Social movement involvement and healthy diet and activity behaviors among US adults

Social movement involvement and healthy diet and activity behaviors among US adults Summary Unhealthy lifestyle behaviors, namely poor diet and inadequate physical activity, significantly contribute to poor health and obesity risk, which in turn impact chronic illness outcomes. A possible approach to improving these health behaviors and subsequent outcomes is to capitalize on the theorized link between social movement involvement and overlapping health behaviors. Social movement involvement may be a viable stealth intervention for health, utilizing intrinsic motivators to improve health without an explicit focus on changing health behavior. Thus, the current study explored the links between social movement involvement and diet and physical activity. Two samples from a college population (N = 196) and the general population (N = 195) participated in an online survey, which included measures of social movement involvement, social movement-related health behaviors and dietary intake and physical activity. After controlling for known covariates, social movement-related health behaviors mediated the relationship between level of social movement involvement and fruit and vegetable consumption, whole grain intake and average daily physical activity in both samples. These findings suggest that health behaviors associated with social movement involvement may be an important mechanism in promoting health among social movement members and that the model holds across adult populations. This research adds to existing literature on stealth interventions as a viable means of improving important behavioral health components linked with obesity and chronic disease and supports social movement involvement as a potential form of stealth intervention. health behavior, social action, diet, physical activity, community health promotion INTRODUCTION Unhealthy lifestyle is one of the largest contributors to disease. Cardiovascular disease, the leading cause of death in the US, is strongly linked to poor diet, inadequate physical activity and obesity (Centers for Disease Control and Prevention, 2015). Overweight and obesity are due in large part to the global increase in high fat, energy-dense food consumption and a decrease in physical activity (World Health Organization, 2017). Elevated BMI and accompanying metabolic markers (e.g. high abdominal adiposity, high blood pressure) are leading risk factors for many preventable causes of death: cardiovascular disease, diabetes, stroke and even some cancers (National Heart, Lung and Blood Institute, n.d.; World Health Organization, 2017). Thus, improving these healthy lifestyle behaviors is essential. Challenges of current interventions Although many weight interventions exist, such programs have generally failed to produce significant long-term health improvements. Current behavioral weight loss interventions encourage at-risk individuals to change their lifestyle, including techniques such as self-monitoring (e.g. food diaries), nutrition education, increasing physical activity (Foster et al., 2005). While many interventions produce positive short-term outcomes, few have been able to sustain long-term weight loss and changes in health behaviors (e.g. Hartmann-Boyce et al., 2015). Even highly interactive and individually tailored interventions that achieved significant weight loss post-treatment and 6 months afterward showed no improvements at 12 months. In addition, this review found that interventions tended to be more effective for individuals with higher SES and education. Thus, current interventions are not typically successful at improving long-term weight outcomes for participants, particularly disadvantaged individuals. A significant challenge with interventions that emphasize individual behavior change is that they fail to consider situational constraints that interfere with a person’s ability to maintain the behaviors recommended. For example, deterrents to obtaining adequate physical activity include time constraints, poor state of health and already overweight status (Korkiakangas et al., 2011). Healthy eating behavior is hindered by established taste preferences, money constraints and lack of convenience and availability (Alaimo et al., 2008; Lucan et al., 2010) as well as political barriers (e.g. government subsidizing of fat and sugar production; Swinburn, 2008). Another challenge is that attempts to improve health assume that humans act rationally in their own best interest, conduct cost-benefit analyses for each behavioral choice they make and focus on future benefits while ignoring short-term rewards (Robinson, 2010). In reality, human behavior is far from rational and is influenced by our environment and cognitive biases (Kahneman and Lovallo, 1993; Wansink, 2006). Stealth interventions Due to the limited success of existing behavioral health interventions, some researchers have turned their attention to the potential of stealth interventions as a way to overcome current constraints. Stealth interventions are a way to ‘tap into the deeper needs and desires of the participants—what we refer to as intrinsic motivators—while improving their health as a side effect,’ (Ipaktchian, 2010). For example, a study exploring goals for exercise showed that women exercised less when their goals were weight-loss related than when their goals were intrinsic, such as improved well-being and stress-reduction (Segar et al., 2008). Stealth interventions do not aim to conceal the connection between health and a given motivator, they aim to utilize these motivators to encourage health behavior without an explicit goal to act for the sake of health. Because they often target values (e.g. social justice, meaningful activities, social belonging, etc.), motivation to partake in health behaviors is more likely to be maintained despite barriers and irrational thinking. Findings suggest that the number of lifestyle recommendations made within an intervention is negatively associated with how likely a person is to adopt health behaviors (Wilson et al., 2015), indicating that less explicit interventional push may in fact be more useful. Although research in this field is sparse, several studies have investigated stealth interventions as a means of improving health behaviors associated with obesity and chronic disease. Robinson found that these behaviors can be improved via stealth interventions such as raising students’ awareness of the negative aspects of media usage (Robinson and Borzekowski, 2006); increasing participation in an after-school dance program to reduce television viewing (Robinson et al., 2010); an after-school soccer team to reduce BMI (Weintraub et al., 2008) and conducting a food-related college course focusing on the environmental and social impacts of food versus health issues to produce more healthful diets (Hekler et al., 2010). The latter study in particular aimed to harness highly motivating values: those related to one’s awareness of social issues. This topic has yet to be explored with other types of social movements and how one’s involvement may impact diet and activity behaviors. Social movements and individual behaviors Getting people more involved in their valued social movements may be an important intrinsic motivator for health behavior and is a plausible next step within the stealth intervention approach. In his foundational book, Heberle (1951) defined social movements as any collective attempt to ‘bring about fundamental changes in the social order,’ typically organized in the form of committees, clubs or formal organizations. According to Heberle, social movement involvement is more often motivated by emotional rather than rational reasons, exemplifying the potential in shifting away from the current theories of behavioral interventions towards a more affective, value-laden approach. As such, motivation to engage in social movement-related behaviors may be key in sustaining associated health behaviors. Robinson (2010) lists 13 social movements with values and behaviors that overlap with healthy diet and activity behaviors (Table 1). To adequately explore the proposed model, related behaviors are likely a crucial mechanism, as it may not be general involvement in social movements alone that promotes health but instead the overlapping health behaviors. For example, the environmental movement overlaps considerably with health promotion (Skouteris et al., 2013). Some individual-level health behaviors include eating less meat, processed and packaged foods and foods that require long-distance transportation and less automobile use supplemented with more walking and biking. One study looked at the association between attitudes toward organic, local and sustainable foods and dietary quality (Pelletier et al., 2013). Those who rated these food choices as highly important consumed more fruits and vegetables and dietary fiber, and less sugar, fat, fast food and sugar-sweetened beverages than those who rated these food choices of moderate and low importance. Table 1: Social movements with behavioral goals that overlap with obesity prevention Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Note: Adapted from ‘Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements,’ by Robinson, 2010. View Large Table 1: Social movements with behavioral goals that overlap with obesity prevention Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Note: Adapted from ‘Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements,’ by Robinson, 2010. View Large In addition to the potential to influence health behaviors and outcomes, social movements offer a multitude of other benefits. On an individual level, social movements offer rewards such as social cohesion and a sense of community, feelings of meaningfulness and accomplishment and the enjoyment of success in achieving goals (Gomes, 1992). Among college students, higher rates of social change behavior are associated with greater ability to take someone else’s point of view (Johnson, 2015). On a broader level, social movements can contribute to a better society through positive political change and improvement of social issues. The current study The aim of this study was to explore preliminary support for the proposed model: Is greater involvement in social movements, as mediated by social movement-related health behaviors, associated with healthier diet and activity behaviors? Diet and physical activity were selected as the primary health behaviors, as low levels of these have major implications in chronic diseases and they are often the main targets in current behavioral weight loss interventions. METHODS Participants To increase the generalizability of results, samples were drawn from two populations. Little research has been done on base rates of social movement involvement in the general population, so an adult sample obtained through Amazon’s Mechanical Turk (MTurk) was selected to provide a socio-economically, ethnically and geographically diverse sample (Casler et al., 2013). MTurk is an online recruitment platform that allows account holders to complete a wide range of tasks and questionnaires in return for compensation. A sample size of 200 was chosen to provide 0.8 power to detect a small to medium mediation effect (Fritz and MacKinnon, 2007). A total of 229 adults were recruited to complete the questionnaire through MTurk. Twenty-three participants did not meet quality control criteria because (1) survey length was less than 15 min and/or (2) both quality control items (e.g. ‘Please select some of the time’) were not accurately endorsed. An additional 11 responses were removed from the data set due to endorsing no social movement involvement. Thus, analyses were conducted on a sample of 195 adults. Due to a long history of civic engagement occurring in higher education as well as increasing prioritization of students’ moral and civic development in universities (Colby et al., 2003; Jacoby, 2009), a college student sample was also included. Inclusion of this sample in addition to a general adult sample aimed to explore the existence of any differential findings between the two, namely whether the proposed model would hold for both adults and college students and whether students are more involved in social movements and related behaviors. College students were recruited through an online system for students to participate in research for class credit. Again aiming for a sample of 200 236 students were recruited. Based on exclusion criteria described above (i.e. minimal survey time and failed quality control items), 28 students were excluded from the data set and nine additional responses were removed due to endorsing no social movement involvement. Three participants over the age of 27 were excluded to maintain a typical college student age range, resulting in a final sample of 196 students. All procedures were approved by the Bowling Green State University Human Subjects Review Board. Measures These measures were included in a longer survey on social movement involvement and health behaviors. In addition to the measures described here, participants also reported how important they considered each social movement listed, their general health (e.g. mental wellbeing) and any symptoms related to diabetes. Demographics Participants reported their age, gender, race/ethnicity, household income (adults only), socioeconomic status (students only) and height and weight. Social movement involvement From a list of 13 social movements (Table 1; Robinson, 2010), participants were asked to choose which movement was their highest priority. To capture self-reported involvement level in participants’ prioritized movement, the authors adapted the Indicators of Environmentalism measure (Stern et al., 1999) and the Environmental Involvement Inventory (Matsuba et al., 2012) to include other social movements of interest and to better assess individuals of all generations (Supplementary Material). For example, ‘Watched a television special on the environment’ was changed to ‘Watched a video, movie, or television show on your social cause.’ This measure consisted of 12 items, measured either on a Likert scale from 0 (never) to 4 (a lot) or with a yes/no response. Items were averaged to determine mean level of social movement involvement. Internal consistency was high, α (general adults) = 0.83 and α (college students) = 0.73. All social movements were combined in analyses to examine social movement involvement broadly in a single model. Social movement-related health behaviors Based on the individual behaviors listed by Robinson (2010) and described in Table 1, a measure of health behaviors presumed to be associated with various social movements was created (Supplementary Material). This list included 19 behaviors with a health focus but no explicit tie to social movement involvement. Items assessed how often participants engage in an activity in a typical month on a scale from 1 (never) to 7 (almost every day). Responses were averaged and used as the measure of frequency of social movement-related health behaviors. In both samples, internal consistency was high, α (general adults) = 0.88 and α (college students) = 0.85. Dietary intake To explore more specific dietary intake, the Dietary Screener Questionnaire (DSQ; National Cancer Institute, 2016) provided detailed information about nutrient intake. This measure included 28 items that assess how often various foods (never to 2 or more times a day) and beverages (never to 6 or more times a day) are consumed (e.g. ‘During the past month, how often did you eat fruit? Include fresh, frozen or canned fruit. Do not include juices’). Data reduction analyses (conducted using SAS statistical software) yielded daily consumption estimates of four dietary variables utilized in statistical analyses: daily fruit and vegetable (FV; without the inclusion of fried potatoes; cup equivalents), whole grain (ounce equivalents), added sugar (tsp equivalents) and calcium (mg) consumption. All the dietary outcomes were highly positively skewed in both samples; therefore, all variables were log transformed, which resolved some skews and improved others in both samples. In statistical analyses, these four variables were examined separately due to their nutritional dissimilarity and differing relevance in terms of both social movements and health outcomes. Physical activity To explore physical activity levels, participants completed the International Physical Activity Questionnaire (IPAQ). This measure included 27 items that ask how many days per week the individual participates in an activity (e.g. ‘Not counting any walking you have already mentioned, during the last 7 days, on how many days did you walk for at least 10 min at a time in your leisure time?’) with follow-up items about how many hours and minutes were spent on the activity. Outliers were handled according to IPAQ guidelines. Average amount of physical activity (PA) per day was computed for each participant. This variable had a high positive skew, and square root transformation resulted in a more normal distribution in both samples. Method of analysis Descriptive statistics were conducted to provide demographic information on each sample. In addition, t-tests were conducted to explore differences between samples on level of social movement involvement and frequency of associated health behaviors. Main effects on the variables of interest were examined to provide stronger support for follow-up mediations. To demonstrate mediation in the context of the current study, the predictor must be associated with the mediator, which must in turn be associated with the outcome variable (Baron and Kenny, 1986). Significant direct effects between the predictor and outcomes are not required and are not discussed here. Pearson correlations were conducted to ascertain the existence of these relationships, and mediation analyses were conducted using the Process macro for SPSS (Hayes and Preacher, 2014) controlling for known covariates. Each dietary variable was examined separately in all analyses to explore the unique contribution of social movement involvement to various dietary and physical activity behaviors. Baron and Kenny’s terminology was utilized to describe mediation effects: full mediation occurs when the direct effect becomes non-significant when including the mediator, whereas partial mediation (where the direct effect is significant) would suggest an insufficient theoretical framework and/or unexplored mediators. To interpret mediation indirect effect sizes, the index of mediation (ab’) proposed by Preacher and Kelley (2008) was utilized, as it is comparable across studies as it does not depend on variable metrics as other measures of effect size often do (Field, 2013). The bias corrected and accelerated bootstrap (BCa) method of constructing confidence intervals was used to report significant indirect effects and effect sizes. RESULTS Descriptive statistics Both the general adult and college student samples were predominantly Caucasian (81% and 84%, respectively) and female (68% and 75%, respectively). In the adult sample, mean age was 36.21 (SD = 11.74), mean BMI was overweight (27.83, SD = 7.58), and most lived near or below the 2016 median income of $56 516 (56.3% between $18 000 and $75 000). In the college sample, mean age was 19.34 (SD = 1.54), mean BMI was normal (24.82, SD = 5.14), and most considered their families to be middle class (57.1%). In the adult sample, age was negatively correlated with calcium, income was positively correlated with level of PA and gender was significant for all dietary outcomes with males consuming more of each subgroup (p’s < 0.05). In the college sample, gender was significant for FV and calcium intake with males consuming more of both, and race was significant for sugar intake with Caucasians consuming more (p’s < 0.05). In both samples, human rights/social justice was the most frequently endorsed social movement (28.7% of adults, 27.6% of students), followed by environmental sustainability (17.7%) in the general adult sample and animal protection (17.6%) in the college student sample. Adults reported greater involvement in social movements, t(376.56) = 2.51, p < 0.05 and more related behaviors, t(378.2) = 3.63, p < 0.001, than the college sample. Main effects In the adult sample, greater social movement (SM) involvement was highly correlated with more SM health behaviors (r = 0.44, p < 0.001), and SM health behaviors were positively correlated with FV intake (r = 0.36, p < 0.001), whole grain intake (r = 0.24, p = 0.001) and PA (r = 0.48, p < 0.001). In the college student sample, level of SM involvement and SM health behaviors were highly correlated (r = 0.25, p < 0.001) and SM health behaviors were in turn correlated with FV intake (r = 0.40, p < 0.001), whole grain intake (r = 0.33, p < 0.001) and PA (r = 0.26, p < 0.001). Following Baron and Kenny’s model, these analyses supported follow-up mediation analyses. Mediation analyses Refer to Figure 1 for a visual depiction of all mediation results. After covarying out the effects of gender among adults, SM health behaviors fully mediated the relationship between greater SM involvement and FV consumption (ab’ = 0.15, 95% BCa CI [0.08, 0.23]) and whole grain intake (ab’ = 0.13, 95% BCa CI [0.05, 0.22]). After covarying out the effects of income among adults, SM health behaviors fully mediated the relationship between greater SM involvement and PA (ab’ = 0.19, 95% BCa CI [0.12, 0.28]). Fig. 1: View largeDownload slide Model of social movement involvement as a predictor of dietary intake and physical activity, mediated by social movement-related health behaviors. The adult sample is in bold, the college sample in normal font. The confidence interval for the indirect relationships is a BCa bootstrapped CI based on 1000 samples. Fig. 1: View largeDownload slide Model of social movement involvement as a predictor of dietary intake and physical activity, mediated by social movement-related health behaviors. The adult sample is in bold, the college sample in normal font. The confidence interval for the indirect relationships is a BCa bootstrapped CI based on 1000 samples. Among college students, after covarying out the effects of gender, SM health behaviors fully mediated the relationship between greater SM involvement and FV consumption (ab’ = 0.10, 95% BCa CI [0.05, 0.19]). SM health behaviors also fully mediated the relationship between greater SM involvement and whole grain consumption (ab’ = 0.07, 95% BCa CI [0.03, 0.15]) and PA (ab’ = 0.07, 95% BCa CI [0.03, 0.13]). DISCUSSION This is the first empirical study to examine social movements as they relate to health behaviors, and the results suggest a promising avenue for improving diet and activity behaviors of individuals. As an intervention, encouraging greater involvement in valued movements and activities that vicariously improve health may sustain behavior change long-term and circumvent barriers common in current behavioral weight loss interventions. Furthermore, as social movements offer social and mental benefits beyond physical health, this more holistic approach to health promotion emphasizes quality of life and fulfillment. Based on the current findings, being more involved in one’s valued social movement is associated with numerous positive health behaviors. Specifically, the frequency of practicing social movement-related health behaviors is a significant mechanism in the relationship between greater involvement and healthier diet and activity behaviors. This suggests that those who are more involved in these social issues are likely to eat more nutritious foods and get adequate physical activity in part due to certain activities considered valuable to their social movement. Notably, in both samples, full mediation models were significant for the same dietary and activity variables, suggesting that the proposed model is likely to hold across various populations. FV and whole grains were the significant dietary variables supported by mediation analyses. Greater FV consumption has been linked to reduced risk of adiposity (Schwingshackl et al., 2015) and lower risk of cardiovascular disease (Hung et al., 2004), and legume consumption has been linked to reduced risk of incident ischemic heart disease (IDH; Afshin et al., 2014). Fiber, a nutrient found highly in produce, legumes and whole grains, is well-known to promote microbiota health, which is linked to obesity, immunology, gut-related diseases (e.g. Crohn’s disease) and many chronic conditions such as type 2 diabetes and heart disease (Sonnenburg and Sonnenburg, 2015). Level of physical activity was also supported by mediation analyses. Greater physical activity (i.e. aerobic fitness) is associated with reduced risk for all-cause and cardiovascular mortality, even among overweight individuals (Fogelholm, 2010). Thus, interventions that increase these targets are likely to influence broader, crucial health outcomes. Improved health linked to the social movement-related behaviors assessed here has also been found in other research. For example, gardeners and adults with a household member involved in community gardens consume more FV than non-gardeners and other households (McCormack et al., 2010); farmers’ market access is associated with higher FV consumption (Robles et al., 2017); consuming a plant-based diet and fewer animal-based foods (e.g. vegetarianism) is both healthier and associated with lower environmental impact (Nelson et al., 2016) and reducing media usage among children is associated with decreases in weight-related indicators of health (Robinson, 1999). On the other hand, it is unclear why other dietary behaviors (i.e. added sugar and calcium) were not supported in the current study. While research has found no effect of calcium intake on weight-related health indicators among children (Winzenberg et al., 2007), added sugar has been strongly linked to health outcomes: There is a dose-response relationship between sugar exposure and diabetes prevalence (Basu et al., 2013), and added sugar intake is significantly associated with increased risk for CVD mortality (Yang et al., 2014). Consistent with the current study’s non-significant finding, research conducted on dietary intake of farmers’ market attendees did not find a significant inverse association with sugar-sweetened beverage consumption (Robles et al., 2017). It is possible that the theorized behaviors assessed in the current study only influence specific outcomes and do not have broader impacts; for example, while certain movements promote purchasing more FV from local farmers or foods that are organic, this may not also extend to reduced added sugar consumption. More research on these variables is warranted to better understand these findings. Adults somewhat unexpectedly reported greater involvement in social movements and more related health behaviors. Perhaps this study’s measures assessing these activities reflect those that are more accessible to adults than to students (e.g. money-related activities; Supplementary Material). Or, perhaps these findings are typical and future research on similar comparisons will yield similar results. Nonetheless, these findings suggest even wider applicability of these interventions, as adults who are generally more overweight than their young adult counterparts (Sutin et al., 2011) may benefit substantially if they are more involved. There are several alternative explanations for the mediation findings that should be explored. First, values likely play a role in one’s dedication to and participation in a social movement (e.g. Schultz and Zelezny, 1999). In addition, values may play a role in both one’s level of involvement in social movements as well as his or her health behaviors independently. Second, perceived benefits of participating in social movements may also play a role in the impact of involvement on diet and physical activity. As identified by Gomes (1992), some of the most commonly perceived benefits of involvement––social cohesion, feelings of accomplishment, and the actualization of goal achievement and success––contribute to one’s emotional and mental health. Limitations and future directions Several limitations in the current study are worth noting. First, all measures used to assess social movement involvement and behaviors were created or adapted by the authors for the specific purposes of the study. While they were developed based on supporting literature and internal consistencies were high, these measures could be further refined to better measure these constructs. Only 11 adults and 9 college students selected no social movement as a priority, but there may be other movements not discussed in Robinson’s paper worth exploring. Regarding the measurement of SM behaviors, individuals involved in social movements may not partake in some of the behaviors proposed by Robinson, and still other behaviors may not have been assessed at all. Further validation of this measure is warranted. Measurement of diet and physical activity could also have impacted findings. The DSQ inly provides rough estimates, and the IPAQ resulted in many outliers in the current, indicated that self-report of average health behaviors over longer periods of time is challenging. Perhaps an average of multiple 24-h dietary recalls collected by phone interview or web-based applications, Ecological Momentary Assessment (EMA) methods and objective measures (e.g. pedometers) may provide more reliable and valid dietary and activity data. Future research would benefit from more detailed assessment of these health behaviors. As with all self-report measures, there is always the possibility of inaccurate reporting. In addition, both the MTurk and college student samples self-selected to participate in a study advertised to assess involvement in community activities, which may skew results. Finally, while the MTurk sample was utilized to obtain a representative US sample, these adults tended to be slightly overweight, younger and predominantly female, so results may not appropriately generalize to other demographics. Finally, it is possible that this relationship functions in the opposite direction, meaning that healthier people may be more likely to get involved in social movements and partake in these activities. Longitudinal studies and prospective and experimental designs would be beneficial to examine the directionality and causality of these relationships. Despite these limitations, the current findings provide support for the use of social movement involvement as a means of improving diet, physical activity, and disease prevention efforts and suggest future directions for both basic and applied research. For individuals who are already highly involved, capitalizing on this link (e.g. by training doctors to appeal to social movement motivations for their patient engagement in health-promoting activities) may further enhance the health benefits these individuals may experience. For those who are less involved but still hold associated values, encouraging greater involvement may motivate increasing these health behaviors. Efforts to increase social movement involvement and associated health behaviors might be successful in the form of a public health campaign (e.g. school programming, community health programming or marketing, etc.). In addition, other potential mechanisms in the relationship between social movement involvement and dietary and activity behaviors (e.g. values, social cohesion) should be explored. CONCLUSION Social movements are a particularly relevant intervention strategy for health promotion, as many of the causes of poor health involve the current social system that activists want to change. Social and environmental issues in agriculture, urban design, transportation, work demands and food systems have a major influence in how Americans live. Thus, improvement of these cultural impediments to living healthfully could be a potential remedy to poor dietary and physical health, and social movement agendas are in a perfect position to play a role in that improvement. This study provides novel, substantial support for social movements as a viable stealth intervention. 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Social movement involvement and healthy diet and activity behaviors among US adults

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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Abstract

Summary Unhealthy lifestyle behaviors, namely poor diet and inadequate physical activity, significantly contribute to poor health and obesity risk, which in turn impact chronic illness outcomes. A possible approach to improving these health behaviors and subsequent outcomes is to capitalize on the theorized link between social movement involvement and overlapping health behaviors. Social movement involvement may be a viable stealth intervention for health, utilizing intrinsic motivators to improve health without an explicit focus on changing health behavior. Thus, the current study explored the links between social movement involvement and diet and physical activity. Two samples from a college population (N = 196) and the general population (N = 195) participated in an online survey, which included measures of social movement involvement, social movement-related health behaviors and dietary intake and physical activity. After controlling for known covariates, social movement-related health behaviors mediated the relationship between level of social movement involvement and fruit and vegetable consumption, whole grain intake and average daily physical activity in both samples. These findings suggest that health behaviors associated with social movement involvement may be an important mechanism in promoting health among social movement members and that the model holds across adult populations. This research adds to existing literature on stealth interventions as a viable means of improving important behavioral health components linked with obesity and chronic disease and supports social movement involvement as a potential form of stealth intervention. health behavior, social action, diet, physical activity, community health promotion INTRODUCTION Unhealthy lifestyle is one of the largest contributors to disease. Cardiovascular disease, the leading cause of death in the US, is strongly linked to poor diet, inadequate physical activity and obesity (Centers for Disease Control and Prevention, 2015). Overweight and obesity are due in large part to the global increase in high fat, energy-dense food consumption and a decrease in physical activity (World Health Organization, 2017). Elevated BMI and accompanying metabolic markers (e.g. high abdominal adiposity, high blood pressure) are leading risk factors for many preventable causes of death: cardiovascular disease, diabetes, stroke and even some cancers (National Heart, Lung and Blood Institute, n.d.; World Health Organization, 2017). Thus, improving these healthy lifestyle behaviors is essential. Challenges of current interventions Although many weight interventions exist, such programs have generally failed to produce significant long-term health improvements. Current behavioral weight loss interventions encourage at-risk individuals to change their lifestyle, including techniques such as self-monitoring (e.g. food diaries), nutrition education, increasing physical activity (Foster et al., 2005). While many interventions produce positive short-term outcomes, few have been able to sustain long-term weight loss and changes in health behaviors (e.g. Hartmann-Boyce et al., 2015). Even highly interactive and individually tailored interventions that achieved significant weight loss post-treatment and 6 months afterward showed no improvements at 12 months. In addition, this review found that interventions tended to be more effective for individuals with higher SES and education. Thus, current interventions are not typically successful at improving long-term weight outcomes for participants, particularly disadvantaged individuals. A significant challenge with interventions that emphasize individual behavior change is that they fail to consider situational constraints that interfere with a person’s ability to maintain the behaviors recommended. For example, deterrents to obtaining adequate physical activity include time constraints, poor state of health and already overweight status (Korkiakangas et al., 2011). Healthy eating behavior is hindered by established taste preferences, money constraints and lack of convenience and availability (Alaimo et al., 2008; Lucan et al., 2010) as well as political barriers (e.g. government subsidizing of fat and sugar production; Swinburn, 2008). Another challenge is that attempts to improve health assume that humans act rationally in their own best interest, conduct cost-benefit analyses for each behavioral choice they make and focus on future benefits while ignoring short-term rewards (Robinson, 2010). In reality, human behavior is far from rational and is influenced by our environment and cognitive biases (Kahneman and Lovallo, 1993; Wansink, 2006). Stealth interventions Due to the limited success of existing behavioral health interventions, some researchers have turned their attention to the potential of stealth interventions as a way to overcome current constraints. Stealth interventions are a way to ‘tap into the deeper needs and desires of the participants—what we refer to as intrinsic motivators—while improving their health as a side effect,’ (Ipaktchian, 2010). For example, a study exploring goals for exercise showed that women exercised less when their goals were weight-loss related than when their goals were intrinsic, such as improved well-being and stress-reduction (Segar et al., 2008). Stealth interventions do not aim to conceal the connection between health and a given motivator, they aim to utilize these motivators to encourage health behavior without an explicit goal to act for the sake of health. Because they often target values (e.g. social justice, meaningful activities, social belonging, etc.), motivation to partake in health behaviors is more likely to be maintained despite barriers and irrational thinking. Findings suggest that the number of lifestyle recommendations made within an intervention is negatively associated with how likely a person is to adopt health behaviors (Wilson et al., 2015), indicating that less explicit interventional push may in fact be more useful. Although research in this field is sparse, several studies have investigated stealth interventions as a means of improving health behaviors associated with obesity and chronic disease. Robinson found that these behaviors can be improved via stealth interventions such as raising students’ awareness of the negative aspects of media usage (Robinson and Borzekowski, 2006); increasing participation in an after-school dance program to reduce television viewing (Robinson et al., 2010); an after-school soccer team to reduce BMI (Weintraub et al., 2008) and conducting a food-related college course focusing on the environmental and social impacts of food versus health issues to produce more healthful diets (Hekler et al., 2010). The latter study in particular aimed to harness highly motivating values: those related to one’s awareness of social issues. This topic has yet to be explored with other types of social movements and how one’s involvement may impact diet and activity behaviors. Social movements and individual behaviors Getting people more involved in their valued social movements may be an important intrinsic motivator for health behavior and is a plausible next step within the stealth intervention approach. In his foundational book, Heberle (1951) defined social movements as any collective attempt to ‘bring about fundamental changes in the social order,’ typically organized in the form of committees, clubs or formal organizations. According to Heberle, social movement involvement is more often motivated by emotional rather than rational reasons, exemplifying the potential in shifting away from the current theories of behavioral interventions towards a more affective, value-laden approach. As such, motivation to engage in social movement-related behaviors may be key in sustaining associated health behaviors. Robinson (2010) lists 13 social movements with values and behaviors that overlap with healthy diet and activity behaviors (Table 1). To adequately explore the proposed model, related behaviors are likely a crucial mechanism, as it may not be general involvement in social movements alone that promotes health but instead the overlapping health behaviors. For example, the environmental movement overlaps considerably with health promotion (Skouteris et al., 2013). Some individual-level health behaviors include eating less meat, processed and packaged foods and foods that require long-distance transportation and less automobile use supplemented with more walking and biking. One study looked at the association between attitudes toward organic, local and sustainable foods and dietary quality (Pelletier et al., 2013). Those who rated these food choices as highly important consumed more fruits and vegetables and dietary fiber, and less sugar, fat, fast food and sugar-sweetened beverages than those who rated these food choices of moderate and low importance. Table 1: Social movements with behavioral goals that overlap with obesity prevention Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Note: Adapted from ‘Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements,’ by Robinson, 2010. View Large Table 1: Social movements with behavioral goals that overlap with obesity prevention Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Movements/causes Individual-level behaviors Environmental sustainability/climate change Preventing global warming and climate change, sustainable agriculture, organic farming, slow food, eating locally (locavores), agrarianism, recycling/waste reduction, improving air quality, conserving water Eat more fresh fruits and vegetables. Eat less meat, particularly beef. Eat less processed and packaged foods. Eat fewer foods transported over long distances. Less automobile use, more walking, bicycling and mass transit use. Food safety Reducing risk of infectious diseases from food (e.g. Escherichia coli O157: H7) and potentially harmful additives and/or contaminants (e.g. toxic additives) Eat less meat, particularly beef and less fast food restaurant food. Eat more organically and locally grown fruits and vegetables. Human rights/social justice Improving workers’ rights, poor working conditions in fast food industry and suppliers; increasing access to more healthful foods such as fresh fruits and vegetables in low-income areas; reducing racial/ethnic and gender discrimination from stereotypes in media Eat less fast food restaurant food. Eat less meat. Eat more fruits and vegetables from farmers’ markets, local farmers, CSA, following fair trade practice. Watch less media to reduce exposure to negative racial/ethnic gender stereotypes. Antiglobalization Farmers, labor unions, human rights groups, nationalists, etc. resisting corporate and cultural globalization and WTO and World Bank free trade policies Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. Animal protection Reducing inhumane treatment of animals during farming and slaughter Less beef, pork, poultry, dairy and fish consumption, more vegetarianism Anticonsumerism Reducing consumer culture and/or the influence of consumer culture Less purchase and consumption of heavily advertised and marketed fast food and snack foods/convenience foods. Less television watching and other screen media use. Cause-related fundraising Raising awareness and funding for charitable causes such as cancer or AIDS research and services (e.g. Team-in-Training) Walk-a-thons, door-to-door fundraising, training and participation in distance and/or endurance races, long distance walks and bike rides, etc. Energy independence/reduce dependence on foreign oil Freeing nations from dependence on foreign oil Less automobile use, more walking, bicycling, and mass transit. Eat more locally grown produce and less meat and processed and packaged foods transported over long distances. Youth violence and crime prevention Reducing youth involvement in gangs and crime Participating in after school sports programs for at-risk youth, or as mentors or coaches; participating in community policy/neighborhood watch programs. Community safety, beautification and traffic reduction Improving safety and beauty to increase neighborhood quality of life and property values Participating in gardening, clean-up, home and neighborhood improvement and repair and other community beautification projects. Spend more time outdoors in recreation and neighborhood social activities. Political action As part of political campaigns or in support of the movements listed and other specific causes Door-to-door campaigning or petition drives, picketing, public demonstrations, marches Patriotism, nationalism Supporting one’s own national economy and culture Eat more locally grown/domestically grown food. Eat less fast food and processed foods and beverages from multinational corporations. Eat less imported foods. National security Protecting the nation’s security from foreign countries and terrorists with a strong military, protected food supply, and food and energy independence/self-sufficiency Regular participation in physical activity to maintain physical fitness Eat more locally grown produce and less meat. Eat less from multinational corporations. Eat less imported foods. Eat less processed and packaged foods transported over long distances. Less automobile use, more walking, bicycling and mass transit. Note: Adapted from ‘Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements,’ by Robinson, 2010. View Large In addition to the potential to influence health behaviors and outcomes, social movements offer a multitude of other benefits. On an individual level, social movements offer rewards such as social cohesion and a sense of community, feelings of meaningfulness and accomplishment and the enjoyment of success in achieving goals (Gomes, 1992). Among college students, higher rates of social change behavior are associated with greater ability to take someone else’s point of view (Johnson, 2015). On a broader level, social movements can contribute to a better society through positive political change and improvement of social issues. The current study The aim of this study was to explore preliminary support for the proposed model: Is greater involvement in social movements, as mediated by social movement-related health behaviors, associated with healthier diet and activity behaviors? Diet and physical activity were selected as the primary health behaviors, as low levels of these have major implications in chronic diseases and they are often the main targets in current behavioral weight loss interventions. METHODS Participants To increase the generalizability of results, samples were drawn from two populations. Little research has been done on base rates of social movement involvement in the general population, so an adult sample obtained through Amazon’s Mechanical Turk (MTurk) was selected to provide a socio-economically, ethnically and geographically diverse sample (Casler et al., 2013). MTurk is an online recruitment platform that allows account holders to complete a wide range of tasks and questionnaires in return for compensation. A sample size of 200 was chosen to provide 0.8 power to detect a small to medium mediation effect (Fritz and MacKinnon, 2007). A total of 229 adults were recruited to complete the questionnaire through MTurk. Twenty-three participants did not meet quality control criteria because (1) survey length was less than 15 min and/or (2) both quality control items (e.g. ‘Please select some of the time’) were not accurately endorsed. An additional 11 responses were removed from the data set due to endorsing no social movement involvement. Thus, analyses were conducted on a sample of 195 adults. Due to a long history of civic engagement occurring in higher education as well as increasing prioritization of students’ moral and civic development in universities (Colby et al., 2003; Jacoby, 2009), a college student sample was also included. Inclusion of this sample in addition to a general adult sample aimed to explore the existence of any differential findings between the two, namely whether the proposed model would hold for both adults and college students and whether students are more involved in social movements and related behaviors. College students were recruited through an online system for students to participate in research for class credit. Again aiming for a sample of 200 236 students were recruited. Based on exclusion criteria described above (i.e. minimal survey time and failed quality control items), 28 students were excluded from the data set and nine additional responses were removed due to endorsing no social movement involvement. Three participants over the age of 27 were excluded to maintain a typical college student age range, resulting in a final sample of 196 students. All procedures were approved by the Bowling Green State University Human Subjects Review Board. Measures These measures were included in a longer survey on social movement involvement and health behaviors. In addition to the measures described here, participants also reported how important they considered each social movement listed, their general health (e.g. mental wellbeing) and any symptoms related to diabetes. Demographics Participants reported their age, gender, race/ethnicity, household income (adults only), socioeconomic status (students only) and height and weight. Social movement involvement From a list of 13 social movements (Table 1; Robinson, 2010), participants were asked to choose which movement was their highest priority. To capture self-reported involvement level in participants’ prioritized movement, the authors adapted the Indicators of Environmentalism measure (Stern et al., 1999) and the Environmental Involvement Inventory (Matsuba et al., 2012) to include other social movements of interest and to better assess individuals of all generations (Supplementary Material). For example, ‘Watched a television special on the environment’ was changed to ‘Watched a video, movie, or television show on your social cause.’ This measure consisted of 12 items, measured either on a Likert scale from 0 (never) to 4 (a lot) or with a yes/no response. Items were averaged to determine mean level of social movement involvement. Internal consistency was high, α (general adults) = 0.83 and α (college students) = 0.73. All social movements were combined in analyses to examine social movement involvement broadly in a single model. Social movement-related health behaviors Based on the individual behaviors listed by Robinson (2010) and described in Table 1, a measure of health behaviors presumed to be associated with various social movements was created (Supplementary Material). This list included 19 behaviors with a health focus but no explicit tie to social movement involvement. Items assessed how often participants engage in an activity in a typical month on a scale from 1 (never) to 7 (almost every day). Responses were averaged and used as the measure of frequency of social movement-related health behaviors. In both samples, internal consistency was high, α (general adults) = 0.88 and α (college students) = 0.85. Dietary intake To explore more specific dietary intake, the Dietary Screener Questionnaire (DSQ; National Cancer Institute, 2016) provided detailed information about nutrient intake. This measure included 28 items that assess how often various foods (never to 2 or more times a day) and beverages (never to 6 or more times a day) are consumed (e.g. ‘During the past month, how often did you eat fruit? Include fresh, frozen or canned fruit. Do not include juices’). Data reduction analyses (conducted using SAS statistical software) yielded daily consumption estimates of four dietary variables utilized in statistical analyses: daily fruit and vegetable (FV; without the inclusion of fried potatoes; cup equivalents), whole grain (ounce equivalents), added sugar (tsp equivalents) and calcium (mg) consumption. All the dietary outcomes were highly positively skewed in both samples; therefore, all variables were log transformed, which resolved some skews and improved others in both samples. In statistical analyses, these four variables were examined separately due to their nutritional dissimilarity and differing relevance in terms of both social movements and health outcomes. Physical activity To explore physical activity levels, participants completed the International Physical Activity Questionnaire (IPAQ). This measure included 27 items that ask how many days per week the individual participates in an activity (e.g. ‘Not counting any walking you have already mentioned, during the last 7 days, on how many days did you walk for at least 10 min at a time in your leisure time?’) with follow-up items about how many hours and minutes were spent on the activity. Outliers were handled according to IPAQ guidelines. Average amount of physical activity (PA) per day was computed for each participant. This variable had a high positive skew, and square root transformation resulted in a more normal distribution in both samples. Method of analysis Descriptive statistics were conducted to provide demographic information on each sample. In addition, t-tests were conducted to explore differences between samples on level of social movement involvement and frequency of associated health behaviors. Main effects on the variables of interest were examined to provide stronger support for follow-up mediations. To demonstrate mediation in the context of the current study, the predictor must be associated with the mediator, which must in turn be associated with the outcome variable (Baron and Kenny, 1986). Significant direct effects between the predictor and outcomes are not required and are not discussed here. Pearson correlations were conducted to ascertain the existence of these relationships, and mediation analyses were conducted using the Process macro for SPSS (Hayes and Preacher, 2014) controlling for known covariates. Each dietary variable was examined separately in all analyses to explore the unique contribution of social movement involvement to various dietary and physical activity behaviors. Baron and Kenny’s terminology was utilized to describe mediation effects: full mediation occurs when the direct effect becomes non-significant when including the mediator, whereas partial mediation (where the direct effect is significant) would suggest an insufficient theoretical framework and/or unexplored mediators. To interpret mediation indirect effect sizes, the index of mediation (ab’) proposed by Preacher and Kelley (2008) was utilized, as it is comparable across studies as it does not depend on variable metrics as other measures of effect size often do (Field, 2013). The bias corrected and accelerated bootstrap (BCa) method of constructing confidence intervals was used to report significant indirect effects and effect sizes. RESULTS Descriptive statistics Both the general adult and college student samples were predominantly Caucasian (81% and 84%, respectively) and female (68% and 75%, respectively). In the adult sample, mean age was 36.21 (SD = 11.74), mean BMI was overweight (27.83, SD = 7.58), and most lived near or below the 2016 median income of $56 516 (56.3% between $18 000 and $75 000). In the college sample, mean age was 19.34 (SD = 1.54), mean BMI was normal (24.82, SD = 5.14), and most considered their families to be middle class (57.1%). In the adult sample, age was negatively correlated with calcium, income was positively correlated with level of PA and gender was significant for all dietary outcomes with males consuming more of each subgroup (p’s < 0.05). In the college sample, gender was significant for FV and calcium intake with males consuming more of both, and race was significant for sugar intake with Caucasians consuming more (p’s < 0.05). In both samples, human rights/social justice was the most frequently endorsed social movement (28.7% of adults, 27.6% of students), followed by environmental sustainability (17.7%) in the general adult sample and animal protection (17.6%) in the college student sample. Adults reported greater involvement in social movements, t(376.56) = 2.51, p < 0.05 and more related behaviors, t(378.2) = 3.63, p < 0.001, than the college sample. Main effects In the adult sample, greater social movement (SM) involvement was highly correlated with more SM health behaviors (r = 0.44, p < 0.001), and SM health behaviors were positively correlated with FV intake (r = 0.36, p < 0.001), whole grain intake (r = 0.24, p = 0.001) and PA (r = 0.48, p < 0.001). In the college student sample, level of SM involvement and SM health behaviors were highly correlated (r = 0.25, p < 0.001) and SM health behaviors were in turn correlated with FV intake (r = 0.40, p < 0.001), whole grain intake (r = 0.33, p < 0.001) and PA (r = 0.26, p < 0.001). Following Baron and Kenny’s model, these analyses supported follow-up mediation analyses. Mediation analyses Refer to Figure 1 for a visual depiction of all mediation results. After covarying out the effects of gender among adults, SM health behaviors fully mediated the relationship between greater SM involvement and FV consumption (ab’ = 0.15, 95% BCa CI [0.08, 0.23]) and whole grain intake (ab’ = 0.13, 95% BCa CI [0.05, 0.22]). After covarying out the effects of income among adults, SM health behaviors fully mediated the relationship between greater SM involvement and PA (ab’ = 0.19, 95% BCa CI [0.12, 0.28]). Fig. 1: View largeDownload slide Model of social movement involvement as a predictor of dietary intake and physical activity, mediated by social movement-related health behaviors. The adult sample is in bold, the college sample in normal font. The confidence interval for the indirect relationships is a BCa bootstrapped CI based on 1000 samples. Fig. 1: View largeDownload slide Model of social movement involvement as a predictor of dietary intake and physical activity, mediated by social movement-related health behaviors. The adult sample is in bold, the college sample in normal font. The confidence interval for the indirect relationships is a BCa bootstrapped CI based on 1000 samples. Among college students, after covarying out the effects of gender, SM health behaviors fully mediated the relationship between greater SM involvement and FV consumption (ab’ = 0.10, 95% BCa CI [0.05, 0.19]). SM health behaviors also fully mediated the relationship between greater SM involvement and whole grain consumption (ab’ = 0.07, 95% BCa CI [0.03, 0.15]) and PA (ab’ = 0.07, 95% BCa CI [0.03, 0.13]). DISCUSSION This is the first empirical study to examine social movements as they relate to health behaviors, and the results suggest a promising avenue for improving diet and activity behaviors of individuals. As an intervention, encouraging greater involvement in valued movements and activities that vicariously improve health may sustain behavior change long-term and circumvent barriers common in current behavioral weight loss interventions. Furthermore, as social movements offer social and mental benefits beyond physical health, this more holistic approach to health promotion emphasizes quality of life and fulfillment. Based on the current findings, being more involved in one’s valued social movement is associated with numerous positive health behaviors. Specifically, the frequency of practicing social movement-related health behaviors is a significant mechanism in the relationship between greater involvement and healthier diet and activity behaviors. This suggests that those who are more involved in these social issues are likely to eat more nutritious foods and get adequate physical activity in part due to certain activities considered valuable to their social movement. Notably, in both samples, full mediation models were significant for the same dietary and activity variables, suggesting that the proposed model is likely to hold across various populations. FV and whole grains were the significant dietary variables supported by mediation analyses. Greater FV consumption has been linked to reduced risk of adiposity (Schwingshackl et al., 2015) and lower risk of cardiovascular disease (Hung et al., 2004), and legume consumption has been linked to reduced risk of incident ischemic heart disease (IDH; Afshin et al., 2014). Fiber, a nutrient found highly in produce, legumes and whole grains, is well-known to promote microbiota health, which is linked to obesity, immunology, gut-related diseases (e.g. Crohn’s disease) and many chronic conditions such as type 2 diabetes and heart disease (Sonnenburg and Sonnenburg, 2015). Level of physical activity was also supported by mediation analyses. Greater physical activity (i.e. aerobic fitness) is associated with reduced risk for all-cause and cardiovascular mortality, even among overweight individuals (Fogelholm, 2010). Thus, interventions that increase these targets are likely to influence broader, crucial health outcomes. Improved health linked to the social movement-related behaviors assessed here has also been found in other research. For example, gardeners and adults with a household member involved in community gardens consume more FV than non-gardeners and other households (McCormack et al., 2010); farmers’ market access is associated with higher FV consumption (Robles et al., 2017); consuming a plant-based diet and fewer animal-based foods (e.g. vegetarianism) is both healthier and associated with lower environmental impact (Nelson et al., 2016) and reducing media usage among children is associated with decreases in weight-related indicators of health (Robinson, 1999). On the other hand, it is unclear why other dietary behaviors (i.e. added sugar and calcium) were not supported in the current study. While research has found no effect of calcium intake on weight-related health indicators among children (Winzenberg et al., 2007), added sugar has been strongly linked to health outcomes: There is a dose-response relationship between sugar exposure and diabetes prevalence (Basu et al., 2013), and added sugar intake is significantly associated with increased risk for CVD mortality (Yang et al., 2014). Consistent with the current study’s non-significant finding, research conducted on dietary intake of farmers’ market attendees did not find a significant inverse association with sugar-sweetened beverage consumption (Robles et al., 2017). It is possible that the theorized behaviors assessed in the current study only influence specific outcomes and do not have broader impacts; for example, while certain movements promote purchasing more FV from local farmers or foods that are organic, this may not also extend to reduced added sugar consumption. More research on these variables is warranted to better understand these findings. Adults somewhat unexpectedly reported greater involvement in social movements and more related health behaviors. Perhaps this study’s measures assessing these activities reflect those that are more accessible to adults than to students (e.g. money-related activities; Supplementary Material). Or, perhaps these findings are typical and future research on similar comparisons will yield similar results. Nonetheless, these findings suggest even wider applicability of these interventions, as adults who are generally more overweight than their young adult counterparts (Sutin et al., 2011) may benefit substantially if they are more involved. There are several alternative explanations for the mediation findings that should be explored. First, values likely play a role in one’s dedication to and participation in a social movement (e.g. Schultz and Zelezny, 1999). In addition, values may play a role in both one’s level of involvement in social movements as well as his or her health behaviors independently. Second, perceived benefits of participating in social movements may also play a role in the impact of involvement on diet and physical activity. As identified by Gomes (1992), some of the most commonly perceived benefits of involvement––social cohesion, feelings of accomplishment, and the actualization of goal achievement and success––contribute to one’s emotional and mental health. Limitations and future directions Several limitations in the current study are worth noting. First, all measures used to assess social movement involvement and behaviors were created or adapted by the authors for the specific purposes of the study. While they were developed based on supporting literature and internal consistencies were high, these measures could be further refined to better measure these constructs. Only 11 adults and 9 college students selected no social movement as a priority, but there may be other movements not discussed in Robinson’s paper worth exploring. Regarding the measurement of SM behaviors, individuals involved in social movements may not partake in some of the behaviors proposed by Robinson, and still other behaviors may not have been assessed at all. Further validation of this measure is warranted. Measurement of diet and physical activity could also have impacted findings. The DSQ inly provides rough estimates, and the IPAQ resulted in many outliers in the current, indicated that self-report of average health behaviors over longer periods of time is challenging. Perhaps an average of multiple 24-h dietary recalls collected by phone interview or web-based applications, Ecological Momentary Assessment (EMA) methods and objective measures (e.g. pedometers) may provide more reliable and valid dietary and activity data. Future research would benefit from more detailed assessment of these health behaviors. As with all self-report measures, there is always the possibility of inaccurate reporting. In addition, both the MTurk and college student samples self-selected to participate in a study advertised to assess involvement in community activities, which may skew results. Finally, while the MTurk sample was utilized to obtain a representative US sample, these adults tended to be slightly overweight, younger and predominantly female, so results may not appropriately generalize to other demographics. Finally, it is possible that this relationship functions in the opposite direction, meaning that healthier people may be more likely to get involved in social movements and partake in these activities. Longitudinal studies and prospective and experimental designs would be beneficial to examine the directionality and causality of these relationships. Despite these limitations, the current findings provide support for the use of social movement involvement as a means of improving diet, physical activity, and disease prevention efforts and suggest future directions for both basic and applied research. For individuals who are already highly involved, capitalizing on this link (e.g. by training doctors to appeal to social movement motivations for their patient engagement in health-promoting activities) may further enhance the health benefits these individuals may experience. For those who are less involved but still hold associated values, encouraging greater involvement may motivate increasing these health behaviors. Efforts to increase social movement involvement and associated health behaviors might be successful in the form of a public health campaign (e.g. school programming, community health programming or marketing, etc.). In addition, other potential mechanisms in the relationship between social movement involvement and dietary and activity behaviors (e.g. values, social cohesion) should be explored. CONCLUSION Social movements are a particularly relevant intervention strategy for health promotion, as many of the causes of poor health involve the current social system that activists want to change. Social and environmental issues in agriculture, urban design, transportation, work demands and food systems have a major influence in how Americans live. Thus, improvement of these cultural impediments to living healthfully could be a potential remedy to poor dietary and physical health, and social movement agendas are in a perfect position to play a role in that improvement. This study provides novel, substantial support for social movements as a viable stealth intervention. 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Journal

Health Promotion InternationalOxford University Press

Published: Jun 1, 2019

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