GENDER, INDIVIDUALISM-COLLECTIVISM ORIENTATION, AND PROGRAM

ORIENTATION INFLUENCES ON NUTRITION AMONG HISPANIC

PREADOLESCENTS

APPROVED BY SUPERVISING COMMITTEE:

________________________________________

Stella Lopez, Ph.D., Chair

________________________________________

Raymond Garza, Ph.D.

________________________________________

Ann Eisenberg, Ph.D.

Accepted: _________________________________________

Dean, Graduate School

DEDICATION

This thesis is dedicated to my friends and family. Thank you so much for your constant support

and inspiration.

GENDER, INDIVIDUALISM-COLLECTIVISM ORIENTATION, AND PROGRAM

ORIENTATION INFLUENCES ON NUTRITION AMONG HISPANIC

PREADOLESCENTS

by

SARA GARCIA, B.A.

THESIS

Presented to the Graduate Faculty of

The University of Texas at San Antonio

in Partial Fulfillment

of the Requirements

for the Degree of

MASTER OF SCIENCE IN PSYCHOLOGY

THE UNIVERSITY OF TEXAS AT SAN ANTONIO

College of Liberal and Fine Arts

Department of Psychology

May 2014

iii

ACKNOWLEDGEMENTS

I would like to thank Dr. Stella Lopez for her guidance and constant encouragement. I

would not be where I am today if it were not for the opportunity and support provided to me by

her. I would also like to thank Dr. Garza for encouraging me to keep pursuing my goals, and

keep looking ahead to what is next. Thank you to Dr. Ann Eisenberg for her tremendous

feedback and support during the writing process. Finally, a special thanks to all the faculty and

staff in the department for always providing help and guidance when I needed it.

May 2014

iv

GENDER, INDIVIDUALISM-COLLECTIVISM ORIENTATION, AND PROGRAM

ORIENTATION INFLUENCES ON NUTRITION AMONG HISPANIC

PREADOLESCENTS

Sara Garcia, M.S. The University of Texas at San Antonio, 2014

Supervising Professor: Stella Lopez, Ph.D.

The present study examined the influence of gender and the individualism-collectivism

characteristic on Hispanic youth’s attitudes and behaviors about nutrition using a collectivist,

individualist, and standard intervention program. The standard, collectivist, and individualist

curricula were implemented in this pretest-posttest design. The Health Perception scale, Eating

and Exercise questionnaire, Health Behavior Questionnaire, and interview responses were used

to assess attitudes and behaviors. Data were collected from 146 Hispanic 6th

graders. The results

indicated that females reported better perceived health and eating habits than males overall.

Females who went through a collectivist intervention reported more control over food choices

and remembered more information about healthy behavior than males and females in the other

intervention conditions. In addition, males who went through the individualist intervention

reported higher associations of health with well-being. These findings suggest that programs that

incorporate the cultural dimension that is compatible with participants’ cultural orientation along

with gender could help improve attitudes and behaviors about nutrition.

v

TABLE OF CONTENTS

Acknowledgements ........................................................................................................................ iii

Abstract .......................................................................................................................................... iv

List of Tables ................................................................................................................................ vi

List of Figures ............................................................................................................................... vii

Chapter One: Introduction ...............................................................................................................1

Chapter Two: Method ....................................................................................................................10

Chapter Three: Results ...................................................................................................................18

Chapter Four: Discussion ...............................................................................................................27

Appendices.....................................................................................................................................36

References ......................................................................................................................................73

Vita

vi

LIST OF TABLES

Table 1 Inter-rater reliability analysis for Interviews .........................................................18

Table 2 Differences in Gender and Gender-IC Orientation ................................................19

Table 3 Descriptive Statistics for Program Orientation ......................................................19

vii

LIST OF FIGURES

Figure 1 Main Effect of Gender for HPS Scale ....................................................................20

Figure 2 Main Effect of Gender for EEQ Scale Scores .......................................................20

Figure 3 Main Effect of Gender for Question One Should not-Type Response ..................21

Figure 4 Main Effect of Gender for Question One Undefined Response ............................21

Figure 5 Main Effect of Gender for Question Four Behavior Change Responses ...............22

Figure 6 Interaction between IC orientation and Gender .....................................................23

Figure 7 Interaction Between Gender and Curricula Condition for Question One. .............26

1

CHAPTER ONE: INTRODUCTION

According to U.S. census data collected in 2010, the Hispanic population in the United

States accounts for more than half of the total population growth and is considered the nation’s

largest ethnic or racial minority (U.S. Census, 2012). This continuing growth among the

Hispanic population is accompanied by substantial health concerns (Boyles, 2011; CDC, 2012;

OMH, 2013). Recent data suggests Hispanic children are especially at risk of health problems

such as obesity and diabetes (CDC, 2012). Researchers have tried to address these health

concerns through programs designed specifically for children to adopt healthy attitudes and

behaviors about nutrition. However, developing these programs has been a challenge. One

important challenge has been to make an intervention program relevant to the Hispanic

population. The variable of culture has been proposed as an important aspect to incorporate into

intervention programs for this particular group. Previous research has found that Hispanic

children born outside of the United States have lower obesity rates compared to U.S.-born

Hispanic children. In fact, young Hispanic women are 40% more likely to be obese than Non-

Hispanic women (Singh & Yu, 2012; Schwartz, Des Rosiers, Huang, Unger, Zamboanga,

Knight, & Szapocznik, 2013; CDC, 2012). These findings suggest that a culturally focused

program on nutrition should be considered.

Culture and Nutrition

Previous research has reported that, regardless of race or ethnicity, only a small fraction

of children consume fruits and vegetables, drink three or more glasses of milk a day, have

breakfast daily, participate in physical activity, and know the foods in the food pyramid guide

(Lorson, Melgar-Quinonez, & Taylor, 2009; Pearson Biddle, & Gorely, 2008; Zapata, Bryant,

McDermott, & Helfelfinger, 2008; Shmeer, 2011; Ogden, Carroll, Kit, & Flegal, 2012).In one

2

study, Piernas and Popkin (2011), measured trends in portion sizes of energy dense foods for

U.S. children and adolescents from 1977-2006. Parents of African-American and Hispanic

children reported serving and consuming larger portions of calorie dense foods than did Non-

Hispanic White children. In addition, U.S.-born Hispanic children are more likely to be obese

than non-U.S.-born Hispanic children (Popkin & Udry, 1998; Gordon-Larson, Harris, Ward, &

Popkin, 2003; Singh, & Yu, 2012). Similarly, U.S.-born Spanish speakers are more likely to

develop higher BMIs than non-U.S.- born English-speakers (Guendelman, Fernandez, Thornton,

& Brinis, 2011).

Other cultural factors, such as the method of cooking preparation, traditional foods,

family support, acculturation, and economic deprivation, have also been examined with regards

to nutrition (Gans, et al., 1999; Taveras, et al., 2007; Schmeer, 2012). Using data from the 2012

National Survey of Children’s Health, researchers found that the association of living in a low

socioeconomic status community and being obese was stronger for Hispanic than non-Hispanic

children. Furthermore, Hispanic children who had less access to preventative health care due to

low socioeconomic status were 22% more likely to be overweight compared to African-

American or White children facing the same conditions (Lutfiyya, Garcia, Dankwa, Young, &

Lipsky, 2008).

Nutrition Programs

The Academy of Nutrition and Dietetics identified pre-adolescence and adolescence as

critical periods for obesity prevention. In order to see long-term changes in nutrition-related

attitudes, the Academy recommended that children should be exposed to nutrition programs

early because younger children are more amenable to changing their behaviors about nutrition

than older children who are becoming young adults. Similarly, the Academy found that school

3

and community environments are important settings to initiate primary interventions for young

adolescents (Hoelscher, Kirk, Ritchie, & Cunningham-Sabo, 2013).

These findings have guided efforts to design and implement programs for nutrition-

related changes (Sing & Yu, 2012; Schmeer, 2012; Lutfiyya, et al., 2008; Black, et al., 2012;

Hanni, Ahn, & Winkleby, 2013). For example, Somerville, Kessler, Wallace, and Burns-

Whitmore (2012) implemented a garden-based nutrition education program to increase the fruit

and vegetable intake of Hispanic youth. The program engaged children in activities, such as

preparing healthy snacks, in order to promote healthy eating among Hispanic children.

Another program utilized Internet-delivered nutrition interventions, developed for the

purpose of weight management and fat reduction. The intervention was catered to students and

was carried out by school teachers. The program consisted of eight modules, in which each

module provided information about healthy lifestyle choices and prompted students to answer

questions about their nutrition-related preferences. Based on student responses, the program

offered tailored feedback for each student on how to change unhealthy behaviors (Ezendam,

Noordegraaf, Kroeze, Brug, & Oenema, 2012).

In addition, there are several school-based intervention programs that promote daily and

healthy breakfast choices (Eilat-Adar, Koren-Morag, Siman-Tov, Livne, & Altmen, 2011),

include mandatory nutrition classes (Prelip, Kinsler, Thai, Erasquin, & Slusser 2012), encourage

dietary and physical activity change (Gortmaker, Lee, Mozaffarian, Sobol, Nelson, Roth, &

Wiecha, 2012), use peer modeling (Nixon, Moore, Douthwaite, Gibson, Vogele, Kreichauf,

Wildgruber, Manios, & Summerbell, 2012), and involve parent-focused programs (Van

Lippevelde et al., 2012; Hendrie et al., 2012; Campbell et al., 2013).These programs, however,

generally focus on the “what” –related (factual) information that children must learn. These

4

knowledge-based programs are informative, but are not designed to inspire long-term changes

that result in consistently healthy eating habits (McBean & Miller, 1999; Rosas et al., 2011;

Thomas, 2006; Zapata et al., 2008). Other programs focus on factors such as refusal skills or

self-efficacy and have been reported to influence children and adolescents in much the same way

as factually based nutrition programs (Nixon et al., 2012; Cerin, et al., 2009; McClain, Chappuis,

Nguyen-Rodriguez, Yaroch, & Spruijt-Metz, 2009; Peters, et al., 2009; Thomas, 2006). In order

to enact long-term behavior changes regarding nutrition, the literature suggests a need for

culturally targeted nutrition intervention programs (Barrera, Castro, Strycker, & Toobert, 2013;

Lindberg, Vega-Lopez, Kauffman, Calderon, & Cervantez, 2012).

Culturally Sensitive Nutrition Programs

Designing and implementing programs about nutrition for Hispanic youth should

incorporate specific cultural aspects that are relevant to the Hispanic population, such as

collectivism, acculturation, and language (Elder, et al., 2009; Oyserman & Lee, 2008; Sussner, et

al., 2008). Culture has the capability of influencing cognitions and self-concept, and programs

aimed at altering behaviors about nutrition should accommodate the participants’ culture in order

to maximize the programs’ effectiveness.

The relevance of cultural factors in behaviors about nutrition was reported in a study by

Liu, Chu, Frongillo, & Probst (2012). In this study, the researchers reported that second- and

third- generation Mexican-American adolescents consumed fewer fruits and vegetables and more

sweetened beverages as well as high fat foods in comparison to first-generation adolescents. The

researchers also found that second- and third- generation children who still spoke Spanish in the

home, but considered themselves acculturated into American culture, had a greater risk of

developing a high BMI, compared to children who did not consider themselves to be as

5

acculturated. These findings suggest that acculturation and language affect children’s behaviors

regarding nutrition and should be considered in efforts to influence Hispanic children’s attitudes

about nutrition.

Individualist-Collectivist Based Interventions

Two cultural variables that are prominent in the cross-cultural literature are individualism

and collectivism (IC; Triandis, 1995), which have been proposed as an important facet of culture.

Individualist cultures tend to value attitudes, beliefs, and behaviors that benefit the self, whereas

collectivist cultures tend to value attitudes, beliefs, and behaviors that reflect and support the

family, community, and the collective unit in general. In the U.S., the Hispanic population tends

to identify as collectivist, as opposed to Anglo-Americans, who tend to identify as individualist.

These basic cultural concepts have promising implications for effective intervention and

prevention programs for Hispanic youth. Programs can be oriented in a collectivist or

individualist way in order to make them more relevant to the target population, and bring about

long term change for the behaviors being targeted (Lopez, Garza, & Gonzalez-Blanks, 2012).

Specifically, a collectivist oriented nutrition program would contain knowledge-based

information and would be designed to inform the students how individual decisions to eat in a

healthy or unhealthy manner affects one’s group and how one’s collective unit (i.e., family and

peers) would affect one’s nutrition-related behaviors. An individualist oriented nutrition

program would contain knowledge-based information and would be designed to inform how

decisions to eat healthy or unhealthy foods fosters or impedes their achievement of their own

goals (Lopez et al., 2012).

A recent study examined the role of program orientation (individualist versus

collectivist), the participants’ IC characteristic, acculturation level, and their influence on

6

Hispanic youth’s attitudes towards smoking (Lopez et al., 2012). The collectivist condition

contained school-based materials but emphasized the interdependence between the individual

and family and peers. The individualist condition on the other hand, emphasized the individual’s

independence. Lopez et al. (2012) reported that Hispanic sixth graders who were exposed to the

collectivist-oriented intervention program about smoking reported more desirable and accurate

perceptions and communication about smoking compared to those in the individualist-focused

program. The findings strongly support the role of specific aspects of culture in effective anti-

smoking programs for Hispanic youth. Recognizing the theoretical and practical importance of

culture’s influence on individual behavior, the present study examined the influence of IC in

enhancing healthy attitudes and behaviors in nutrition among Hispanic youth.

Gender and IC Orientation

When IC orientation is assessed, gender is an important factor to consider. A previous

study of self-construal involving five countries found that women in the United States score

higher for collectivism on average than men did (Kashima, Kim, Gelfand, Yamaguchi, Choi, &

Yuki, 1995). In addition, women are more likely to express a collectivist ideology and resolve

dilemmas using strategies that reflect themes of social responsibility (Lykes, 1985). Similar

results were found in a study assessing competitive and cooperative behaviors among 3-12 year

old children. The results showed that girls favored cooperative rather than competitive

interactions with others, a characteristic that is associated with collectivism. In contrast, boys

favored more competitive interactions (Knight & Chao, 1989). Similarly, in a meta-analysis,

Marcus and Le (2013) found individuals with a collectivist orientation showed higher levels of

cooperation than those with an individualist orientation.

The tendency for women to be more collectivist than men are is especially true within

7

minority groups. In a study of gender differences in measures of cultural orientation as a function

of race/ethnicity, African-American and Hispanic women were found to be more collectivist, on

average, than African-American and Hispanic men (Gaines, Marelich, Bledsoe, Steers, &

Henderson, 1997). This result suggests that culture and gender can influence IC orientation, and

may in part, contribute to the ways men and women respond to collectivist or individualist

oriented interventions in regards to nutrition. Furthermore, women may be more likely to benefit

from a collectivist-oriented intervention, since they view themselves as being interdependent and

emotionally related to others (Green, Deshamps, & Paez, 2005; Kashima et al., 1995).

Surprisingly, few studies have examined the possible association between IC orientation and

gender in regards to nutrition interventions.

The possible association between gender and cultural aspects warrants careful

consideration in the development of programs about nutrition for Hispanic youth. Culturally

targeted and sensitive interventions should incorporate an individual’s collectivist or

individualist tendencies and examine their influence on eating habits.

The Current Study

Lopez, Gonzalez-Blanks, Garza, & Garcia (in review, 2014) examined the role of cultural

dimensions of IC in the development of healthy attitudes and behavior regarding nutrition among

Hispanic youth who varied in acculturation. The aim of the research was to examine how an

intervention program oriented towards a collectivist or an individualist perspective in attitudes

towards nutrition aided in the adoption of healthy attitudes about nutrition. In addition, the study

examined the influence of collectivism and individualism in the adoption of healthy attitudes and

behavior regarding nutrition. Overall, the study examined intervention program orientation

(individualist, collectivist, control or standard), the characteristic of individualism-collectivism,

8

and acculturation level, and their influence on Hispanic youth’s attitudes and behaviors about

nutrition.

The design of the previous study included three interventions. The standard curriculum

was modeled on the school district’s curriculum and contained knowledge-based facts about

nutrition and refusal skills. An individualist condition consisted of information contained in the

school-based materials along with information regarding how students’ decisions to eat in an

unhealthy manner impede one’s achievement of a goal. A collectivist condition also contained

school-based materials but with the addition of informing the students that individual decisions

to be nutritious and healthy affect one’s collective unit (e.g. family and peers), who would then

affect one’s behaviors. Sixth graders’ eating behavior and attitudes about nutrition were assessed

before and after the intervention program. In addition, their degree of individualism and

collectivism was also assessed.

The study found that individuals who were characteristically collectivist in orientation

reported healthier attitudes and behaviors in nutrition than those who were characteristically

individualist. It also found that collectivist individuals benefited more from a collectivist-

oriented intervention program than an individualist or standard-focused intervention program.

The present research aimed to expand on Lopez et al.’s (2013) results by examining the role of

gender and its combined influence with IC orientation on attitudes and behaviors about nutrition

among Hispanic children. In addition, the present study sought to investigate gender differences

that exist as a function of the IC-focused nutrition intervention programs. The present study

examined gender differences using the same dependent variables as Lopez et al. (2014). These

two sets of dependent variables were: (1) scores on health behavior questionnaires assessed at the

post-test phase, and (2) the participant’s responses to interview questions.

9

Hypotheses

The present study was designed to test gender differences in IC orientation and curricula

on program outcome. The following hypotheses were tested:

(1). It was expected that there would be gender differences on the dimension of

individualism-and collectivism. Specifically, girls were predicted to be more collectivist than

boys, but not less individualist than boys are.

(2). It was predicted that there would be a main effect for gender on several outcome

variables. Specifically, girls were expected to score higher on the nutrition behavior

questionnaires and to remember more nutrition information during post-test interviews than boys

would.

(3). It was also expected that there would be a gender by individualism-collectivism

orientation interaction effect such that, girls who identify as collectivist would report more

healthy eating habits and would remember more nutrition information in the post-test interviews

than girls who identify as individualist. However, boys who were collectivist were not expected

to differ significantly from boys who were individualist.

(4). A gender by curricula interaction effect was also predicted. Specifically, girls who

participate in the collectivist program were expected to score higher on the nutrition behavior

questionnaire and remember more nutrition information during post-test interviews than boys in

either condition.

The main effects and interactions of program and individualist-collectivist orientation on

each of the three main dependent variables were not assessed in the proposed research because

these results were already analyzed and reported by Lopez et al. (2014).

10

CHAPTER 2: METHOD

Participants

Participants were 6th

grade students recruited from San Antonio Independent School

District (SAISD) academies, which integrate specialized coursework in different fields. There

were three academies randomly assigned to receive the control (n=48), individualist (n=53), and

collectivist (n=45) curriculum. There were a total of 146 participants. The children were from

predominantly Mexican-American neighborhoods located in San Antonio’s inner city. There

were 88% Hispanic students in the control, 68% in the individualist, and 71% in the collectivist

condition. All participants were between 10 to 13 years of age (M = 11.4 years).

Materials

Child Demographics. Each student completed a demographics questionnaire that

included items about the students’ age, gender, grade level, and race.

Health Perception Scale (HPS). Students completed the 4-item HPS (Garcia-Maas,

1999; Gillis, 1994; Lawton, Moss, Fulcorner, & Cleban, 1982) which assessed the extent to

which an individual perceives him or herself as healthy (e.g., “How would you rate your overall

health at the present time?”). Responses were reported on a 3 or 4-point Likert scale. Higher

scores indicated a healthier self-perception (See Appendix C).

Lafrey health conception scale(LHCS). The 26-item LHCS (Laffrey, 1986) is a self-

report measure assessing individuals’ conception or definition of health. The LHCS consists of

four subscales measuring an individual’s conception of health with respect to clinical health

(e.g., “free of symptoms”), functional health (e.g., “able to do what I have to do”), adaptive

health (e.g., “cope with stressful events”), and eudemonistic health (e.g., “realize full potential”).

11

Total scale and subscales could range from 1(Strongly Disagree) to 6 (Strongly Agree). (See

Appendix F).

Eating and Exercise Questionnaire (EEQ). The 7-item EEQ (Brener, Kann, Kinchen,

Sundberg, & Ross, 2002; Centers for Disease Control and Prevention, 2002; Zullig, Pun, Patton,

& Ubbes, 2006) assessed frequency of eating healthy foods and exercising (e.g., “During the past

7 days, how many times did you eat fruit?”, “In an average week when you are in school, on how

many days do you go to P.E. class?”). Responses were reported on a 7-point Likert scale ranging

from “none” to “4 or more times per day.” Higher scores meant a high frequency of healthy

eating. The 5-item exercise subscale was responded to using an 8-point Likert scale ranging

from “0 days” to “7 days.” Higher scores meant a high frequency of exercise. The TV viewing

subscale is a single item that assessed the number of hours of TV watching on a school day, and

the scores ranged from “0 hours” to “7 hours” (See Appendix D).

Health Behavior Questionnaire (HBQ). The HBQ (Parcel et al., 1995) assessed both

eating and exercise behaviors. It has eight subscales (See Appendix E).

The 13-item dietary intention subscale assessed dietary intention using a dichotomous

response option (e.g., “Which would you put in your hamburger? Ketchup or tomatoes?”). The

students were presented with pairs of food items (one healthy and the other unhealthy) and were

asked which they would choose if they had to pick just one. Higher scores signified healthy

nutritious intent.

The 14-item usual food choice subscale also used a dichotomous response option. The

students were presented with pairs of food items and were asked which they eat most often.

Higher scores reflected high frequency of usual (nutritious) food choice.

12

The 14-item dietary knowledge subscale similarly presented a dichotomous response.

The students were presented with pairs of food items and were asked which was better for one’s

health. Higher scores represented knowledge of nutritious food.

The 9-item home eating behaviors subscale had a dichotomous response option and

assessed whether the students had control over food choices. Higher scores indicated healthy

eating at home.

The 18-item social support for physical activity was measured using a dichotomous

response option. Higher scores pointed to more social support for physical activity.

The 21-item social support for healthy eating also had a dichotomous response option.

The items assessed whether parents, teachers, or friends were supportive of healthy eating.

Higher scores denoted a high social support for healthy eating.

The 15-item self-efficacy for healthy eating measured the certainty students have in

eating some of the foods presented. Respondents could choose “Not Sure,” “A Little Sure,” or

“Very Sure.” Higher scores identified those with high self-efficacy for healthy eating (Parcel, et

al., 1995).

The 5 item self-efficacy for participating in physical activity subscale assessed the

certainty students were about being physically active. Responses were on a 3-point Likert scale

of “Not Sure,” “A Little Sure,” or “Very Sure.” Higher scores showed high exercise self-

efficacy.

Child Individualism-Collectivism Scale (CIC). The 22-item CIC scale (Soh & Leong,

2002) assessed the extent to which an individual was collectivist or individualist (e.g.,

collectivism: “Family members should stick together no matter what”; individualism: “I’d rather

depend on myself than others”) on a 10-point scale ranging from 1 (“Not true at all”) to 10

13

(“Very true”). IC orientation was determined by performing mean splits on IC scale scores (See

Appendix B).

Intervention Program

The curricula were designed to enhance and supplement the current school-based

curricula. LifeSkills (Botvin, 2006) and the Texas Health and Wellness book (Meeks & Heit,

2006) were used to create the three curricula based on the concepts of (1) individualism, (2)

collectivism, and (3) standard information (See Appendix G).

Collectivist Curriculum. In addition to knowledge-based information, the collectivist

curriculum was designed to inform the students how individual decisions to eat in a healthy or

unhealthy manner affects one’s group and how one’s collective unit (i.e., family and peers)

would affect one’s nutrition-related behaviors. It included aspects of health (e.g. “These foods

will also help increase your energy so you are able to participate in activities with friends and

family.”), cosmetic (e.g. “If you have a healthy weight, you will look your best and could gain

more friends”), and athletics (“You also won’t have as much fun playing the sports with your

friends if you eat unhealthy foods.”) that would be affected by nutrition.

Individualist Curriculum. In addition to knowledge-based information, the individualist

curriculum was designed to inform students how decisions to eat healthy or unhealthy foods

foster or impede their achievement of their own goals and how they affect their health (e.g. “By

eating healthy foods, you will have many more options to enjoy activities that are important to

you.”), cosmetic (e.g. “By eating healthily, you will be able to be the person who you want to

be.”), and athletics (e.g. “You would rather want to stand out in an athletic crowd by presenting

yourself as healthy and a person who takes care of their body by eating healthy.”).

14

Control Curriculum. The control curriculum was modeled closely on the curriculum

currently used in the SAISD. It contained knowledge-based facts about nutrition (e.g. “Choosing

to stay away from foods that are high in salt, fat, and increasing the amount of fruits and

vegetables can dramatically increase health status.”). There were no collectivist or individualist

themes in the control curriculum.

Procedure

The UTSA Institutional Review Board, the SAISD superintendent and the parent

committee granted approval for the study.

Participant Recruitment. Consent for participant recruitment was obtained from the

principals, teachers or coaches, and parents. Parental consent forms were distributed. Students

were instructed to return the signed parental consent forms. Students who returned signed parent

consent forms were asked to sign a child assent form as well. Students who did not return a

parent consent form were not included in the study. The intervention programs took place in the

students’ physical education or health classes.

Pretest Administration

The first day of the study consisted of the administration of the pretest to all 9 schools

within the same school-week. The pretest consisted of all the questionnaires described above.

All surveys were completed in English. No one requested a Spanish version of the

questionnaires.

Intervention Phase

A week later, a nutrition curriculum was administered to each academy. Based on

random assignment, three academies received the control curriculum, three academies received

15

the individualist curriculum, and three academies received the collectivist curriculum. The

procedures for each condition are outlined below.

Collectivist Condition. Students in the collectivist condition were instructed to gather

into groups. The groups were decided based upon the students’ peer groups to ensure a

collectivist nature of instruction. The groups varied from 4 students to 6 students, with a total of

13 groups across the 3 academies. After the groups were formed, the students were asked to

collaborate with their own group to formulate reasons regarding the importance of eating

healthy. The students wrote their reasons and then shared their responses with the class.

After the discussion of the students’ reasons to eat healthy foods, an experimenter

presented knowledge-based nutrition information and then discussed collectivist reasons that

revolved around a collectivist theme: how individuals’ decisions to maintain a healthy or

unhealthy nutrition lifestyle affects one’s group and how one’s collective unit would affect one’s

set of behaviors. For example, they discussed how poor nutrition can impact the students’

performance in sports and how peers will be less likely to select a player who is unhealthy. This

action could result in fewer opportunities to be involved with one’s group.

Individualist Condition. Students gathered in a classroom for the curriculum. In

addition to knowledge-based information, the curriculum was individualist in content. For

example, the students discussed how eating nutritious food can impact their own performance in

sports (e.g., “By eating fruits and vegetables, you will enjoy participating in activities that are

important to you.”) and how eating healthy enhances an individual’s ability and desire to become

a great athlete.

16

Control Condition. Students were presented the standard curriculum (e.g., “Eating fruits

and vegetables will give you the necessary nutrients.”). No deviations from this curriculum were

made, and no individualist and collectivist themes were introduced.

The three curricula were each 40 minutes long. A week later, the student assembled

again. A recap of the original content was first presented. Then students engaged in a drawing-

poster activity with regards to their curriculum program.

Posttest Phase

Four months later, posttest questionnaires were administered. The posttest session was

administered to all nine schools during the same school week. The questionnaires included the

HPS, HBQ, and EEQ. Afterwards, each student participated in a short, one-on-one, five-

question interview with the researcher that assessed his or her evaluation of the curriculum. The

questions were as follows: (1) “What did you think the lessons and posters were about?” (2) “Did

you learn anything from the lessons?” (3) “Were the lessons useful for you?” (4) “What did you

like about the lessons?” and (5) “What did you not like about the lessons?” They were then

thanked and allowed to return to their class. In summary, the present research used data from the

health behaviors questionnaire assessed at the post-test phase and participants’ responses to the

interview questions.

Interviews

Interview rater’s recruitment. Experimenters transcribed all the interviews.

Undergraduate and graduate research assistants from the University of Texas at San Antonio

(UTSA) read the transcriptions and identified the most common themes within the responses. A

different set of UTSA undergraduate research assistants served as interview raters. There was a

total of 8 raters. They were given all transcriptions and copies of the rating scale. The

17

following instructions were given in the smoking study. A similar set of instructions were

provided in the nutrition study.

Thank you for agreeing to participate in the rating of 6th

grader interviews. You are asked

to read every interview and rate each of the child’s responses according to the following

notes: Please place a tally mark next to every topic/theme (e.g. HEALTH

FACTS/REFERENCE TO TOPIC/SHOULD, etc) that fits the child’s response to each

question. Please note that child responses may fit more than one theme/topic. For example,

“Smoking makes your lungs black and you shouldn’t do it.” This response contains at least a

HEALTH FACT “makes your lungs black,” and a SHOULD NOT “you shouldn’t do it,”

(*note this example can fit other statements not mentioned depending on your own personal

criteria). Some of the responses may also include multiple references to one statement;

therefore multiple tally marks will be necessary. For example “Smoking makes your teeth

yellow and causes cancer.” This response contains at least two HEALTH FACTS, therefore

two tally marks in the blank for HEALTH FACTS are necessary. (*note this example can fit

other statements not mentioned depending on your own personal criteria). If you have any

questions feel free to contact the experimenters.

Interview rating scale. The scale is made up of the overall questions that were asked of the

students. The most prominent themes were specified for each question. Raters would have to

tally the number of times the students’ responses fit with each theme. Examples of themes that

were identified included health facts, reference to topic (i.e., nutrition and smoking), collectivist

oriented responses, individualist oriented responses, should, should not, behavior change, etc.

Table 1: Inter-rater reliability analysis for Interviews Scale or Subscale Chronbach’s Alpha

Nutrition Interview Rating Scale .896

18

CHAPTER 3: RESULTS

Strategy for Analysis

Questionnaire and interview responses from the study conducted by Lopez et al. (2014)

were analyzed. To test the first hypothesis, gender differences in IC orientation were analyzed

using an independent samples t-test. For the remaining hypotheses, a 2 (gender) X 2 (IC

orientation) X 3 (Intervention Curricula) MANOVA was conducted in order to analyze a

possible gender main effect and interaction effects with IC orientation and curriculum on

questionnaire and interview responses.

The independent variables used in the analysis were child gender (male, female),

participant individualist-collectivist (IC) orientation (individualist and collectivist) and program

orientation condition (individualist, collectivist, control). The data were analyzed using 2 x 2 x 3

fully crossed MANOVA and an independent samples t-test. The dependent measures were

participant responses to the HPS, EEQ, HBQ, and Laffrey HCS scales and subscales. Participant

IC orientation was determined by performing mean splits on IC scale scores which ranged from -

10 to +10. The number of male and female individualists and collectivists can be seen in Table 2.

In addition, the number of males and females in the collectivist, individualist, and control

intervention programs are presented in Table 3.

Surprisingly, the independent samples t-test analysis revealed no significant gender

differences on the dimension of individualism and collectivism. Thus, the first hypothesis which

stated there would be gender differences in IC-orientation was not supported.

19

Table 2: Differences in Gender and Gender-IC Orientation

Student Gender IC characteristic N

Male Individualist 41

Collectivist 34

Female Individualist 27

Collectivist 25

Table 3: Descriptive Statistics for Program Orientation

Program Orientation Student Gender N

Control Male 29

Female 15

Individualist Male 26

Female 20

Collectivist Male 21

Female 17

Total 128

Main effect of Gender

Support for the second hypothesis, which predicted that there would be main effects of

gender on several outcome variables, was found. The child gender (male, female) X program

orientation (collectivist, individualist, and control) MANOVAS on the questionnaire data

revealed significant main effects of gender for the HPS scale (F(1,141)= 4.08, p< .05), and EEQ

scale (F(1,141)= 5.11, p< .03). Females reported better perceived health on the HPS scale than

males did (Mfemales= 2.66, SD= .39; Mmales= 2.52, SD= .42). This main effect can be seen in

Figure 1. As seen in Figure 2, females also reported better eating habits than males did according

to the Eating and Exercising Habits scale (Mfemales= 3.18, SD= .097; Mmales= 2.89, SD=.08).

20

Figure 1: Main Effect of Gender for HPS Scale.

Figure 2: Main Effect of Gender for EEQ Scale Scores.

For the interview responses, a significant main effect of gender was found for question

one “What do you think the lessons were about?” for should-not oriented responses (F(1, 126)=

4.27, p< .05). As seen in figure 3, males reported more should-not type behavior responses (e.g.

“You should not eat un-healthy because it is bad for you”) than females did (Mmales= .09, SD=

.18; Mfemales= .03, SD= .09). In addition, a significant main effect of gender was found for

question one for the “other” undefined oriented responses (F(1, 126)= 5.67, p< .02). Females

responded with more undefined type responses (e.g. “Teaching me about how to grow up

healthy”) than males (Mfemales= .11, SD= .33; Mmales= .01, SD= .08) (See Figure 4).

21

Figure 3: Main Effect of Gender for Question One Should not-Type Response.

Figure 4: Main Effect of Gender for Question One Undefined Response

Additionally, a significant main effect of gender was present for question four “What did

you like about the lessons?” for behavior change-oriented responses (F(1, 125)= 5.95, p< .02).

Females reported liking the behavior changes they saw in themselves (e.g., now I don’t add too

much salt to my food”) after the program more than males did (Mfemales= .03, SD= .01; Mmales=

.000, SD= .007). This main effect can be seen in figure 5. Again, these results support the second

hypothesis.

22

Figure 5: Main Effect of Gender for Question Four Behavior Change Responses.

Gender and IC orientation

Partial support for the third hypothesis, which predicted a gender by IC-orientation

interaction effect on the questionnaire and interview responses, was found. The child gender

(male, female) X IC orientation (collectivist and individualist) MANOVAS for the questionnaire

data revealed a significant interaction of IC and gender on social support for physical activity

(F(1,107) = 5.20, p < .03). As seen in Figure 6, females who were high in collectivism reported

having more social support for physical activity than female individualist and male collectivists

and individualists. Post hoc comparisons using the Tukey HSD test indicated that the mean

scores for female collectivists (Mfemale.collectivism= 1.88, SD= .09) was significantly different than

the scores for female individualists (Mfemale.individualism= 1.75, SD= .19). However male

collectivists Mmale.collectivism= 1.83, SD= .11) did not differ significantly from male individualists

(Mmale.individualism= 1.82, SD= .14) or females of both IC orientations.

23

Figure 6: Interaction between IC orientation and Gender.

For the interview data, in response to question one (“What did you think the lessons were

about”), there was a significant interaction between gender and IC orientation (F(1,109) = 4.91,

p< .03). Not surprisingly, males who identified as being individualist gave more individualist-

oriented responses (“It doesn’t matter what others are doing, don’t eat unhealthy.”) than male

collectivists, female individualists, and female collectivists (Mmale.individualism= .16, SD= .29;

Mmale.collectivism= .03, SD= .10; Mfemale.individualism= .03, SD= .10; Mfemale.collectivism= .07, SD= .18).

However post-hoc comparisons using the Tukey HSD test revealed no significant differences

between groups.

Furthermore, there was a significant interaction between gender and IC orientation in

response to question three (“Were the lessons useful for you?”), for gain response (F(1,105)=

4.14, p< .05) and gain response with a topic reference (F(1,105)= 5.02, p< .03). Female

collectivists reported “yes” to gaining information more than female individualists and males of

both IC orientations on average (Mfemale.collectivism=.46, SD= .66; Mf.individualism=.13, SD= .36;

Mmale.individualism= .36, SD= .64; Mmale.collectivism= .24, SD=.49). In addition, when pressed for more

detail on what they gained, females who identified as collectivists made more topic references on

average (e.g. “information on nutrition”) than female individualists and males of both IC

24

orientations (Mfemale.collectivism= .41, SD= .59; Mfemale.individualism= .10, SD= .30; Mmale.collectivism= .17,

SD= .37; Mmale.individualism= .29, SD= .58). Post-hoc comparisons using the Tukey HSD test found

no significant differences between male and female individualists and collectivists in their

responses to question three. These results partially support the third hypothesis predicting gender

by IC-orientation interaction effects on the questionnaire and interview responses. Female

collectivists were predicted to report healthier attitudes and recall more nutrition information

during interviews than female individualists and males of both IC-orientations. However, post-

hoc tests only showed significant differences between female collectivists and female

individualists on one of the questionnaire subscales, and no significant differences between

males and females of both IC-orientations for interview responses.

Gender and Program Orientation

Partial support for the fourth hypothesis predicting a gender by curricula interaction

effect on interview and questionnaire responses was also found. A significant interaction for

program orientation and child gender were evidenced in the HBS control of food subscale

(F(2,119)= 3.84, p< .03). On average, females who went through the collectivist curriculum

reported having more control over food choices at home than males and females in the

individualist, and control curriculum conditions (Mfemale.collectivist= 1.71, SD= .1922; Mmale.collectivist=

1.61, SD= .19; Mfemale.individualist= 1.63, SD= .24; Mmale.individualist= 1.60, SD= .21). However post-

hoc comparisons using the Tukey HSD test found no significant differences between females and

males in any of the curricula conditions.

There was also a significant interaction for child gender and program orientation

condition in the HCS function subscale (F(2, 135)= 4.35, p< .02), and eudaimonistic subscale

(F(2, 135)= 3.80, p< .03). Males in the individualist condition reported higher associations of

25

health with functionality than males and females in the collectivist and individualist conditions

on average (Mmale.individulist= 5.34, SD= .74; Mfemale.individualist= 4.59, SD= 1.12; Mmale.collectivist= 5.08,

SD= .97; Mfemlae.collectivist= 4.83, SD= 1.04). Males in the individualist condition also reported

higher associations of health with well-being than females and males in the individualists and

collectivist conditions on average (Mmale.individualist= 5.11, SD= .79; Mfemale.individualist= 4.34, SD=

1.12; Mmale.collectivist= 5.06, SD= .87; Mfemale.collectivist= 4.61, SD= 1.12). Contrary to expectation,

post-hoc comparisons using the Tukey HSD tests found no significant differences between

groups for both the HCS function and eudaimonistic subscales.

In regards to the interview data, a significant interaction was found between gender and

curricula condition for question one (“What do you think the lessons were about?”)on the topic

reference (F(2, 122)= 3.81, p< .03), collectivist theme(F(2, 122)= 3.09, p< .05), and should-

statement oriented responses (F(2,122)= 4.71, p< .01). However, post-hoc comparisons using the

Tukey HSD test found no significant differences between groups for topic references or

collectivist-oriented responses, but did find significant differences between groups for should-

oriented responses.

For should-oriented responses the Tukey HSD test revealed significant differences

between males in the collectivist curricula condition and males in the control curricula condition.

The mean response of males in the collectivist condition (Mmale.collectivist= .29, SD= .34) was

significantly different than males in the control condition (Mmales.control = .01, SD= .06) such that

males in the collectivist condition provided more should oriented behavior responses (e.g. “You

should do sports instead of eating junk food”) than males in the control condition did. However

the females in the collectivist, individualist, and control conditions did not differ significantly

from each other or from males in each of the curricula conditions (Mfemale.collectivist= .08, SD= .19;

26

Mmale.individualist= .14, SD= .30; Mfemale.individualist= .09, SD= .18). This interaction can be seen in

Figure 7.

Figure 7: Interaction Between Gender and Curricula Condition for Question One.

Additionally, a significant interaction between gender and condition was found for

question 2 (“Did you learn anything from the lessons?”) for responses related to should-type

behaviors (F(2,121)=5.338, p< .01). However post-hoc comparisons using the Tukey HSD test

found no significant differences between groups. These results partially support the fourth

hypothesis which predicted that there would be an interaction between gender and curricula

condition on interview and questionnaire responses. It was expected that females in the

collectivist curricula would report healthier attitudes and recall more nutrition-related

information during interviews. Although females did report healthier attitudes on some of the

questionnaire subscales and interview responses, post-hoc tests revealed significant differences

between males in the collectivist and control conditions only.

27

CHAPTER FOUR: DISCUSSION

The purpose of the present study was to expand on the results found by Lopez et al. (in

review, 2014) by investigating gender differences that may exist as a function of IC-focused

nutrition intervention programs along with gender differences in IC-orientation. The results in

the present study both support and expand on the findings from Lopez et al. (in review, 2014),

and provide support for the idea that both culture and gender should be taken into consideration

when designing and implementing programs about nutrition for Hispanic youth. Participants’ IC

orientation and gender along with program orientation all have a significant role in the

effectiveness of the nutrition intervention programs. In general, both gender on its own and the

interactions between gender, program orientation, and IC orientation influenced participants’

health perceptions and attitudes.

Surprisingly, the first hypothesis was not supported by the data. There were no gender

differences in IC orientation; in other words, females in this sample of Hispanic middle school

students were not more collectivist than males. The lack of gender differences in IC orientation

could be attributed to various factors. First, sample size could have been an issue. There were

more males in the sample than females, and females of both IC orientations did not exceed 30

participants, which could have made it difficult to detect any true gender differences in IC

orientation. Second, the sample consisted of only Hispanic youth; thus, the participants all shared

a common ethnic background, which could account, in part, for the lack of variability among IC

orientations. Future research should incorporate a larger and more ethnically diverse sample in

order to test for gender differences in IC orientation.

In regards to the second hypothesis, as expected, females reported having better eating

habits and healthier perceptions of themselves overall than males. This finding supports the

28

second hypothesis which predicted that females would report better eating habits and health

behaviors overall. Previous research investigating gender differences in health and diet related

behaviors also found that females place a higher value on nutrition and eating healthy than males

do (Bothmer & Fridlund, 2005; Courtenay, McCreary, & Merighi, 2002; Wardle, Hasse, Steptoe,

Nillapun, Jonwutiwes, & Bellisle, 2004). This is not surprising considering the amount of social

and societal pressures females face to be thin and healthy from a very early age (Stephen &

Perrera, 2014; Mischner, Schie, & Engels, 2013; Dakanalis, Clerici, Caslini, Favagrossa,

Prunas…Zinetti, 2013). Females also begin to care about their appearance and weight at an

earlier age than males do. The sample in this study consisted of sixth graders, and, at this age,

boys may not yet place much emphasis on health or health related behaviors, which could

account, in part, for the gender differences in health perceptions and attitudes (Shriver, Harrist,

Paige, Hubbs-Tait, Moulton, & Topham, 2013).

Males and females also differed in the way they responded to the interview questions. In

response to a question concerning what the students thought the lessons were about, males were

more likely to respond with should-not oriented responses. For example, in response to the

question, males made statements such as “you should not eat unhealthy because it is bad for

you.” In contrast, females were more likely to respond with undefined responses (e.g. “Teaching

me about how to grow up healthy”). These findings suggest that both males and females were

able to recall the central ideas of the curriculum; however, they attuned to the information in

differing ways. Females focused on the global, overarching effects, while males focused on

specific behaviors and their immediate relation to health. In short, both males and females were

able to recall nutrition-related information during the post-test interviews, but did so in differing

ways. The difference in the way they remembered information partially supports the second

29

hypothesis that females would remember more nutrition information during interviews than

males would. Females did remember the global themes more than males did; however, males

were able to remember specific behavior-related information.

In addition, when responding to the question regarding what the students liked about the

lessons, females reported liking behavior changes they saw in themselves after the program more

than males did. This finding is in line with the previous results of Lopez et al.’s (2014) study as

well as with research suggesting that females place a greater emphasis on nutrition and health

related behaviors beginning at an early age (Bothmer & Fridlund, 2005; Courtenay et al. 2002;

Stephen and Perrera, 2014).

Surprisingly, there was only one significant difference present between the female

collectivist and female individualist groups for the questionnaire responses. Although the

MANOVA including gender and IC orientation revealed significant interactions between gender

and IC orientation on one of the HBS subscales and interview responses, post-hoc tests only

revealed significant differences between groups for the support for physical activity sub-scale.

Female collectivists reported higher social support for physical activity than female

individualists. Therefore, the third hypothesis stating that female collectivists would report better

health attitudes and recall more information was only partially supported. This result was

unanticipated and warrants further investigation. Only 25 female collectivists could be included

in the final sample and thus the small sample size could account in part, for the lack of

significant differences between males and females of both IC-orientations on the interview

responses and other questionnaire responses.

The fourth hypothesis was partially supported as well. Specifically, the curriculum that

presented knowledge-based information within a collectivist framework was effective for both

30

females and males in aiding in the retention of the nutrition-related information in comparison to

the individualist and control conditions. Females who went through the collectivist nutrition

intervention program reported better eating habits along with a more positive perception of

themselves as healthy than males and females in any of the other curriculum conditions.

However, even though post-hoc analysis revealed no significant differences between the

curricula groups on the questionnaire data, there are clear differences within the results that

warrant further investigation.

Although post-hoc analysis revealed no significant differences between groups on the

questionnaire data, the post-hoc analysis revealed significant differences between males in the

collectivist and control conditions for “should”-oriented responses to interview question one

“What do you think the lessons were about?” Males who went through the collectivist

curriculum provided more “should” statement responses (e.g. “You should eat healthy because it

is good for you”) than males in the control curriculum. This was not the predicted interaction, but

it provides some evidence for the collectivist curricula doing better at helping the students to

retain information on what they should do to stay healthy than the control curricula. This

difference between males in the collectivist and control curriculum partially supports the fourth

hypothesis in the sense that there were differences between students in the control and

collectivist curriculum. However, the significant difference was between males and not females,

which was not the predicted result. Future research could be done to investigate the gender X

curriculum interaction effects further, along with why students remembered the nutrition

information in a “should-oriented” way.

In addition, females who went through the collectivist curriculum reported having more

control over their food choices at home than males and females in the individualist or control

31

curriculum. Perhaps for females, a collectivist oriented program presents information in a way

that is more salient and relevant to the collective and social nature of their interactions regarding

health and body image.

Although the post-hoc analysis revealed no significant differences, males who went

through the individualist curriculum reported higher associations of health with being able to

fulfill daily responsibilities and maintain good bodily function on average. In addition, males in

the individualist curriculum reported higher associations of health with well-being and happiness

than males and females in each of the other curricula conditions. This finding could be explained

by the idea that males are encouraged to engage in physical activity more than females are and,

thus, associate health more with physical well-being and physical strength (Calasanti, King,

Pietila, & Ojala, 2013). The more one engages in physical activity, the higher his or her body-

esteem may be and the more likely he or she may be to associate nutrition and health with

wellness (Williams & Cash, 2001).

Overall, the results in the present study expand on the results reported by Lopez et al.

(2014). Both gender and culture should be considered key factors when using programs about

nutrition to bring about necessary health-related changes among Hispanic youth. In general, the

results support the idea that Hispanic males and females could benefit more from a collectivist-

oriented nutrition intervention program. However, males seemed to benefit from the

individualist-oriented curricula as well. In the survey and questionnaire responses, males who

went through the individualist curriculum showed a strong tendency to relate nutrition to

physical and emotional well-being. In contrast, in response to the interviews, males who went

through the individualist or collectivist curriculum displayed almost equal retention of the facts

and concepts from the program. Since the sample for this study only included Hispanics, the

32

differences in males’ behavior could be partially attributed to males being more collectivist than

individualist within the sample.

Future Research

This study provides an example of a simple and easy culturally relevant curriculum that

other researchers can expand upon and implement. Future work in this area can examine the

cross-cultural benefits of culturally-oriented intervention programs for other minority and non-

minority groups. In addition, future research can also sample from various levels of SES and

attempt to incorporate culturally relevant messages into other programs aimed at altering

attitudes and behaviors.

More work is needed to examine if Hispanic males could benefit more from an

individualist rather than a collectivist-oriented program. The results presented in this study were

fairly inconclusive in regards to males, so future research should examine the relevance of

gender for culturally oriented curricula for males more critically. Future research could also

investigate why Hispanic males as well as those in a collectivist curriculum remembered “should

not” behaviors better than other information. Future research investigating which aspects of the

curriculum students most attended to could help to inform teachers not only how characteristics

of students can affect the way they view information, but how that information can be presented

to best suit the student’s needs.

The present study examined only sixth graders. Yet previous research has found that pre-

adolescence is a critical period for obesity prevention and that, in order to see long-term changes

in nutrition-related behaviors and attitudes, children should be exposed to nutrition programs

early (Hoelscher et al., 2013). Future research should use a younger sample, perhaps from third

33

or fourth grade, in order to assess more long-term changes in nutrition related attitudes and

behaviors and the impact of the program on participants’ future health related attitudes.

Limitations

Surprisingly, the results from the interview data were fairly inconclusive. Since the

gender of the interviewer was not taken into account when the interviews were conducted, it is

possible that the gender of the interviewer could possibly have impacted the ways in which the

students responded to the questions. The male and female students may have provided different

responses or given different examples of the information they remembered depending on

whether the interviewer was male or female. Thus future studies should consider the gender of

the interviewer and its impact on students’ responses.

Another limitation of the study is that the sample size for the study was small, with a total

of 146 participants, and only 25 female collectivists in the analysis in contrast to the larger group

of 41 male individualists. This lack of equality between groups could have affected the results

and made it difficult to detect significant differences between groups in the post-hoc analysis.

Furthermore, the questionnaire and survey responses assessed in the present study were

administered to the participants in one post-test phase four months after the initial nutrition

curriculum was presented. Including a second post-test phase six to eight months after the initial

curriculum was presented would allow us to more reliably assess changes in behaviors and

attitudes regarding nutrition as a function of the intervention program.

Implications

Despite these limitations, it is clear that for this sample of Hispanic youth, a culturally-

oriented nutrition intervention program worked better than presenting the information in a purely

fact-based way. At the practical level, to be most effective, programs should integrate

34

participant characteristics, such as participant IC and gender. On another practical note, it would

be relatively inexpensive to incorporate this program into existing nutrition programs in schools.

These cultural concepts can be easily integrated into health-related school programs or classes.

Lesson plans can be revised to add the IC perspective as a program orientation. Coaches or

instructors can also be made aware of the relevance of these variables along with how gender and

culture can influence the students’ perceptions of the information.

At the theoretical level, the results presented here encourage and support further

examinations of underlying cultural dimensions as a means of increasing the effectiveness of

intervention programs. The content of culturally relevant programs needs to go beyond a

superficial integration of cultural differences in the promotion of healthy attitudes and behavior.

The research presented here promotes the relevance of collectivism, individualism, and gender in

the development and maintenance of healthy attitudes and behaviors about nutrition. It is

important to teach youth about healthy nutrition and to do so in a way they can easily identify

with. The cultural framework in which this information is communicated is more salient, more

relevant, and more motivational than a standard-focused program. It is clear that in order to

promote healthy attitudes and behaviors among individuals from diverse backgrounds, programs

should present information in a culturally relevant way, while also appealing to participant

characteristics such as gender.

The nutrition intervention program presented in this study can also be used in a global

context to address the growing obesity problem not only in the U.S. but internationally as well.

The Organization for Economic Co-operation and Development recently issued a report stating

that the obesity rates in Mexico are rapidly increasing, especially among children (OECD, 2011).

As a group, Hispanics generally tend to identify as collectivist, so a collectivist-oriented nutrition

35

intervention program could be useful in places such as Mexico in encouraging individuals to

adopt healthier attitudes and behaviors. If the nutrition intervention is provided to students during

early childhood, then they may engage in healthier behaviors as they get older, which could

prevent future health problems.

In conclusion, it is clear that culturally-oriented nutrition intervention programs work

better to bring about healthier attitudes and behaviors among Hispanic preadolescents. More

work is needed to investigate how culturally-oriented nutrition intervention programs could work

cross-culturally and among younger children. The results presented in this study indicate clear

gender differences in nutrition-related attitudes and adds to the existing knowledge that culture is

an important variable to consider when administering information to youth. The limitations of

this study limited the ability to detect clear differences among males and females in both IC-

orientation and curricula effectiveness. However, there was evidence to suggest that there are

interactions between gender and IC-orientation and gender and type of curricula, so future

research is needed to investigate these possible interactions.

Overall, the results from the current study and the results from Lopez et al. (in review,

2014) indicate that programs aimed at altering behaviors and attitudes about nutrition should

present the information in a way that meaningfully relates to factors such as culture and gender.

Furthermore, in order to address the rising issues of obesity on both the local and global level,

the present study represents the need to investigate gender differences regarding nutrition-related

attitudes more critically.

36

APPENDIX A

Interview Rating Scale_Nutrition Interview ID:______________ Interviewer ID: ____________ Rater ID:______________ What did you think the lessons and the posters were about? _______Health Facts (e.g. “It makes your lungs black/fat/makes you look older.”) _______Reference to topic (i.e. smoking, alcohol, nutrition) _______Collectivist Oriented Response (e.g. “About respecting your family and staying healthy.”) _______Individualist Oriented Response (e.g. “It doesn’t matter what others are doing, don’t smoke.”). _______Should (e.g. “You should do sports instead of smoking, drinking, or eat junk food.”) _______Should not (e.g. “You should not smoke or drink or eat unhealthy because its harmful.”) _______Behavior Change (e.g., now I don’t add too much salt to my food”) _______I don't know _______Other (e.g. “Teaching me about how to grow up and stay out of jail.”) Did you learn anything from the lessons? _______Yes _______No _______Health Facts _______Reference to topic (i.e. smoking, alcohol, nutrition) _______Should (e.g. “You should do sports instead of smoking, drinking, or eat junk food.”) _______Should not (e.g. “You should not smoke or drink or eat unhealthy because its harmful.”) _______Collectivist Oriented Response _______Individualist Oriented Response _______Behavior Change _______I don't know _______Other Were the lessons useful for you? _______Yes _______No _______Gained information _______Health Fact _______Reference to topic (i.e. smoking, alcohol, nutrition) _______Should _______Should not _______Behavior Change _______Collectivist Oriented Response _______Individualist Oriented Response _______I don't know _______Other What did you like about the lessons? _______Liked everything _______Liked nothing _______Gained information _______Health Fact _______Reference to topic (i.e. smoking, alcohol, nutrition) _______Should _______Should not _______Materials (e.g. “I liked the glitter and stencils a lot.”) _______Procedures (e.g. “I enjoyed working in a group with my friends.”)

37

_______Should (e.g. “You should do sports instead of smoking, drinking, or eat junk food.”) _______Should not (e.g. “You should not smoke or drink or eat unhealthy because its harmful.”) _______Collectivist Oriented Response _______Individualist Oriented Response _______Behavior Change _______I don't know _______Other What did you not like about the lessons? _______Liked everything _______Liked nothing _______Materials _______Procedures _______Should (e.g. “You should do sports instead of smoking, drinking, or eat junk food.”) _______Should not (e.g. “You should not smoke or drink or eat unhealthy because its harmful.”) _______Collectivist Oriented Response _______Individualist Oriented Response _______Behavior Change _______I don't know _______Other

38

APPENDIX B

Individualism/Collectivism Scale

How true are the following statements of you? Fill in the blank with a number from 0 to 10 to

show whether the statement is true for you, with 0 being “not true” and 10 being “very true” for

you.

0 1 2 3 4 5 6 7 8 9 10

Not true Somewhat true Very

at all true

_____ 1. I’d rather depend on myself than others.

_____ 2. If another student does really well in school, I would feel proud.

_____ 3. Doing badly in school will disappoint my parents very much.

_____ 4. Winning is everything.

_____ 5. Doing poorly in school will hurt my chances for a good job in the future.

_____ 6. I rely on myself most of the time; I rarely rely on others.

_____ 7. My parents expect me to get mostly A’s in school.

_____ 8. It is important that I do better than others.

_____ 9.1 do my homework because it bothers me when I don’t complete it.

_____ 10. The well-being of other students is important to me.

_____ 11. I often do “my own thing.”

_____ 12. If I don’t do well in school I won’t get the job I want in the future.

_____ 13. It’s important to me that I respect decisions made by my group.

_____ 14. My personal identity is very important to me.

_____ 15. To me , fun is spending time with others.

_____ 16. Family members should stick together, no matter what.

_____ 17. I feel good when I work with others.

_____ 18. Competition is the law of nature.

_____ 19. Parents and children must stay together as much as possible.

_____ 20. I don’t think I can get a good job if I do badly in school.

_____ 21. When another person does better than I do, I get tense.

_____ 22. It’s my duty to take care of my family, even if I have to sacrifice what I want.

39

APPENDIX C

Health Perception Scale

Please answer the following questions by placing and “X” next to the answer that you think best

describes your health.

1. How would you rate your overall health at the present time?

_______excellent

_______good

_______fair

_______poor

2. Is your health now better, about the same, or not as good as it was three years ago?

_______better

_______same

_______not as good

3. Do your health problems stand in the way of your doing the things you want to do?

_______not at all

_______a little

_______a great deal

4. Would you say that your health is better, about the same, or not as good as most people

your age?

_______better

_______same

_______not as good

40

APPENDIX D

Eating and Exercise Questionnaire

These questions have been adapted from the YRBS, a national youth behavior survey

administered by the CDC.

Eating

1. During the past 7 days, how many times did you drink 100% fruit juice, such as orange,

apple, or grape juice? (Do not count punch, Kool-Aid, sports drinks, or other fruit-

flavored drinks)

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

g. 4 or more times per day

2. During the past 7 days, how many times did you eat fruit? (Do not count fruit juice)

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

g. 4 or more times per day

3. During the past 7 days, how many times did you eat green salad?

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

g. 4 or more times per day

4. During the past 7 days, how many times did you eat potatoes? (Do not count French fries,

fried potatoes, or potato chips)

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

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g. 4 or more times per day

5. During the past 7 days, how many times did you eat carrots?

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

g. 4 or more times per day

6. During the past 7 days, how many times did you eat other vegetables? (Do not count

green salad, potatoes or carrots)

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

g. 4 or more times per day

7. During the past 7 days, how many glasses of milk did you drink? (Include the milk you

drank in a glass or a cup or from a carton or with ceral)

a. none

b. 1-3 times

c. 4-6 times

d. 1 time per day

e. 2 times per day

f. 3 times per day

g. 4 or more times per day

Exercise

1. On how many of the past 7 days did you exercise at least 20 minutes that made you sweat

and breathe hard, such as a basketball, soccer, running, swimming laps, fast bicycling,

fast dancing, or similar exercise?

a. 0 days

b. 1 day

c. 2 days

d. 3 days

e. 4 days

f. 5 days

g. 6 days

h. 7 days

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2. On how many of the past 7 days did you participate in physical activity for at least 30

minutes that did not make you sweat or breathe hard, such as fast walking, slow

bicycling, skating, pushing a lawn mower, or mopping floors?

a. 0 days

b. 1 day

c. 2 days

d. 3 days

e. 4 days

f. 5 days

g. 6 days

h. 7 days

3. On how many of the past 7 days did you exercise to strengthen or tone your muscles,

such as push-ups or sit-ups?

a. 0 days

b. 1 day

c. 2 days

d. 3 days

e. 4 days

f. 5 days

g. 6 days

h. 7 days

4. On the average school day, how many hours do you watch TV?

a. None

b. Less than 1hour per day

c. 1 hour per day

d. 2 hours per day

e. 3 hours per day

f. 4 hours per day

g. 5 or more hours per day

5. In an average week when you are in school, on how many days do you go to P.E. class?

a. 0 days

b. 1 day

c. 2 days

d. 3 days

e. 4 days

f. 5 days

g. 6 days

h. 7 days

6. During the average P.E class, how many minutes do you spend actually exercising or

playing sports?

43

a. I do not take P.E.

b. Less than 10 minutes

c. 10-20 minutes

d. 21-30 minutes

e. 31-40 minutes

f. 41-50 minutes

g. 51-60 minutes

h. more than 60 minutes

44

APPENDIX E

HEALTH BEHAVIOR QUESTIONNAIRE WHAT WOULD YOU DO?

1. If you were at the movies, which one would you pick?

popcorn with salt or butter popcorn without salt and butter

2. Which one would you pick to fix with dinner?

fresh or frozen vegetables canned vegetables

3. If you were going to eat your lunch, which would you do?

eat the food without adding salt shake salt on the food before eating

4. Which would you put on your hamburger?

INSTRUCTIONS: Circle one of the two foods that you would pick if you had to

choose just one.

45

catsup tomato

5. Which would you pick to drink?

regular milk low fat or skim milk

6. Which food would you eat for a snack?

candy bar fresh fruit

7. What would you put on your toast?

margarine butter

8. Which would you do if you were going to eat a piece of chicken?

Leave on the skin take off the skin and not eat the skin

9. Which food would you ask for?

46

frozen yogurt ice cream

10. Which food would you ask your parents to buy?

plain bread sticks salted crackers

11. Which would you chose to cook if you were going to help make dinner at home?

french fries baked potatoes

12. Which would you do if you were going to eat cooked vegetables?

eat without butter add butter

13. Which would you order if you were going to eat at a fast food restaurant?

47

a regular hamburger a salad from the salad bar

WHAT FOODS DO YOU EAT MOST OF THE TIME?

1.

cookies an apple

2.

hot dog chicken

3.

INSTRUCTIONS: Circle one of the two foods that you

eat most often.

48

buttered popcorn unbuttered popcorn

4.

bran muffin with margarine french toast with butter and syrup

5.

chocolate cake an orange

6.

ice cream fresh fruit popsicle

7.

INSTRUCTIONS: Circle one of the two foods that

you eat most often.

49

sweet roll whole wheat roll

8.

turkey bologna

9.

regular milk lowfat or skim milk

10.

no salt salt

11.

frozen yogurt ice cream

12.

INSTRUCTIONS: Circle one of the two foods that

you eat most often.

50

french toast whole wheat toast

13.

margarine butter

14.

regular hamburger lean hamburger

WHICH FOOD IS BETTER FOR YOUR HEALTH?

1.

whole wheat bread white bread

2.

broiled beef broiled fish

INSTRUCTIONS: Circle one of the two foods that you think is

better for your health.

51

3.

cold cereal eggs and bacon

4.

beef beans

5.

chicken regular hamburger

6.

regular milk lowfat or skim milk

7.

INSTRUCTIONS: Circle one of the two foods that you think is

better for your health.

52

peanut butter bologna

8.

frozen yogurt ice cream

9.

green salad french fries

10.

raisins candy bar

11.

butter margarine

12.

INSTRUCTIONS: Circle one of the two foods that you think is

better for your health.

53

frozen corn canned corn

13.

french fries baked potato

14.

regular peanut butter freshly ground peanut butter

THINGS YOU DO MOST OF THE TIME

1. Do you choose or fix your own 1. YES 2. NO breakfast? 2. Do you choose or fix your own 1. YES 2. NO

INSTRUCTIONS: The questions in this section ask about what you do most of the time. Please answer by circling either YES or NO

for each question.

54

lunch on school days? 3. Do you choose foods at the 1. YES 2. NO grocery store? 4. Do you choose what you want to 1. YES 2. NO eat from the dinner table? 5. Do you choose or fix your own snacks? 1. YES 2. NO 6. Do you eat fresh fruit at home? 1. YES 2. NO 7. Do you eat ice cream at home? 1. YES 2. NO 8. Do you eat chips at home? 1. YES 2. NO 9. Do you put salt on your food 1. YES 2. NO at the dinner table?

PHYSICAL ACTIVITY

Note: Being physically active means doing exercises like running, jogging, walking fast, bike riding, swimming, dancing, skating, or any other activity that makes you breathe faster and your heart beat faster. 1. One or both of my parents are 1. YES 2. NO physically active. They do exercises like running, jogging, walking fast, bike riding, swimming, dancing, or skating. 2. One or both of my parents do 1. YES 2. NO exercises with me like running, jogging, walking fast, bike riding, swimming, dancing, or skating. 3. Most of my friends are physically 1. YES 2. NO active. 4. Most of my parents are physically 1. YES 2. NO active.

INSTRUCTIONS: The questions in this section ask about physical activity. Please answer by circling either YES or NO for each

question.

55

5. Most of my friends want me to be 1. YES 2. NO physically active when we play. 6. My friends and I have fun when we’re 1. YES 2. NO physically active playing together. 7. One or both of my parents want me to 1. YES 2. NO stay inside when I want to be physically active outside. 8. One or both of my parents will not let me 1. YES 2. NO do physical activities when I want to. 9. One or both of my parents like to watch 1. YES 2. NO me when I am being physically active. 10. When I am physically active, one or both 1. YES 2. NO of my parents smile and cheer for me. 11. Most of my classroom teachers criticize 1. YES 2. NO people who exercise. 12. When I am physically active at recess, 1. YES 2. NO most of my classroom teachers tell me to stop. 13. When I am physically active in PE 1. YES 2. NO class, my PE teacher tells me I am doing a good job. 14. Most of my friends tease me a lot 1. YES 2. NO when I am physically active. 15. When doing sports, most of my 1. YES 2. NO classmates choose me last for their team. 16. When I am physically active, most of my 1. YES 2. NO friends make fun of me. 17. When doing sports most of my 1. YES 2. NO classmates want me on their team. 18. When I am physically active, most of my 1. YES 2. NO friends tell me I am a good player

56

WHAT DO OTHER PEOPLE WANT YOU TO EAT?

1. Who wants you to eat popcorn without salt and butter on it? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO c. Your friends 1. YES 2. NO 2. Who wants you to eat lots of fruits and vegetables? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO c. Your friends 1. YES 2. NO 3. Who wants you to eat food without putting salt on it from the salt shaker? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO c. Your friends 1. YES 2. NO 4. Who wants you to drink skim or low milk instead of whole milk? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO c. Your friends 1. YES 2. NO 5. Who wants you to eat margarine instead of butter? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO c. Your friends 1. YES 2. NO 6. Who wants you to eat the chicken meat without the skin? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO

INSTRUCTIONS: The questions in this section ask about what other people want you to eat. Please answer by circling either YES or

NO for each question.

57

c. Your friends 1. YES 2. NO 7. Who wants you to eat a salad from the salad bar instead of eating a hamburger? a. Your parents 1. YES 2. NO b. Your teachers 1. YES 2. NO c. Your friends 1. YES 2. NO

HOW SURE ARE YOU?

1. How sure are you that you 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE can eat food without adding salt from a shaker? 2. How sure are you that you 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE can eat fresh or frozen vegetables instead of canned vegetables? 3. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE ask your parents for popcorn without salt and butter? 4. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE ask for lettuce and tomato instead of pickles on your hamburger? 5. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE drink low fat white milk instead of regular white milk? 6. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE eat cereal instead of a doughnut? 7. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE eat fresh fruit instead of a candy bar? 8. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE eat toast with margarine instead of real butter? 9. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE take the skin off of the chicken (and not eat the skin)?

INSTRUCTIONS: The questions in this section ask how sure you are about being able to eat some of the foods below. Please answer by circling either Not Sure,

A Little Sure, or Very Sure for each question.

58

10. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE ask for frozen yogurt instead of ice cream? 11. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE ask your parents to buy bread sticks instead of salted crackers? 12. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE eat a baked potato instead of french fries? 13. How sure are you that you 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE can drink fruit juice instead of a soft drink (soda pop)? 14. How sure are you that you 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE can eat cooked vegetables without adding real butter to them? 15. How sure are you that you 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE can eat a salad from the salad bar at a fast food restaurant instead of ordering a hamburger and fries?

PHYSICAL ACTIVITY

1. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE

choose to jog during recess? 2. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE be physically active 3-5 times a week? 3. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE exercise and keep moving for most of the time in physical education class? 4. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE improve your physical fitness by running or biking 3-5 times a week? 5. How sure are you that you can 1. NOT SURE 2. A LITTLE SURE 3. VERY SURE keep up a steady pace without stopping for 15-20 minutes when you are physically active?

INSTRUCTIONS: The questions in this section ask how sure you are about being physically active. Please answer by circling either Not Sure, A Little Sure, or

Very Sure for each question.

59

APPENDIX F

Laffrey Health Conception Scale

Instructions. Below are 28 statements to describe the meaning that “healthy” or “being healthy”

has for different people. Depending on your personal definition of health, you may agree or

disagree with the statements. Besides each statement is a scale which ranges from strongly

disagree (1) to strongly agree (6). For each item, please circle the number that best represents the

extent to which you agree or disagree with these statements. The more strongly you disagree

with a statement; the lower will be the number you circle. The more strongly you agree with a

statement, then the higher the number you circle. Please make sure your answer every item and

that you circle only one number per item. This is a measure of how you define health. There are

no right or wrong answers.

Health or “being healthy” means:

Strongly

Disagree

Moderately

Disagree

Slightly

Disagree

Slightly

Agree

Moderately

Agree

Strongly

Agree

1. Feeling

great- on top of

the world.

1 2 3 4 5 6

2. Being able

to adjust to

changes in my

surroundings.

1 2 3 4 5 6

3. Fulfilling my

daily

responsibilities.

1 2 3 4 5 6

4. Being able

to do those

things I have to

do.

1 2 3 4 5 6

5. Not

requiring a

doctor’s

services.

1 2 3 4 5 6

6. Creatively

living life to

the fullest.

1 2 3 4 5 6

7. Adjusting to

life’s changes. 1 2 3 4 5 6

60

Strongly

Disagree

Moderately

Disagree

Slightly

Disagree

Slightly

Agree

Moderately

Agree

Strongly

Agree

8. Not

requiring pills

for illness or

disease.

1 2 3 4 5 6

9. Being able

to function as

expected.

1 2 3 4 5 6

10. Not being

under a

doctor’s care

for illness.

1 2 3 4 5 6

11. Facing each

day with zest

and

enthusiasm.

1 2 3 4 5 6

12. Being able

to cope with

stressful

events.

1 2 3 4 5 6

13. Being able

to change and

adjust to

demands made

by the

environment.

1 2 3 4 5 6

14. Actualizing

my highest and

best

aspirations.

1 2 3 4 5 6

15. Adequately

carrying out

my daily

responsibilities.

1 2 3 4 5 6

16. Living at

top level. 1 2 3 4 5 6

17. Adapting to

things as they

really are, not

as I’d like them

to be.

1 2 3 4 5 6

61

18. I do not

require

medications.

1 2 3 4 5 6

Strongly

Disagree

Moderately

Disagree

Slightly

Disagree

Slightly

Agree

Moderately

Agree

Strongly

Agree

19. Carrying

on the normal

functions of

daily living.

1 2 3 4 5 6

20. Coping

with changes

in my

surroundings.

1 2 3 4 5 6

21. Realizing

my full

potential.

1 2 3 4 5 6

22. Fulfilling

my

responsibilities

as a son,

daughter or

friend.

1 2 3 4 5 6

23. Having no

physical or

mental

problems.

1 2 3 4 5 6

24. Performing

at the expected

level.

1 2 3 4 5 6

25. Not

collapsing

under ordinary

stress.

1 2 3 4 5 6

26. My mind

and body

function at

their highest

level.

1 2 3 4 5 6

TOTAL

62

APPENDIX G

Curriculum for Nutrition (Collectivistic Style)

-Health

-Cosmetics

-Athletics

*****Immediately instruct students to form groups with their friends, where each group

contains four to five students. Assign numbers to each group of students and keep a record of

the members in each group.

My name is _______ and this is _________. We are here from the University of Texas at

San Antonio today to talk to you about health-related behaviors and decisions that you will be

making throughout your life. You are making many decisions, and these will stick with you, so

if you make healthy choices you are more than likely to make good decisions throughout your

life. We want you to make the best decisions!

Sometimes we have to make difficult decisions that are not only best for you, but also

best for everyone around us, including your friends and family members. Look at the friends

in your group and think of your family. Your decisions also affect your friends and family. (IF

COACHES HAVE REVIEWED NUTRITION): Your teachers/coaches have already spoken to

you about eating healthy and good nutrition. We are here to add to some of the information they

have already talked about.

*****For the poster themes: Instruct students to talk to each other in their groups and

create reasons why it is important to eat healthy. For each group, record three to four reasons

that they said. This will be used later for the poster activity.

These are all great reasons why you should eat healthy. Now we will go into more detail

about the risks of not eating healthy, including how it affects yourself as well as the people

around you, like your family and friends.

HEALTH

The word “diet” does not necessarily mean a plan for losing weight. It also means

“regular eating” or the food that a person typically takes in each day. The nutrients in food you

eat determine how healthful your diet is, and the healthier a person eats, the better they feel. The

six types of nutrients include proteins, fats, carbohydrates, vitamins, minerals, and water. All of

these nutrients are important for the body to function properly, but many people do not get the

proper nutrients in the meals they eat. This can lead to many health problems.

Point#1:

This is why it is important for you to choose the correct balance of nutrients. It is not

only important for yourself, but also for your friends. If your friends are in good physical

condition from eating healthy, you will be able to spend more time with them, and not have to

worry about them getting sick. If you eat the right nutrients, you also will be healthy and your

friends will want to spend more time with you to do things together.

63

Point#2: Not only do friends and family eat healthy and do things together, friends and family

members are also a good source of support, and you too provide a great deal of support to your

family and friends. If your parents and other family members were unhealthy due to their diet,

they would not be able to help you and provide for you as they do now. When you grow older,

you will also want to contribute to and help out your family, but its hard when you have poor

health because you chose to eat unhealthily. For example, if you are unhealthy, you could not

help around the house because you wouldn’t have energy!

Point#3:

Choosing a healthy diet can provide a positive influence to others around you, like your

family and friends, and you may also notice your friends deciding to eat a healthy diet. So you

and your friends can influence each other in a positive way, and be able to participate in more

activities together. Following the food pyramid is a great way to decide on what foods to eat. Choosing a

variety of grains, especially whole grains, will make sure your body has the essential fiber to

help prevent illnesses.

Point#4:

Fruits and vegetables are also extremely important foods that are rich in vitamins and

help prevent heart disease and some cancers.

Conversation with kids:

What are some of your favorite fruits? Vegetables?

What is your father’s, mother’s, friend’s favorite fruits? Vegetables?

Do you like it too?

[if not] Why don’t you try it if your friend/family member like it?

Point#5:

These foods will also help increase your energy so you are able to participate in

activities with friends and family. You do not want to feel left out of certain activities only

because you are not healthy enough. Eating a healthy diet can help you be more willing to spend

time and have fun with your friends and family.

Conversation with kids:

What are some activities/things you like to do with your friends?

What do they like to do?

You need lots of energy for these activities, which can be obtained from the right food!

You will have many more options to enjoy activities with your friends if you do not have to

worry about your health. All of your friends want you to be able to participate in sports and

activities with them, so it is important for you to be aware of the foods that you are eating.

Choosing a diet that does not contain high amounts of saturated fat, such as meat and dairy

products, will also reduce your risk for heart disease and certain cancers. Meat products like

beef usually contain more saturated fat than other meats such as chicken. Dairy products like

milk, cheese, and yogurt also contain high amounts of saturated fat, if you don’t choose the low

64

fat products. Choosing low fattening foods will also help increase energy levels. Salt is also a

concern because consuming high levels of sodium can increase the risk for high blood pressure,

heart disease, kidney disease, stroke, and diabetes. Choosing to stay away from foods that are

high in salt, fat, and increasing the amount of fruits and vegetables can dramatically increase

your healthy status. You will not have to worry about seeing the doctor every week, or every

month for conditions such as heart disease and diabetes.

SHOW AND EXPLAIN THE FAT MANIPULATIVE.

Point#6:

Some of your family members may be relying on you when you grow older for some

help and support. How are you going to provide them with that help if you yourself have poor

health due to your eating habits? Having diseases especially heart disease, diabetes and cancers

will severely limit your options with friends and family. It is possible that you will not be

physically able to see the people you like or love the most.

Also, treating diseases and cancers is extremely expensive. Even if you were physically able

to spend time with friends and family members, you may not have the extra money to spend on

activities with friends or family due to all the medical expenses.

Point#7:

Remember that you have options when eating. Even when you eat out, you can make

good decisions. Be sure you don’t add the extra fat, sugar, and salt to your portions and ask

family members or friends to not put too much salt on their food, or not to eat too much. If the

portions are too large, ask to share with a friend, or take the leftover portions home for lunch

the next day or for a snack later on. Also remember that fried foods are extremely high in fat,

and broiled foods contain much less fat. Even if fried foods taste great, remember not to eat too

much of it.

Every time you eat, you are getting calories from the food, and is the energy that your

body uses. Since breakfast refuels your body after a night of not eating, it is important to eat

more whole grains, fruits, and vegetables. Protein is also good for breakfast, like peanut butter,

yogurt, and low-fat milk and cheese. Healthy snacking throughout the day can keep you

energized and include foods like fruits and vegetables such as carrot and celery sticks. Grains,

pasta, low-fat crackers, and popcorn without a lot of salt and butter are also great snacks.

Conversations with kids:

What kind of snacks, healthy ones, do/can you and your family eat together?

What are some more healthy snacks you can eat as a family?

Point#8:

You also want your friends to be proud of you and your actions. Eating unhealthy and

gaining an unhealthy amount of weight means that you are not taking care of yourself. Your

friends may eventually choose not to associate with you because of the bad choices that you

make for yourself. It is also great to represent your friends and your family in a positive light,

choosing to eat healthy and take care of your body. You are a reflection of your friends,

family, and culture, and they will be proud of you and your actions if you decide to make the

right decision when it comes to nutrition.

65

Reading food labels is extremely useful in order to decide which foods to eat. The daily

value is the amount of nutrient that a person needs each day. The food label lists the Percent

Daily Value, the percentage of the recommended daily amount of the nutrient that is found in a

serving of the food. Inspect the food carefully so you don’t eat food that looks, feels, or smells

bad.

Point#9:

This will also prevent any foodborne illness from eating contaminated food. Your

friends and family will be impressed with how much you know about choosing the right foods. And your friends and family will be looking to you for guidance on healthy eating!

COSMETIC

Point#10:

Eating healthy foods is important so that you maintain a healthful weight. Healthy

weights vary from individual to individual depending upon body heights and body types. A

person’s weight is one of the first things that people notice, and you don’t want friends and

family or other people to judge you in a bad way if you don’thave a healthy weight. So it’s

important to maintain a healthy weight to have and keep the respect of your friends and family

members. If you have a healthy weight, you will look your best and could gain more friends

from the positive self-esteem that you gain from the healthy weight.

Point#11:

You will also look much more appealing to other people if you remain healthy. In

order to lose unwanted or excess weight, a person must increase the number of calories used by

physical activity, and do not lose the weight quickly. Continue to eat the correct amount of

servings from the Food Guide Pyramid, and choose lower-calorie foods, with small serving sizes.

Being underweight is also not considered healthy. In order for a person to gain necessary

weight, they should follow the Dietary Guidelines and increase the number of serving from the

food groups in the Food Guide Pyramid, as well as eat healthful snacks, but not before meals.

Eating healthy and maintaining a good weight for your particular body type will help you

present yourself to your friends in the best possible way. You will gain more respect from

friends because you will have a higher self-esteem due to your healthy weight, and your

friends and family will be proud of your accomplishments.

Your skin, eyes, and nails will also be much more attractive. Eating healthy means that

you are giving your body good nutrients that it needs, and can helpclear up facial blemishes.

You will look and feel much better, and be able to present yourself to your friends, family and

others in a positive light.

ATHLETIC

Medical doctors or physicians often use body composition, the proportion of fat tissue to

lean tissue in the body, to determine if a person’s weight is healthy. All people have some fat. A

female teen with a healthful body composition may have about 15 percent of body fat, and a

male teen with 10 percent. Obesity is the term for having too much body fat. Other ways of

determining if a person’s weight is unhealthy is by using the Body Mass Index. It measures

66

mass compared to height. Even if you are at a desirable weight, you still need to keep healthful

eating habits.

Having too much body fat from eating unhealthy foods, or by eating too large of portions,

will limit a person’s athletic ability or will hurt hi/her ability to engage in exercise or sports. Do

you ever see overweight athletes? No!

Point#12:

An overweight person will have difficulty in participating in many of the sports and activities as

his or her friends. Overweight people have a hard time keeping up with others that have a

healthful weight. People who do not eat healthy food will be much more tired and sick due to

lack of exercise. You also won’t have as much fun playing the sports as your friends. You’d be

out of breath too soon; you won’t be able to run and will need to catch up with your friends. That

isn’t fun! On the other hand, being healthy and having a healthy weight means you are eating the

right foods. And if you are, then you have the energy to play sports with the team or with your

friends.

Curriculum for Nutrition (Control Style)

-Health

-Cosmetics

-Athletics

*****Students will be instructed to sit at their desks, or on the floor. The students will

not be in any group formation.

My name is _______ and this is _________. We are here from the University of Texas at

San Antonio today to talk to you about behaviors and decisions that you will be making

throughout your life. You are making many decisions, and these will stick with you, so if you

make healthy choices you are more than likely to make good decisions throughout your life. We

want you to make the best decisions!

Your teachers/coaches have already spoken to you about eating healthy and good

nutrition. We are here to add to some of the information they have already talked about.

These are all great reasons why you should eat healthy. Now we will go into more detail

about the risks of not eating healthy, including how it affects yourself as well as the people

around you.

Health

The word “diet” does not necessarily mean a plan for losing weight. It also means the

food that a person typically takes in each day. Nutrients in the food determine how healthful

67

your diet is, and the healthier a person eats, the better they feel. The six types of nutrients

include proteins, fats, carbohydrates, vitamins, minerals, and water. All of these nutrients are

important for the body to function properly, but many people do not get the proper nutrients in

the meals they eat. This can lead to many health problems. This is why it is important to choose

the correct balance of nutrients.

Point#1:

In order to achieve goals in life, whether it be an athlete, doctor, or teacher, it is

extremely important to remember to eat healthy.

Following the food pyramid is a great way to decide on what foods to eat. Choosing a

variety of grains, especially whole grains, will make sure the body has the essential fiber to help

prevent colon cancer. Fruits and vegetables are also extremely important foods that are rich in

vitamins and help prevent heart disease and some cancers.

Point#2:

These foods will also help increase your energy.

Point#3:

Choosing a diet that does not contain high amounts of saturated fat, such as meat and

dairy products, will also reduce the risk for heart disease and certain cancers.

Point#4:

Choosing low fattening foods will also help increase energy levels. Salt is also a concern

because consuming high levels of sodium can increase the risk for high blood pressure, heart

disease, kidney disease, and stroke.

Point#5:

Choosing to stay away from foods that are high in salt, fat, and increasing the amount of

fruits and vegetables can dramatically increase health status. You would rather be doing the

activities that you enjoy rather than worrying about your health. Having diseases and cancers

will be extremely limiting.

Point#6:

Remember that you have options when eating. Even when you eat out, you can make

good decisions. Be sure you don’t add the extra fat, sugar, and salt to your portions, and if the

portions are too large, ask to share with a friend, or take the leftover portions home. Also

remember that fried foods are extremely high in fat, and broiled foods contain much less fat.

Point#7:

Every time you eat, you are getting calories from the food, and is the energy that your

body uses. Since breakfast refuels your body after a night of not eating, it is important to eat

more whole grains, fruits, and vegetables. Protein is also good for breakfast, like peanut butter,

yogurt, and low-fat milk and cheese. Healthy snacking throughout the day can keep you

68

energized and include foods like fruits and vegetables such as carrot and celery sticks. Grains,

pasta, low-fat crackers, and popcorn without a lot of salt and butter are also great snacks.

Eating healthy foods such as these will help your body stay healthy and lean. Being

overweight can increase the risks of heart disease, diabetes, and some cancers. In addition, being

overweight limits your activity with your friends.

Point#8:

Eating unhealthy and gaining an unhealthy amount of weight means that you are not

taking care of yourself. You are not giving yourself many options when you decide to eat

unhealthily.

Reading food labels is extremely useful in order to decide which foods to eat. The daily

value is the amount of nutrient that a person needs each day. The food label lists the Percent

Daily Value, the percentage of the recommended daily amount of the nutrient that is found in a

serving of the food. Inspect the food carefully so you don’t eat food that looks, feels, or smells

bad. This will also prevent any foodborne illness from eating contaminated food.

Cosmetic

Point#9:

Eating healthy foods is important so that you maintain a healthful weight- the weight that

is desirable for a person. Healthy weights vary from individual to individual depending upon

body heights and body types. Eating healthy will promote a higher self-esteem. You will have

more energy, and the body works best when it’s at a desirable weight.

Point#10:

You can also prevent many injuries if you eat healthy and maintain a healthy weight.

You will not have to worry about your balance as much, so the risk of falling is much less.

Serious injuries could be avoided, so you will not have to worry about having a permanent

injury, casts, or braces. In order to lose weight a person must increase the number of calories

used by physical activity, and do not lose the weight quickly. Continue to eat the correct amount

of servings from the Food Guide Pyramid, and choose lower-calorie foods, with small serving

sizes.

Being underweight is also not considered healthy. In order for a person to gain weight,

they should follow the Dietary Guidelines and increase the number of serving from the food

groups in the Food Guide Pyramid, as well as eat healthful snacks, but not before meals.

Point#11:

Your skin, eyes, and nails will also be much more attractive. Eating healthy means that

you are giving your body good nutrients that it needs, and can clear up facial blemishes. You

will look and feel much better.

Athletic

Medical doctors and physicians often use body composition, the proportion of fat tissue

to lean tissue in the body, to determine if a person’s weight is healthy. All people have some fat.

A female teen with a healthful body composition may have about 15 percent of body fat, and a

male teen with 10 percents. Obesity is the term for having too much body fat. Other ways of

69

determining if a person’s weight is unhealthy is by using the Body Mass Index. It measures

mass compared to height. Even if you are at a desirable weight, you still need to keep healthful

eating habits.

Point#12:

Having too much body fat from eating unhealthy foods, or by eating too large of portions,

will limit a person’s athletic ability. Do you ever see overweight athletes? No! People who do

not eat healthy food will be much more tired and sick due to the lack of exercise they typically

get.

Curriculum for Nutrition (Individualistic Style)

-Health

-Cosmetics

-Athletics

*****Students will be instructed to sit at their desks, or on the floor. The students will

not be in any group formation.

My name is_______ and this is ________. We are here from the University of Texas at

San Antonio today to talk to you about health-related behaviors and decisions that you will be

making throughout your life. You are making many decisions, and these will stick with you, so if

you make healthy choices you are more than likely to make good decisions throughout your life.

We want you to make the best decisions!

Sometimes you have to make difficult decisions that are best for you.

*****For the poster themes: Ask the students individually why they think it is important

to eat healthy. Record their responses for later poster themes.

These are great reasons why you should eat healthy. Now we will go into more detail

about the risks of not eating healthy, including how it greatly affects you.

HEALTH

The word “diet” does not necessarily mean a plan for losing weight. It also means the

food that a person typically takes in each day. The nutrients in food you eat determine how

healthful your diet is, and the healthier your are the better you feel.

The six types of nutrients include proteins, fats, carbohydrates, vitamins, minerals, and water. All

of these nutrients are important for the body to function properly, but many people do not get the

proper nutrients in the meals they eat. This can lead to many health problems such as diabetes

and heart disease. This is why it is important for you to choose the correct balance of nutrients

like the ones in fruits and vegetables.

Point #1:

In order to achieve your goals in life, whether you choose to be an athlete, doctor, or

teacher, it is extremely important to remember to eat healthy. You will not be able to achieve

your goals if you are unhealthy and constantly concerned with medical treatment because you

are unhealthy.

70

Following the food pyramid is a great way for you to decide on what foods to eat.

Choosing a variety of grains, especially whore grains, will make sure your body has the essential

fiber to prevent illnesses. Fruits and vegetables are also extremely important foods that are rich

in vitamins and help prevent heart disease and some cancers.

Conversation with kids:

What are some of your favorite fruits and vegetables?

Point #2:

These foods will also help increase your energy so you are able to participate in several

activities.

Conversation with kids:

What are some activities/things you like to do?

Point#3: Whatever the activity, you’ll need energy! Energy comes from good and

healthy food!

Choosing a diet that does not contain high amounts of saturated fat, such as meat and

dairy products, will also reduce your risk for heart disease, diabetes, and certain cancers.

Point #4:

Choosing low fattening foods will help increase your energy levels. Salt is also a

concern because consuming high levels of sodium can increase the risk for high blood

pressure, heart disease, kidney disease, stroke, and diabetes. You want to be the best possible

healthy person you can be.

Point #5:

Choosing to stay away from foods that are high in salt, fat, and increase the amount of

fruits and vegetables can dramatically increase your healthy status. You will not have to worry

about seeing the doctor every week, or every month. You will have many more options to enjoy

activities that are important to you, and those things that you like to do.

SHOW AND EXPLAIN THE FAT MANIPULATIVE.

Point#6:

You will also feel great about yourself. You don’t want to be spending your time going

to the doctor because of your weigh, or due to unhealthy eating habits. You would rather be

doing the activities that you enjoy rather than worrying about your health. Having heart

disease, diabetes, and cancers will be extremely limiting, and you won’t be able to become the

person that you want to be in life.

Point#7:

71

Remember that you have options when eating. Even when you eat out, you can make

good decisions. Be sure you don’t add the extra fat, sugar, and salt to you portions, and if the

portions are too large, as to share with a friend, or take the leftover portions home. Also

remember that fried foods are extremely high in fat, and broiled foods contain much less fat.

Even if fried foods taste great, remember not to eat too much of them.

Point#8:

Every time you eat, you are getting calories from the food, and is the energy that your

body uses. Since breakfast refuels your body after a night of not eating, it is important to eat

more whole grains, fruits, and vegetables. Protein is also good for breakfast, like peanut butter,

yogurt, and low-fat milk and cheese. Healthy snaking throughout the day can keep you

energized and include foods like fruits and vegetables such as carrot and celery sticks. Grains,

pasta, low-fat crackers, and popcorn without a lot of salt and butter are also great snacks.

Conversations with kids:

What kind of healthy snacks do you eat?

What are other snacks you can try?

What kinds of snacks do you think are healthy?

Would you enjoy eating these snacks?

Eating healthy foods such as these will help your body stay healthy and lean.

Point#9:

Eating unhealthy and gaining an unhealthy amount of weight means that you are not

taking care of yourself. You are not giving yourself many options when you decide to eat

unhealthily. It is important to give people a good impression of yourself. You will be the person

that comes to their mind first if you leave a positive impression. Remember that you are a

reflection of all the positive things that you are doing for your body.

Reading food labels is extremely useful in order to decide which foods to eat. The daily

value is the amount of nutrient that a person needs each day. The food label lists the Percent

Daily Value, the percentage of the recommended daily amount of the nutrient that is found in a

serving of the food. Inspect the food carefully so you don’t eat food that looks, feels, or smells

bad. This will also prevent any foodborne illness from eating contaminated food.

COSMETIC

Point#9:

Eating healthy foods is important so that you maintain a healthful weight. Healthy

weights vary from individual to individual depending upon body heights and body types. Eating

healthy will promote a higher self-esteem.

CRITICAL POINT:

You will respect yourself much more and also gain respect from other people. You will

be able to be the person who you want to be. You will have more energy, and your body works

best when you are at a desirable weight.

Point#10:

72

You can also prevent many injuries if you eat healthy and maintain a healthy weight.

You will not have to worry about your balance as much, so the risk of falling is much less.

Serious injuries could be avoided, so you will not have to worry about having a permanent

injury, casts, or braces. You will be able to worry less about how you appear if you are not

injured, and you will be able to do the things you like to do most. You can heal faster too. In

order to lose weight a person must increase the number of calories used by physical activity, and

do not lose the weight quickly. Continue to eat the correct amount of servings from the Food

Guide Pyramid, and choose lower-calorie foods, with small serving sizes.

Being underweight is also not considered healthy. In order for a person to gain weight,

they should follow the Dietary Guidelines and increase the number of serving from the food

groups in the Food Guide Pyramid, as well as eat healthful snacks, but not before meals.

Point#11:

Eating healthy and maintaining a good weight for your particular body type will help you

present yourself to your friends in the best possible way. You will have a higher self-esteem,

and you will be proud of your self..

Point#12:

Your skin, eyes, and nails will also be much more attractive. Eating healthy means that

you are giving your body good nutrients that it needs, and can help clear up facial blemishes.

You will look and feel much better and you will be able to present yourself in a positive light.

ATHLETIC

Medical doctors or physicians often use body composition, the proportion of fat tissue to

lean tissue in the body, to determine if a person’s weight is healthy. All people have some fat. A

female teen with a healthful body composition may have about 15 percent of body fat, and a

male teen with 10 percents. Obesity is the term for having too much body fat. Other ways of

determining if a person’s weight is unhealthy is by using the Body Mass Index. It measures

mass compared to height. Even if you are at a desirable weight, you still need to keep healthful

eating habits.

Point#13:

Having too much body fat from eating unhealthy foods, or by eating too large of portions,

will limit a person’s athletic ability, or will hurt his/her ability to engage in exercise or sports.

Do you ever see overweight athletes? No! An overweight person will not be able to be the great

athlete that he or she wants to. You would rather want to stand out in an athletic crowd by

presenting yourself as healthy and a person who takes care of their body by eating healthy. People who do not eat healthy food will be much more tired and sick due to the lack of exercise.

You will be too tired and sick to play to the best of your ability. You’d be out of breath too soon

or you won’t be able to run. All of this is not fun! On the other hand, being healthy and having a

healthy weight means you are eating the right foods. And if you are, then you have the energy to

play sports.

73

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VITA

Sara Garcia is from San Antonio, TX. She studied psychology and earned a Bachelor’s

degree from Boston University and Master’s degree in Psychology from The University of Texas

at San Antonio. Her future plans include earning a Ph.D. in Educational Policy, Organization,

and Leadership from the University of Illinois at Urbana-Champaign.