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ABSTRACT
Many health problems, including the obesity epidemic, are linked to poor
nutrition and sedentary life-styles. Current research suggests that environmental factors
play a key role in identifying behavior trends that lead to poor health outcomes.

Lauren Lett, Dietetic Intern


Overweight
and obesityMBA,
is not limited
adults. ItPreceptor
is now being reported among more
Dave Stebbins,
RD, to
Project
Elissa May, Big Brother Big Sister Match Support Specialist
adolescents, and is more likely to continue into adulthood. Presently, research seeks to

identify behavior trends to target interventions


for specific populations. Great evidence
May 27, 2015
points to the powerful effect of mentors on positive change in the lives of youth.
This study was conducted to understand the effect that adult mentors had on
adolescents enrolled in the Big Brothers Big Sisters Program (BBBS). The adult
participants (Bigs) attended nutrition training prior to the intervention. They implemented
practical applications regarding nutrition and physical activities during the time they
spent with these adolescents (Littles). The test subjects were given pre and post-surveys
before and after the intervention period to test for healthy behavior change
The results concluded that the intervention was overall effective. Subjects had and
overall improvement in their attitude and behavior regarding nutrition and physical
activity. The study showed that health behavior measured in the Littles were significantly
increased (p=0.0162).
Mentorship programs like Big Brother Big Sisters are effective in influencing
positive behavior in adolescents. One way to improve childhood growth and development
is to incorporate nutrition focused trainings for adults involved with programs similar to
BBBS.
LITERATURE REVIEW

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Child Health Issues in United States
Childhood obesity impacts the over health of the child, and sets the stage for
developing a number of health risks. Associated effects include high blood pressure and
high cholesterol, which are two markers for developing cardiovascular disease (CVD).
The Centers for Disease Control and Prevention (CDC) reports that 40% of obese
children have two or more risk factors for CVD, while 70% have at least one risk factor.
Children in this category also have an increased risk for developing insulin resistance and
type 2 diabetes. In the United States, CVD is the leading cause of death for adults,
followed closely by complications associated with type 2 diabetes.1
Overweight or obese children are more likely to become obese adults.1 For this reason,
health behaviors related to proper nutrition and physical activity play a significant role in
preventing overweight and obesity in the short- and long-term. Maintaining physical and
mental health impacts the overall growth and development of children. Studies show that
eating a healthy breakfast improves cognition, memory, and mood in students.1
Consistently having breakfast is just one example of a healthy behavior; however, most
youth do not meet the recommended dietary guidelines for daily intake of fruits,
vegetables, and whole grains. The CDC reports that 40% of the daily calories consumed
by children aged 2-18 years of age come from added sugars and fats.1 Their consumption
of empty calories are derived from sources such as soda, juices, desserts, and pizza.
Additionally, adolescents are more likely to choose full-calorie sodas over healthier
beverages like milk or water. The CDCs data show that males and females ages 12-19
drink over twice as much soda as they drink milk each day.1

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The impact of poor health behaviors in children can be detrimental, but with the proper
resources, such behaviors can be unlearned. Many schools, policies, and youth-oriented
programs are aimed at advocating for and encouraging adolescent health. The childs
environment plays a large role in his or her perception of nutrition and physical activity.
Providing children with the knowledge, guidance, and support to make healthy decisions
can foster a change in habits that prevents health risks down the road. Research shows
that the relationship between children and mentors can provide enough structure to
impact a childs behavior. Effective role models have a tremendous voice in a childs life,
and their actions can speak even louder than their words.
Big Brothers Big Sisters Program
History
The early 20th century brought many changes to American life. Many children
endured poverty, living through many uncertainties throughout their childhoods. As many
young boys continuously filed through the courtroom doors of New York City, Earnest
Coulter, the court clerk, 2 decided it was time to take initiative. Knowing what these
young mens lives could become, he believed they simply needed guidance among the
uncertainties of life through the support of an affirming adult. Coulters response over
100 years ago served as a catalyst for what has become the established program, Big
Brothers Big Sisters (BBBS). Through his efforts, volunteers, and the support of
Theodore Roosevelt, Jr., the program has evolved into what it is today.2 The official
website for the organization states, We help children realize their potential and build
their futures. We nurture children and strengthen communities.2

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Big Brothers Big Sisters is available in every state. It is financially supported through
donors, volunteers, partners and other staff members. The program is oriented towards 618 year olds. Qualifications the for the program may include low-socioeconomic status,
single-parent housing, and the need a caring adult. 2 Most families that enroll live below
the poverty line and are on government assistance. BBBS functions to serve a variety of
cultures and circumstances; their programs are geared toward Hispanic, AfricanAmerican, and Native American children, as well as children whose parents are in the
military or incarcerated. 2
Mentor Standards and Matching
Children enrolled in the program are referred to as Littles. Each Little is paired
with an adult volunteer who then becomes that Littles Big Brother or Big Sister.
Elissa May, Match Support Specialist at Big Brothers Big Sisters of the Central Blue
Ridge, reports that the goal when matching Bigs and Littles is to find a good fit (E.
May, personal communication, November 2014). Background checks and screenings of
adult volunteers are required for safety purposes, and Bigs must provide references and
complete an in-person interview (E. May, personal communication, November 2014).
Staff members of individual BBBS programs make sure to select adults who are genuine,
caring, and committed to the program. May states that a strong match can occur with a
Little if they have similar life experiences, as this helps establish a sense of rapport.
Typically, mentors spend two to four hours, or two days each month with their Littles. In
the Blue Ridge region, Bigs commonly spend one day per week with their Littles. May
reports that Bigs and Littles usually participate in activities outside of the home such as

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going to the park, out to eat, to a sporting event, making crafts, and attending community
events.
Big Brothers Big Sisters of the Central Blue Ridge
BBBS of the Central Blue Ridge is located in Charlottesville, VA. It is a resource
for the city, as well as for Albermarle County, Fluvanna County, and Nelson County. It is
currently comprised of 126 volunteer adults (with an average age of 34) to impact the city
and lives of 123 adolescents between 6-17 years old (E. May, oral conversation,
November 2014).
BBBS and Ongoing Physical Health Initiatives
Some of the BBBS programs have been active in supporting the physical and nutritional
health of Littles. BBBS of Canada developed two initiatives for girls and boys: Go Girls!
is a group mentoring program for 12-14 year old girls where they are provided with tools
to help them implement overall wellness.3 Their sessions touch on balanced eating,
staying physically active, and self-reflective meditation. Game On! incorporates similar
values for boys through physical activities and group discussions.3 The results of these
sessions are not available or have not been assessed.
The PB&J Fund, unique to Charlottesville, VA, is a program that serves as a healthy
eating resource for the adolescent community. It aims to decrease food insecurity and its
associated health risks. Food insecurity, defined as the limited or uncertain availability
of nutritionally adequate and safe foods is strongly correlated with childhood obesity.4
Bigs often bring their Littles to the programs free cooking classes, as this allows Littles
to pursue vital hands-on education through a fun environment (E. May, personal
communication, November 2014).

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The Efficacy of Mentor-Mentee Relationships
The Impact of the Big Brothers Big Sisters Program
A nationwide impact study supports the BBBS programs positive impact on adolescents
and the community. This study serves to answer if one-to-one mentoring experiences
make a notable difference in the lives of youth. The study evaluates programs that are
both a large caseload and supported geographic diversity. The sample population includes
boys and girls, ages 10-16, who are enrolled in BBBS.5 To measure the effectiveness of
Bigs, the study calculates 18 months after a child is enrolled in the program.5 The
timeframe suggests that this is an adequate amount of time to match for a Big and Little
to develop a relationship.5
The following table lists the six categories and corresponding values that are measured
for effectiveness5:

Table 1. Categories and Values Measured for Results in An


Impact Study of Big Brother Big Sister
Categories
Antisocial Behaviors
Academic Attitude,
Behaviors and Attitudes

Family Relationship

Peer Relationships

Self-Concept
Social and Cultural Enrichment

Values Measured
Initiation of drug use
Initiation of alcohol use
GPA
Attendance
Relationship with Mother scale of
the Inventory of Parent and Peer
Attachment:
trust, communication, anger,
alienation
Intimacy in Communication,
Instrumental Support, Emotional
Support, Conflict, Relationship
Inequality
Self worth
Social acceptance
Self-confidence
Organized sports/recreation

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programs
Volunteer/community service,
Music/art/language/dance lessons
School clubs
Youth groups
Attending sporting events
Attending plays/performances,
Going to museums
Outdoor activities

From this study, they find that Littles are 46% less likely to initiate drug use, and
27% less likely to initiate alcohol use. Additionally, 33% of Littles are less likely to act
out in violence.5 These results also show an increase in Littles school attendance and
academic performance, as well improvements in parent- and peer-relationships.
Bigs serve as positive role models for their Littles; they function as a support system
during fundamental years of growth and development.2,5 These relationships are meant to
be intensive and long lasting, so as to meaningfully and positively influence healthy
behaviors. Children naturally observe the actions of their mentors. An adult who steps
into a childs life brings him or her a sense of assurance and belonging. BBBS warrants
success due to the strong standard they set for the matches.5
Many Bigs are involved in the Littles academic pursuits, whether this is a part of a
school-based mentoring program or occurs outside of school for extra support. Child
Development, Society for Research in Child Development, Inc. published a research study
on the impact of BBBS school-based mentoring (SBM).6 SBM mentors construct their
relationship with students by engaging with them for approximately one hour per week.
The goal of this program is to reach children who are facing learning difficulties or
struggling with feelings of inadequacy, as these factors are negatively correlated with
academic motivation. The programs intervention includes a treatment group that

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receives SBM, and a group that does not. Researchers follow the two groups for one and
a half years, measuring school-related performance and attitudes, problem behaviors,
social interactions, and personal well-being. However, in following up with these
students, grades declined the following school year when they are no longer engaged with
the SBS. This suggests that relational consistency and duration are imperative factors for
effective mentorship programs.
The Characteristics of Mentor-Mentee Relationships
Mentors offer secure relationships and support to children through shared experiences.
Youth engaged with these adults are more likely to be independent, socially competent,
and disciplined.6 Two researchers, Keller and Price, developed a model for understanding
mentor-mentee relationships. They describe it as a cross between a parent and friend. A
parental relationship is defined as committed, but unequal and a friend as voluntary,
equal relationship.7 A successful mentor balances the relationship by creating structure
as a parent figure and sharing interests as a friend.
The Sponsorship for Adolescents with Diabetes project provides a mentor for each child
with the goal of helping them manage their disease through education and support.7 This
programs findings expose three crucial components in mentor-mentee relationships:
relational patterns, the observed mentor behavior, and emotional encounters.7
After three years, the results conclude that as relationships between mentors and mentees
deepen, children improved managing their diabetes.7 The authors report, the
relationships that actually develop between mentee and mentor apparently meet the
needs, characteristics, and abilities of both parties in the most sensitive and correct

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manner at every point in time.7 Mentees identify their mentors as subjects of hope,
providing empowerment in their management of diabetes.
Three types of learning are also shown to emerge from the mentor-mentee
relationship. The first, which is also considered the most important, is related to how the
mentee perceives the mentors behaviors and actions. Observing the mentor properly
manage his or her diabetes strongly impacts those attitudes and values in the child.7 The
second type of learning comes from the mentor directly educating the mentee about the
management of diabetes. The third is considered negative learning; children are less
likely to practice proper diabetes care if they perceive a lack of responsibility in the
mentors behavior.7 The researcher records a childs report about his inner struggle for his
diabetes management. This child has difficulty recognizing the importance of regularly
checking his blood sugar. However, after he personally witnesses his mentor checking
glucose levels before meals, the mentee starts to follow in his footsteps.
Research suggests that role models buffer against the many stresses of low SES life. Low
socioeconomic status (SES) has been linked to many health risks, two of which include
obesity and cardiovascular disease.1 Chen et al studies the impact of role models on the
clinical risks for CVD in 13-16 year olds.8 The researchers measure cholesterol levels and
the inflammatory markers interleukin-6 (ILK-6) and C-reactive protein. The results
convey that adolescents with role model-type influences have lower inflammatory
response markers related to stress.8
Environmental Influences on Health Behavior Among Adolescents
Parent and Children Eating Behaviors

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A number of environmental factors and behaviors can be involved in children who are
overweight or obese. Methods of obesity prevention are additionally successful when
they consider such variables. The Identification and Prevention of Dietary - and
Lifestyle - Induced Health Effects in Children and Infants (IDEFICS) is an ongoing
international project funded by the European Commission.9 Its goal is to identify
nutritional and physical behavior trends in adolescence that link to overweight and
obesity later on. The IDEFICS conduct an international focus group for children and
parents to evaluate dietary determinants. Findings are consistent across countries: the
majority of adolescents make dietary choices based off of a foods taste, whether or not
they are knowledgeable about that foods nutrition profile.
A lack of time, finances, school policies, and availability of foods and socialenvironments (peers, parent or guardian) are also identified as the top influences for
childrens dietary behavior. In addition, low SES families are less informed of school
policies regarding healthy nutrition, have higher access to unhealthy foods, and are less
likely to buy nutritious school lunches. The trends that these results identify show that
successful interventions must be designed to meet the personal and economic needs of
each population.
Recent Surveys in Adolescent Nutrition
As the previous study infers, the impact of dietary interventions is dependent on the
availability of foods in the environment. One such intervention seeks to improve fruit and
vegetable intake among adolescents. In the study, the researchers describe
changeability as identifying those fruits and vegetables that have the greatest
likelihood for increased consumption.10 These specific fruits and vegetables are then

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targeted for the intervention. To determine which fruits and vegetables have the greatest
changeability, researchers evaluate the USDAs Continuing Survey of Food Intakes by
Individuals (CSFII) for a national level of fruit and vegetable consumption in a specific
age, gender, and geographical location that mirror the studys population.10 The
intervention consists of Partners of all Ages Reading About Diet and Exercise
(PARADE), which is a school-based tutoring program that provides an ongoing eightweek curriculum. The researchers conclude an increase in fruit consumption, while
vegetable intake remains largely unchanged (p <.001).10
Another study using The National Diet and Nutrition Survey looks at common
dietary trends in youth that include consumption of sugar, saturated fat, salt, sugarsweetened beverages, processed foods, fruits, vegetables, and skipping breakfast.11 The
interventions include educational sessions, the distribution of newsletters, and supplying
boxes of food and lunch bags. Health policies are put into practice at schools that provide
free fruit and vegetables, and opt for healthy options in vending machines. Data shows
that school interventions using the HEALTHY material have a 10% higher intake of fruits
compared with the control schools.11 Results across other interventions are significant but
small. Overall, these dietary inventions are limited in producing long-lasting outcomes.11
It is important to identify childrens perceptions of nutrition and health, and how
that yields their decision-making. Adolescence is a critical period for the adoption of
health behavior because it establishes activity and diet-related lifestyle habits and
attitudes that may be tracked into adulthood.12 A study in the Journal of Adolescent
Health targets physical activity and eating behaviors in adolescents. Both behaviors are
linked to adolescents self-perception and interests. Using the expectancy-value model

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(EV), motivation is the main determinant behind behavior. EV separates motivation into
four values: interest (enjoyment), attainment (value in succeeding), utility (usefulness of
behavior), relative costs (negative aspects).12 The purpose of the study is to find
correlations between self-competencies and values in the two health behaviors. Methods
include BMI calculations, scales for assessing competence in physical activity, and
surveys on dietary intake. The study confirms the relationship between EVs motivation
template with physical activity and eating behavior. Data show that factor findings are
high (>.60), significant, and show low standard errors (<.05).12
It is important to consider the positive effects of physical activity coupled with a
healthy diet. A systematic review looks at nine biomedical and social science databases
on interventions that reduce health risk behaviors. Fourty-four randomized control trials
show successful results, comparing the gathered outcomes as weak, moderate, or
strong.13 There is a direct correlation to reduced risk behaviors when the studies target
two or more focuses.13
The International Journal of Behavioral Nutrition and Physical Activity published
research on associated multiple health behaviors and family influence.14 Parents
participated in separate modeling behaviors to measure its affect on physical activity and
fruit and vegetable consumption in boys and girls. Those who reported high physical
activity modeling had a positive association with intake of fruits and vegetables in boys
and girls (p<0.001).14 Parents who provided money for snacks were more likely to have
boys with low fruit and vegetable intake, but increased physical activity.14 This study
infers that modeling a combination of health behaviors to children will result in a positive
impact in multiple aspects of wellness.

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PURPOSE
Physical activity and proper nutrition are fundamental aspects of childrens
growth and development. Research suggests that one of the most powerful learning tools
through observation of behavior in significant others. Therefore, a key method of
adopting positive health behaviors is through the role of mentor-mentee relationships.
These relationships can be a powerful influence on improving physical health. The
purpose of this project is to measure adolescents perceptions and attitudes toward
nutrition and physical activity throughout their involvement in the Big Brother Big
Sisters program.
PROJECT METHOD
The population study targeted the adult volunteers (Bigs) and enrolled adolescents
(Littles) in the Big Brothers Big Sisters of the Central Blue Ridge program in
Charlottesville, VA. The intervention period started on February 9, 2015 and ended on
April 11, 2015. Bigs were required to attend a nutrition education before the intervention.
Further requirements included the completion of pre- and post-surveys administered to
their Littles (see Appendix A for the complete survey). Bigs provided documentation of
their activities with Littles through email. By the end of the project, eight Littles had
completed both the pre- and post-survey. Of the 18 Bigs who participated, these eight
Littles were the only subjects accounted for in the study. Littles were also referred to as
subjects within the study. Bigs were also mentioned as participants.
A dietetic intern from UVA Health System provided the nutrition education to
participants. This was modified from the original curriculum of the UVA Childrens
Fitness Clinic, Growing Up Healthy, originally developed for medical students. It was

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presented at a group session on February 4, 2015. The education focused on the My Plate
teaching method. It also included time for discussion, the timeline of the project, free
health events in Charlottesville, and handouts from the UVA Childrens Fitness Clinic.
Participants received a follow-up email containing the education, handouts, and summary
of the project. Prior to the intervention period, Bigs were instructed to administer the presurvey to Littles. The validated survey used was a modified version of the NIHs Catch
Kids Club questionnaire to assess Littles behavior and attitude.
The dietetic intern served as a coach for participants through the intervention via
email. Weekly emails provided tips, guidance, and discussion on modeling health
behaviors. Bigs were encouraged to meet with their Littles at least four times during the
study, and email a record of their interventions pertaining to nutrition and physical
activity. By the sixth week of the intervention, Bigs were further instructed to administer
the post-survey for completion by the end of the study.
RESULTS
The sample population included two males and six females. Six identified
themselves as Black or African American, one as White or Caucasian, and one indentified
with both Caucasian and Black categories. Subjects age ranged from 7-12 years old,
were enrolled in second through sixth grade. A total of eight Littles completed the preand post-survey after the intervention. The pre- and post-data for each of the eight Littles
was analyzed and reviewed.
During the intervention, Bigs documented their discussion and behavior modeling
strategies that focused on physical activity and nutrition. Particular activities were
grouped into the following categories: healthy snacking, fast food and restaurant choices,

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cooking activities, community event attendance, sports and physical activity, and
choosing water as a beverage.
Conversational topics were grouped into the following categories: food groups,
fruits and vegetables, whole grains, healthy options at restaurants, maintaining physical
activity, choosing water for thirst, and limiting fried foods.
Pre and Post-Survey Analysis
Although subjects (Littles) completed all questions in their pre- and post-surveys,
specific questions were analyzed for meaningful changes in their answers. Questions that
were excluded from analysis did not provide meaningful insight for the purpose of this
study. The studied outcomes were grouped into categories of interest for the present
study: Nutrition-related behavior, self-perception, healthy versus unhealthy choices, fruits
and vegetables, and physical activity. These categories looked at topics most discussed or
modeled per reports of the Bigs, and were considered to be important trends identifiable
in adolescent health.
Nutrition-Related Behavior
Located in Appendix C, is a question set that determined a healthy-behavior score
for each Little. These questions asked the subject which food or drink item they would
choose. Each question had two options. The researcher established one option as
healthy and the other option as unhealthy. The healthy option was scored as 1 point.
The highest achievable score was a total of 7 points. Using a paired t-test, the mean
behavior score for the pre-survey was 3.50 points. After the intervention, the mean
behavior score for the post survey was 5.80 points. Healthy-behavior scores improved
after the intervention, and were statistically significant, p-value = 0.0162.

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A different question set was established to measure subjects knowledge by asking
them to identify which of the two items listed was healthier. One item was ranked as
healthy and valued at 1 point. The highest score possible was 8 points. All of
knowledge-based scores on the pre-test were high; Littles scored either 7 or 8 points.
Subjects could not improve their score after the intervention. Therefore, the post-survey
results were not measured. The healthy-knowledge scores did not correlate with the
healthy-behavior score in the pre-survey data.
Self-Perception
Question 20, listed below, was evaluated to assess for participants self-perception
on eating habits.
Question 20. The foods that I eat and drink now are healthy.
Possible answers:
a. Yes, all of the time
b. Yes, sometimes
c. No
The results show that five subjects answered they sometimes ate healthy prior to
the intervention, and their perception did not change afterwards. Two subjects, who
previously identified their diet as not healthy, reported eating healthier in the post-survey
results. (See Appendix B for the grid analysis of data for question 20.)
Table 2 in Appendix D, compares individual healthy-behavior scores with each
Littles self-perception of his/her diet. Overall, individual healthy-behavior scores
improved significantly, but did not correlate with the post-survey results for selfperception.
Healthy Vs. Unhealthy Choices

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The questions below assessed for the subjects attitude toward making healthy
food choices.
Question 36. How likely are you to eat fresh fruit instead of a candy bar?
Possible answers:
a. Not likely
b. Likely
c. Very likely
Question 38. How likely are you to eat a baked potato instead of French fries?
Possible answers:
a. Not likely
b. Likely
c. Very likely
Question 39. How likely are you to drink fruit juice instead of a soft drink (a
soda pop)?
Possible answers:
a. Not likely
b. Likely
c. Very likely
The post-survey results show that one subject had a greater likelihood of choosing
the healthy option of fruit for a snack in question 16. Overall, majority of subjects
answered likely or very likely to choose fruit over a candy bar for a snack.
The healthy option in question 38 was the baked potato, and the less healthy
option was the French fries. The results show that one subject had a greater likelihood of
choosing a baked potato after intervention. Three subjects remained in the likely
category, and one subject remained in the not likely category. However, two subjects
answered they were less likely to choose a potato over French fries.
For question 39, after the intervention, a total of six subjects were likely or
very likely to choose juice, the healthy option. Three out of these six subjects had a
greater likelihood of making the healthy decision. (See Appendix B for the grid analysis
of data for questions 36, 38, and 39.)

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Fruits and Vegetables
To test for nutrition-based knowledge, question 19, listed below, asked for the
USDAs recommendation of 5-9 daily servings of fruits and vegetables.
Question 19. How many total servings of fruits and vegetables should you eat
each day?
Possible answers:
a. At least 2
b. At least 5
c. At least 9
d. At least 10
e. I dont know
Before the intervention, six subjects answered, I dont know, or answered
incorrectly. At the end of the study, seven subjects correctly answered, at least 5 or at
least 9 servings a day. Figure 1 displays the increased number of participants that
answered correctly in the post-survey results. (See Appendix B for the grid analysis of
data for question 19.)

Figure 1. Subject's Knowledge of Recommended Daily Servings of Fruits and Vegetables Before and After Intervention
6.0
5.0
4.0
Frequency of Response 3.0
2.0
1.0
0.0

2 servings 5 servings 9 servings 10 servings

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In the pre- and post-survey, subjects were asked the questions below to assess for
their daily fruit and vegetable consumption.
Question 6. Yesterday, did you eat any vegetables? Vegetables are salads; boiled,
baked and mashed potatoes; and all cooked and uncooked vegetables. Do not count
French fries or Chips.
Possible answers:
a. No, I didnt eat any vegetables.
b. Yes, I ate vegetables 1 time yesterday.
c. Yes, I ate vegetables 2 times yesterday.
d. Yes, I ate vegetables 3 or more times yesterday.
Question 8. Yesterday, did you eat fruit? Do not count fruit juice.
Possible answers:
a. No, I didnt eat any fruit yesterday.
b. Yes, I ate fruit 1 time yesterday.
c. Yes, I ate fruit 2 times yesterday.
d. Yes, I ate fruit 3 or more times yesterday.
As identified by the answers to the pre-survey, all subjects would benefit from
increased fruit and vegetable consumption to meet recommended intakes. After the
intervention, four subjects increased their vegetable consumption by one additional
serving a day. Two subjects increased their fruit intake by one serving, and one subject
ate an additional intake of two or more servings of fruit. (See Appendix B for the grid
analysis of data for questions 6 and 8.)
Physical Activity
The following questions assessed for physical activity behavior in Littles.
Question 52. How likely are you to be physically active 3-5 times a week?
Possible answers:
a. Not likely
b. Likely
c. Very likely
Question 53. How likely are you to play an organized or recreational sport 3-5
times a week?
Possible answers:
a. Not likely

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b. Likely
c. Very likely
All subjects were likely to participate in physical activity in either pre or postsurvey. Not likely was never selected. Before the intervention, three subjects answered
the ideal category of very likely. After the intervention, a total of six subjects answered
in this same category. Figure 2 displays that 75% of Littles were most likely to be active
after the intervention.

Figure 2. Comparison of Subjects Likelihood to be Physically Active 3-5


Times a Week Before and After Intervention

Pre-survey Results

Very likely 38%


Likely 63%

Post-survey Results

Likely 25%

Very likely 75%

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The results of Question 52 were also compared with the results of Question 53 in
Table 3 of Appendix D. Subjects who were more likely to be active were assessed for
their likelihood to play a sport. The data was analyzed for each individual subject.
The data showed that only Subject #5 was more likely to play a sport after the
intervention, and Subject #1 increased the likelihood of being active, despite not playing
a sport. (See Appendix B for the grid analysis of data for questions 52 and 53.)
Screen time, defined as TV and computers (including Ipads), video games
(including smart phone apps), and Internet (including smart phones), was assessed using
questions 13 and 16, listed below.
Question 13. During the week, how many TV shows or videos do you usually
watch each day?
Possible answers:
a. I dont watch TV or videos
b. 1
c. 2
d. 3 or more
Question 16. During the week, how many hours per day do you usually play
video games like Nintendo, Sega, games at the arcade, or use the computer to
surf the Internet?
Possible answers:
a. I dont play video games or use the computer
b. Less than 1 hour a day
c. 1-2 hours a day
d. 3-4 hours a day
e. More than 4 hours a day
The pre-survey results show that all but 1 subject could improve in this category
by reducing the amount screen time. It was hypothesized that with the increase in
physical activity among subjects, over all screen time would be reduced. The post-survey

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results did not report any significant improvement. Most subjects remained the same, or
answered that screen time increased. (See Appendix B for the grid analysis of data for
question 52 and 53.)
DISCUSSION
The Bigs that participated in the study were highly motivated to initiate behavior
modeling of healthy nutrition and physical activity with Littles, as evidenced by personal
communication with the dietetic intern. Bigs engaged them in numerous recreational
sports and activities. They also incorporated discussions about quality nutrition during
activities that involved food such as cooking, going to the grocery store, and eating out.
Though the sample was small, the results of these interventions showed a positive impact
on the physical health of Littles.
Littles had a significant increase in making healthy choices by the measure of
their post-survey healthy-behavior score (p=0.0162). They were more likely to be
consuming fruits and vegetables by the end of the intervention. They were also more
likely to choose healthy alternatives over common junk food items such as French fries,
soda, and candy bars. The results also showed an increase in weekly physical activity.
This was possibly correlated to the amount of times Bigs spent engaging in physical
activities with Littles. Documentation of activity per reports of the Bigs included the
following: skateboarding, walking, playing soccer or basketball, and jumping at the local
indoor trampoline.
Behavior change was not linked to increased knowledge about healthy foods.
Littles demonstrated their understanding of healthy foods early in the intervention. Presurvey knowledge-based scores were high. The subjects could already identify whole

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grains, fish, foods low in saturated fat, grilled or baked items, and fresh vegetables as the
healthier alternative. However, their behavior trends were less than ideal.
Following the intervention, Littles significantly improved their attitude toward
health and nutrition from the impact of their Bigs action. Bigs practically applied their
nutrition knowledge in shared environments with Littles. Therefore, it was inferred that
Littles adapted the behaviors that were modeled to them during the time they spent with
Bigs. Subjects perceived the actions of their role models, and effectively engaged with
them in conversation and activity through a trusting and supporting relationship.
Environmental Barriers
Subjects in this study were enrolled in a mentorship program based off of socioeconomic need. This provided insight into a few barriers toward healthy change. One Big
reported that her Little lived in a neighborhood that did not provide a safe environment
for playing outdoors. Documented reports from Bigs indicated barriers to improving
nutrition were related to poor dietary patterns set by family or home structure. The
availability of healthy foods may have been limited to Littles. It was likely that a Littles
family was on government assistance. 83% of Littles in Charlottesville were enrolled in a
school lunch program for free or reduced lunch. Therefore, it was likely subjects in this
study were apart of the school lunch program, providing an opportunity for a healthy
meal option during weekdays.
Limitations
A few limitations to the study were related to participant and subject compliance.
The population sample was exclusive to the BBBS program only. Initially, 18 Bigs
volunteered for the study. Of the 18, two participants dropped out during the intervention

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period. Records on behavior interventions were communicated from 10 Bigs. Of the presurveys received, eight completed the post-surveys, limiting the sample size and data
received. Pre-surveys were given to the Littles at various times during the intervention
period, and could not truly assess the Littles behavior prior to the start of the
intervention. There were also inconsistencies for how often Bigs spent time with Littles,
and a true measure of frequency during the intervention period could not be obtained.
Some surveys had questions left unanswered. Subjects were in the age range of 7-12
years old, causing a discrepancy in developmental stages and education. Wording of
questions had potential to be misinterpreted due to variance of reading levels.
SUMMARY
Bigs play an important role in the lives of their Littles by fostering structure,
support, and friendship. When Bigs emphasized the importance of making healthy
decisions through role-modeling and discussions, Littles were more likely to adopt these
behaviors by the end of the intervention.
From this small study, the results yield positive benefits of how role-modeling
influences change. Implementing a nutrition education in BBBS and similar programs
enables mentors to provide support for the physical health status of adolescents.
Continued research of larger population samples is needed to make further conclusions
about the effectiveness of role-modeling, and shaping adolescent attitudes toward
nutrition and exercise.

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REFERENCES
1. Overweight and Obesity. Center for Disease Control and Prevention. November 2014.
www.cdc.gov/data/statistics. Accessed November 20, 2014
2.Starting something since 1904. Big Brothers Big Sisters of America. 2014. Accessed
November 20, 2014. http://www.bbbs.org/site/c.9iILI3NGKhK6F/b.5960955/k.E56C/
3. Mentoring Programs. Big Brothers Big Sisters of Canada. 2011. Accessed November
20, 2014. http://www.bigbrothersbigsisters.ca/en/home/mentoringprograms/
4.The Facts. PB&J Fund. 2012. http://pbandjfund.org/facts. Date Accessed November 21,
2014
5. Grossman JB, Resh NL, Tierney JP. Making a Difference: An Impact Study of Big
Brothers Big Sisters. Public/Private Ventures. 2000.
http://www.bbbs.org/site/c.9iILI3NGKhK6F/b.5961035/k.A153/Big_impact8212proven_
results.htm. Accessed October 20 2014
6. Grossman JB, Herrera C, Kauh TJ, McMaken J. Mentoring in schools: an impact study
of big brothers big sisters school-based mentoring. Child Development. 2011;82(1):346361.
7. Barnetz Z, Feignin R. We didnt have to talk: Adolescent perception of mentormentee relationships in an evaluation study of a mentoring program for adolescents with
juvenile diabetes. Child Adolescence Social Work. 2012;29(6):463-483.
http://connection.ebscohost.com/c/articles/83587510. Accessed October 27, 2014.
8. Cavey L, Chen E, Ho A, Lee WK. Role models and the psychological characteristics
that buffer low-socioeconomic-status youth from cardiovascular risk. Child
Development. 2013;84(4):1241-1252.
9. Haerens L, et El. Developing the IDEFICS community-based intervention program to
enhance eating behaviors in 2- to 8-year old children: findings from focus groups with
children and parents. Oxford Journals. 2008;24(3)381-393.
http://her.oxfordjournals.org/content/24/3/381.full Accessed October 21, 2014.
10. Brownson RC, Elliot M, Hair-Joshu D, Hessler K, Nanney MS. Evaluating
changeability to improve fruit and vegetable intake among school aged children.
Nutrition Journal. 2005;4. http://www.nutritionj.com/content/4/1/34. Accessed October
27, 2014.
11. Derbyshire RC. Strategies to encourage healthy eating among children and young
adults. Primary Health Care. 2014;24(5)33-41.

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12. Crocker PRE, Sabiston CM. Examaining an integrative model of physical activity and
healthy eating self-perceptions and behaviors among adolsceents. Journal of Adolescent
Health. 2008;42:64-72.
13. Fitzgerald N, Hale DR, Viner RM. A systematic review of effective interventions for
reducing multiple health risk behaviors in adolescence. American Journal of Public
Health. 2014;104(5):19-41.
14. Biddle SJH, Crawford D, Pearson N, Salmon J, Timperio A. Family influences on
childrens physical activity and fruit and vegetable consumption. International Journal of
Behavioral Nutrition and Physical Activity. 2009;6.
http://www.ljlbnpa.org/content/6/1/34. Accessed October 20, 2014.

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APPENDIX A Pre and Post-Survey for Littles

itle

u rv

.d
y

APPENDIX B Pre and Post-Survey Grids


The grids below were used to evaluate change in subjects answers for particular questions of the pre- and
post-survey. The pre-survey results are listed in rows. The post-survey results are listed in columns. The
shaded regions, where pre-survey row and post-survey column answers are the same, identify the subjects
who did not change. Any number above or below the shaded region identifies change. The multiple-choice
option (A B C D E) for each question represents an ordered level of desirable answers, either least to
greatest, or greatest to least. The lightest shade of blue indicates the least desirable answer and the darkest
shade of blue indicates the most desirable answer for the question. The numbers in the grid identify the
frequency of participants for possible pre- and post- survey results.
Example: For question 6, the grid displays the frequency of participants who selected the least
ideal to the most ideal answer, A to D. The pre-survey results, row A, and the post-survey results, column
A, display that 1 subject selected answer A before and after the intervention. This indicates that no change
occurred. Three subjects who chose answer B in the pre-survey (row B), selected answer C in the postsurvey (column C). For this specific question, the results show that these
Question 13
Post-survey
3 subjects had a desirable change after the intervention.

A
A 1
Pre-survey
B6
Question
C
Pre-survey
D
A
B
C
D

Question 8
Pre-survey

C D

Post-survey
1A B 1 C D
1 1 4
1 1
3
1 1

Post-survey
A B C D
A 1 1
B
1
1
C
1
2 1
D

Key
Pre-survey answers = grid rows
Pre-survey answers = grid columns
Frequency of answer = #
Most ideal answer = aaa
Least ideal answer = aaa
No change in answer = aaa

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Question 16

Post-survey
A
B C D
A 1
B 1
2 1
C
1 1
D
E

Pre-survey

Question 20

Post-survey
A B C
A 1
B
5
C
2

Pre-survey

Question 36

Post-survey
A B C

Pre-survey

Question 38
Pre-survey

Question 39
Pre-survey

Question 52
Pre-survey

A
B
C

4
1

1
1

Post-survey
A B C
A 1 1
B
3
C 1 2
Post-survey
A B C
A 1 2
B
2
1
C 1
1

Post-survey
A B C
A
B
2
3
C
3

Question 53
Pre-survey

Post-Survey
A B C
A 3 1
B
1

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C

APPENDIX C Behavior Score Question Set


26. If you were at the movies, which one would you pick as a snack?
a. Popcorn with butter
b. Popcorn without butter
27. Which would you pick to drink?
a. Regular milk
b. Low fat or skim milk
28. Which would you eat for a snack?
a. Candy bar
b. Fresh fruit
29. Which type of chicken would choose?
a. Fried
b. Grilled
30. Which would you choose to cook if you were going to help make dinner at home?
a. French fries
b. Baked potato
32. Which would you do if you were going to eat cooked vegetables?
a. Eat without butter b. Add butter
33. Which would you order if you were going to eat at a fast food restaurant?
a. A regular hamburger
b. A grilled chicken sandwich

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APPENDIX D Subject Data Tables

Table 2. Comparison of Individual Subjects Self-Perception on Diet with


Healthy-Behavior Scores Before and After Intervention

Subject
#
1
2
3
4
5
6
7
8

The Foods You Eat


are Healthy
Pre-survey

HealthyBehavior Score
(pre value)

5
4
1
5
4
0
6
3

Sometimes
Sometimes
No
Sometimes
No
Sometimes
Always
Sometimes

The Foods You Eat


are Healthy
Post-survey

HelathyBehavior Score
(post value)

7
5
6
6
7
6
6
3

Sometimes
Sometimes
Sometimes
Sometimes
Sometimes
Sometimes
Always
Sometimes

Table 3. Comparison of Subjects Likelihood to be Active


with Likelihood of Playing Before and After Intervention
Subjec
t#
1
2
3
4
5
6
7
8

Activity
Pre-Survey

Sport
Pre-Survey

Activity
Post-Survey

Sport
Post-Survey

Likely
Likely
Likely
Very Likely
Very Likely
Likely
Very Likely
Likely

Not Likely
Very Likely
Likely
Very Likely
Not Likely
Very Likely
Not Likely
Not Likely

Very Likely
Very Likely
Very Likely
Very Likely
Very Likely
Likely
Very Likely
Likely

Not Likely
Likely
Very Likely
Very Likely
Likely
Very Likely
Not Likely
Not Likely

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1
1
1
1
1
2
2
2
2
2
4
5
5
5
5
6
7
7
7
7
7
7
1
8
8
9
10
10
10
11
11
11
12
12
12

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