social support

moderated the relationship between child-reported peer victimization and average daily

minutes spent in physical activity. Table 3-10 shows the sample’s means and standard

deviations for the Social Experience Questionnaire. To examine these relationships, two

separate multiple regression analyses were run, using centered main effects (Preacher,

28

Curran, & Bauer, 2006) and controlling for child gender. Both social skills and social

support did not moderate the relationship between peer victimization and total time

spent in physical activity. Also, contrary to previous findings in the literature (Storch et

al., 2007; Faith, Leone, Ayers, Moonseong, & Pietrobelli, 2002), peer victimization was

not associated with average daily minutes time spent in total physical activity. These

results are presented in Tables 3-11 and 3-12.

29

Table 3-1. Demographic characteristics of the sample

Mean SD

Child Age 10.57 1.40 BMI z-score 2.13 0.42

%

Gender Boys 46.1 Girls 53.9 Child Race Caucasian 60.7 African-American

Bi-racial 14.6

9.0 Hispanic 6.7 Asian

Native American 1.1 1.1

Not Reported 6.8 Median Family Income Below $19,999 13.5 $20,000-$39,999 31.5 $40,000-$59,999 23.6 $60,000-$79,000 16.9 $80,000-$99,999 6.7 Over $100,000

Not Reported 5.6 2.2

30

Table 3-2. Child report of social skills

Mean SD Possible Range

Social Skills Improvement System (Student Form)a

Total Social Skills 100.51 15.80 0-138

Communication 13.73 3.27 0-18 Cooperation 16.89 3.62 0-21

Assertion 14.25 4.42 0-21

Responsibility 15.45 3.87 0-21 Empathy 14.09 3.46 0-18 Engagement 15.07 4.12 0-21

Self-Control 10.81 4.49 0-18 a Higher scores indicate better social skills

Total Social Skills represented as a standard score; subscales represented as raw scores Table 3-3. Behavior levels corresponding to total standard and subscale raw scores for

the SSIS Student Form

Below Average

Average Above Average

Social Skills Improvement System (Student Form)a

Total Social Skills <85 85-115 >115

Communication 0-10 11-17 18

Cooperation 0-12 13-20 21

Assertion 0-9 10-18 19-21

Responsibility 0-11 12-19 20-21

Empathy 0-9 10-17 18

Engagement 0-11 12-19 20-21

Self-Control 0-6 7-15 16-18 a Higher scores indicate better social skills

Total Social Skills represented as a standard score; subscales represented as raw scores

31

Table 3-4. Mean differences in social skills (total and subscale scores) among child gender and race

Child Gender

Male (n = 41)

Female (n = 48)

M SD M SD

Total Social Skills 98.54 16.34 102.19 15.29 Communication 13.27 3.20 14.13 3.31 Cooperation 16.00* 3.96 17.65 3.14 Assertion Responsibility Empathy Engagement Self-Control

13.76 14.56* 13.63 14.83 11.56

4.65 4.05 3.64 4.35 4.18

14.67 16.21 14.48 15.27 10.17

4.21 3.58 3.28 3.95 4.68

Child Race

Caucasian

(n = 54)

Racial and/or

Ethnic Minority (n = 34)

M SD M SD

Total Social Skills 102.72 16.71 96.59 13.70 Communication 13.96 3.44 13.29 3.01 Cooperation 17.33 3.77 16.12 3.31 Assertion Responsibility Empathy Engagement Self-Control

14.91 15.98 14.35 15.46 11.31

4.34 4.07 3.50 4.36 4.66

13.03 14.59 13.62 14.29 10.00

4.31 3.47 3.43 3.63 4.21

*p < .05. ** p < .01.

32

Table 3-5. Associations of child age and BMI-z with social skills (total and subscale scores)

r p

Age Total Social Skills -.225 .034* Communication -.191 .073 Cooperation -.250 .018* Assertion Responsibility Empathy Engagement Self-Control

-.121 -.068 -.213 -.227 -.178

.260

.529

.045*

.033*

.095

BMI-z Total Social Skills .097 .367 Communication .041 .704 Cooperation .144 .179 Assertion Responsibility Empathy Engagement Self-Control

-.035 .069 .139 .107 .095

.742

.519

.192

.317

.378 *p < .05. ** p < .01.

Table 3-6. Physical activity descriptive data

Mean SD Minimum Maximum

Sedentarya 1235.60 109.18 836.75 1385.50 Total Time in PA (≥3 METS)a 111.90 52.72 29.25 271.50 Moderate (3-6 METS)a 106.67 48.21 27.75 248.00 Vigorous (> 6 METS)a 6.02 9.53 0.00 70.75 a Units represent average time in minutes per day

33

Table 3-7. Mean differences in sedentary and physical activity (PA) among child gender and race

Child Gender

Male (n = 41)

Female (n = 48)

M SD M SD

Sedentary 1205.54* 117.22 1261.27 95.72 Total PA 129.99** 58.01 96.45 42.56 Moderate 121.52** 51.81 93.98 41.35 Vigorous 8.51*

12.54 3.88 5.09

Child Race

Caucasian

(n = 54)

Racial and/or

Ethnic Minority (n = 34)

M SD M SD

Sedentary 1217.62 123.49 1261.46 76.29 Total PA 116.06 57.02 106.21 45.82 Moderate 111.78 52.96 99.39 39.62 Vigorous 5.54 6.51 6.86 13.14 *p < .05. ** p < .01.

Table 3-8. Associations of child age and BMI-z with physical activity at different levels of intensity

r p

Age Sedentary .131 .221 Moderate -.173 .105 Vigorous .085 .427 Total

-.127 .234

BMI-z Sedentary -.037 .733 Moderate -.067 .532 Vigorous -.064 .553 Total -.093 .388 *p < .05. ** p < .01.

34

Table 3-9. Social skills in relation to average daily minutes spent in physical activity

B SE B β

Step 1 Constant 12.655 .802 Child Gender -1.532 .495 -.315** Step 2 Constant 11.598 1.707 Child Gender -1.573 .500 -.323** SSIS Total Social Skills .011 .016 .072 *p < .05. **p < .01. ΔR

2 = .104

Table 3-10. Child report of peer victimization and prosocial support (Social Experience

Questionnaire)

Mean SD Range

Total Peer Victimizationa 20.62 8.80 10-50

Overt Victimizationa 10.15 5.15 5-25 Covert Victimizationa 10.47 4.27 5-25 Peer Prosocial Supportb 17.93 4.60 5-25 a higher scores indicate more victimization b higher scores indicate more prosocial support

35

Table 3-11. Interaction between peer victimization (PV) and social skills in relation to average daily minutes spent in physical activity

B SE B β

Step 1

Constant 12.655 .802

Child Gender -1.532 .495 -.315**

Step 2

Constant 12.924 .827 Child Gender -1.703 .515 -.350**

SEQ Total PV -.039 .030 -.139 SSIS Total Social Skills .007 .016 .048 Total PV*Total Social Skills .000 .002 .004 *p < .05. **p < .01 ΔR

2 = .122

Table 3-12. Interaction between peer victimization (PV) and peer social support in relation to average daily minutes spent in physical activity

B SE B β

Step 1

Constant 12.655 .802

Child Gender -1.532 .495 -.315**

Step 2

Constant 13.086 .829

Child Gender -1.711 .509 -.351**

SEQ Total PV -.021 .033 -.077

SEQ Peer Support .009 .060 .018

Total PV * Peer Support .009 .006 .160

*p < .05. **p < .01. ΔR

2 = .142

36

CHAPTER 4 DISCUSSION

As the prevalence of obesity among youth in the United States remains relatively

unchanged over the past five years (Ogden et al., 2010), comprehensive prevention

and intervention efforts to address healthy lifestyle behaviors have become more

widespread. Given that the majority of overweight children are not meeting

recommendations for physical activity, initiatives aimed at increasing youth participation

in physical activity are warranted. There is a particular need for research to identify

modifiable factors associated with youth involvement in physical activity, especially as

lifetime physical activity habits are often established during this period (Janz, Dawson, &

Mahoney, 2000; Tammelin, Nayha, Hills, & Jarvelin, 2003).

Unfortunately, overweight children tend to experience more social difficulties than

their non-overweight peers, most notably peer victimization and social isolation

(Hayden-Wade et al., 2005; Strauss & Pollack, 2003). These negative interactions have

been shown to increase barriers for engaging in healthy behaviors, particularly physical

activity (Gray et al., 2008). Although several aspects of social functioning (e.g., teasing,

friendship nomination, social support) have been widely studied in relation to youth

participation in physical activity (Faith et. al, 2002; Storch et al., 2007, Strauss &

Pollack, 2003; Sallis et al., 2000), there is a lack of research examining the association

between social skills and physical activity. To date, only one study has assessed social

skills in an overweight population of youth using a well-validated measure specific to

social skills (Lumeng, et al., 2010) and there is no research that has examined the

relationship between social skills and physical activity. This study serves to extend

current literature on social functioning and physical activity in overweight children by

37

incorporating a well-validated measure to describe social skills in a rural population of

treatment-seeking overweight youth, utilizing objectively-measured accelerometry data

to assess physical activity, and examining the association between social skills and

physical activity.

The first aim of this study was to describe self-reported social skills in this

treatment-seeking population of youth. Although total social skills were not significantly

different for males and females, males reported significantly lower scores on the

Responsibility and Cooperation subscales. There was also an unexpected significant

difference in total social skills by age, such that older children reported lower total social

skills. Most importantly, children in this sample reported social skills in the average

range when compared to published norms. This finding does not support the initial

hypothesis that overweight and obese children would report lower social skills scores

than a healthy sample of same-age peers. There are a number of possible reasons for

this finding. It may be that many overweight children have adequate social skills, but

continue to exhibit limited social functioning due to other factors, including lack of social

support and peer victimization (e.g., weight-related teasing). However, this sample of

youth actually did not report high levels of peer victimization or low peer support. In fact,

children in this study appear to be functioning quite well from a social perspective. Thus,

one might hypothesize that overweight children who have low social skills did not opt to

participate in this program, as it involved significant interaction with same-age peers in a

group setting. Children may also not have been able to accurately assess and report

their social skills. For example, age and developmental factors may have resulted in

considerable variability with regard to how well children were able to perceive their own

38

limitations. This hypothesis is substantiated by the fact that older children reported

significantly lower total social skills scores than younger children. Also, it is possible that

children in this study who experience impairments in social functioning may have been

influenced by social desirability bias and over-reported the frequency of engaging in

socially-skilled behavior. Thus, future research should use data from multiple

informants, including parents and teachers, to discern if children are accurately

reporting frequency of social skill use.

A second aim of the study was to examine if child social skills were related to

physical activity. Contrary to what was hypothesized, no relationship was found

between social skills and average daily minutes spent in total physical activity, after

controlling for child gender. In addition, results from separate post-hoc analyses

revealed that social skills were not significantly associated with average daily minutes

spent in sedentary, moderate, or vigorous physical activity. There are a number of

possible explanations for this result. First, there may have been a selection bias based

on time spent in physical activity after discounting children that did not record enough

physical activity data to interpret. In this sample, average daily minutes spent in physical

activity well exceeded the recommended amount of 60 minutes per day, which is

inconsistent with previous findings suggesting that the majority of youth do not meet this

recommendation. Thus, this data may not be representative of physical activity

participation in the general population of same-age overweight youth.

Also, it is important to note that children who initiated treatment and had sufficient

physical activity data had higher social skills scores, on average, compared to children

who did not have sufficient physical activity data to interpret. It is possible that this trend

39

was influenced by the use of a specific cut-off criterion for physical activity, which likely

limited findings by reducing variability in social skills scores. Nevertheless, these

findings suggest that children with lower social skills were more likely to drop out of the

study before the start of the intervention. Thus, the children with lower social skills may

have had lower levels of physical activity; unfortunately this is unknown. Overall, this

could have important implications for children who are not able to participate in weight

management treatment due to behavioral, social, or emotional difficulties.

Also, it may be possible that the relationship between social skills and physical

activity is better explained by other mediating factors, such as depressive symptoms or

social support. Finally, social skills may not be related to physical activity. Perhaps other

domains of social functioning, including peer victimization and social support are more

relevant to participation in physical activity for youth in this age group, especially

considering that social skills are often already well-developed in children of this age.

A final aim of the study was to determine if child-reported social skills and peer

social support moderated the relationship between peer victimization and average daily

minutes spent in physical activity. Both social skills and social support did not moderate

this relationship. Also, child-reported peer victimization was not associated with average

daily minutes spent in physical activity. This was not expected. These findings may be

explained by the fact that on average, this sample reported adequate social skills and

social support and low levels of peer victimization. One study found that while

behavioral and emotional problems were more prevalent in a sample of treatment-

seeking obese children compared with a community sample of obese children, social

competence was higher (Braet, Mervielde, & Vandereycken, 1997). This finding, along

40

with data from the current study may suggest that children seeking weight management

treatment have more social support and experience less peer victimization than non-

treatment-seeking overweight peers. Thus, it may be important to further explore the

role of social skills and social support in a sample of non-treatment seeking children.

There are some limitations with the current study that deserve mention. First,

there were a significant number of children (N = 82) that were not included in the

analyses, mostly as a result of attrition or insufficient data. This may have resulted in a

selection bias such that the remaining participants reported high levels of social

functioning and physical activity. In turn, reduced variability among the examined

constructs may have limited power to detect significant relationships. Also, the cross-

sectional design of the current study precludes evidence for directionality among social

skills and physical activity. Finally, this study used a measure of peer victimization and

social support that is not specific to weight status or physical activity. Utilizing the

weight-teasing subscale from the Perceptions of Teasing Scale (Thompson, Cattarin,

Fowler, & Fisher) or the Teasing/Marginalization subscale of the Sizing Me Up

questionnaire (Zeller & Modi, 2009) may have yielded greater report of peer

victimization. Likewise, questions that assess peer support in the context of participation

in physical activity may have been more appropriate to use in a study examining social

functioning and health behaviors.

Moreover, the method used to assess physical activity presents as a potential

key limitation of this study. Although accelerometry-based activity monitors have

become the most widely used objective assessment of physical activity among youth,

many challenges concerning the measurement accuracy of these devices remain. More

41

specifically, the sporadic and intermittent levels of physical activity in children

(Freedson, Pober, & Janz, 2005) and variability due to growth and maturation (Wickel,

Eisenmann, & Welk, 2007) make the assessment of physical activity in youth

particularly complex. First, there is no identified criterion for how much wear time is

necessary to define a valid day of measurement. Several studies have used at least 10

hours of daily wear time in youth (Ekelund et al., 2001; Macfarlane, Lee, Ho, Chan K., &

Chan D., 2006; Riddoch et al., 2004); however, it is difficult to generalize this criteria to

all studies, given that many children are not required to wear the device for 24 hours a

day. While the current study follows guidelines by encouraging children to wear the

accelerometer during waking and sleeping hours, additional issues of practicality arise,

as many children may have removed the accelerometer during sleep or periods of

competitive vigorous activity to reduce discomfort. This may have limited comparability

between participants, especially since physical activity was expressed as a daily

average value. Although analyzing minutes of wear time during sleep would likely not be

feasible in a sample this size, it may be useful to instead determine average daily

minutes of physical activity relative to daily minutes of wear time.

Furthermore, although children were told to maintain normal levels of physical

activity while wearing the accelerometers, and had not yet received any educational

material on the topic of physical activity at this point in treatment, it is possible that

children participated in more than usual amounts of physical activity during this time.

This phenomenon has been referred to as the ―Hawthorne Effect‖ (Corder et al., 2008).

In one study, accelerometer counts were 3% higher during the first day of measurement

than subsequent days in 11-year-old children (Mattocks et al., 2008). However, because

42

this issue was not apparent on other days, it may be advisable to just disregard the first

day of measurement (Corder et al., 2008).

Keeping these limitations in mind, future studies should continue to investigate

the association between these variables using a longitudinal design. Moreover, utilizing

meditational models to explore relationships among these variables may also be useful,

as other factors, including internalizing behaviors or social support, may better explain

the association between social skills and physical activity. There is already some

research to suggest that these relationships may exist, with a few studies reporting that

depressive symptoms are associated with social skills deficits and problems with peers

(Deater-Deckard, 2001; Hay, Payne, & Chadwick, 2004; Masten, 2005; Segrin, 2000).

Also, Dierk and colleagues (2006) proposed a model that suggests social skills enhance

one’s ability to mobilize social support for engaging in healthy behaviors.

Researchers are encouraged to also explore the relationship between social

skills and quality of life in overweight youth, especially since overweight children have

been shown to experience more deficits in physical and social quality of life than non-

overweight children (Williams, Wake, Hesketh, Maher, & Waters, 2005). There has

been research to suggest that social support and social skills, rather than BMI, are

associated with subjective well-being in obese adults (Dierk et. al, 2006), which

highlights the importance of social functioning and social relationships in enlisting

support for and adopting a healthy lifestyle.

Finally, dieting and food intake modifications are also critical elements in the

treatment of childhood overweight (Latzer et al., 2009). Thus, future research should

also examine the relationship between social skills and unhealthy eating behaviors.

43

Considering that this sample of youth reported adequate social skills and peer social

support, they may be more integrated into various social networks, and thus receive

increased pressure to attain the ―thin ideal.‖

Findings from this study offer a new perspective on social functioning in

overweight youth, with a sample of treatment-seeking overweight children reporting

social skills that are comparable to those of non-overweight same-age peers. Also, it is

promising that, on average, this sample reported high levels of peer support and low

levels of peer victimization. While social skills do not appear to be related to youth

involvement in physical activity among treatment-seeking youth, it is necessary to

examine this relationship among children who experience more victimization and social

marginalization within the peer environment. When making recommendations for diet

and physical activity, it is imperative that clinicians and health care professionals

become aware of the difficulties encountered by overweight youth in the social

environment, keeping in mind that negative peer interactions may limit motivation to

engage in healthy behaviors.

44

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BIOGRAPHICAL SKETCH

Shana Schuman is a second year graduate student in the Clinical and Health

Psychology Program at the University of Florida. She obtained a Bachelor of Science

degree in psychology at the University of Florida in 2008 and completed an honors

thesis on parent predictors of child and adolescent body dissatisfaction. Shana has also

worked as a research assistant on studies involving children with chronic pulmonary

conditions, including asthma and cystic fibrosis. She is currently serving as a group

leader for a family-based weight management program for children living in rural

counties in Florida. She is also managing a study examining psychosocial functioning

in adolescents with Inflammatory Bowel Disease.