Cited by 176Nutrition, Health and Food BehaviorBehavioral Health and InterventionsObesity, Physical Activity, Diet

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Testing Theories of Dietary Behavior Change in Youth Using the Mediating Variable Model with Intervention Programs

Cerin, Ester, Barnett, Anthony, Baranowski, Tom·2009·Journal of Nutrition Education and Behavior

DOI 10.1016/j.jneb.2009.03.129

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Abstract

Objective To review and critique current experimentally-based evidence of theoretical mechanisms of dietary behavior change in youth and provide recommendations on ways to enhance theory evaluation. Methods Interventions that examined mediators of dietary behavior change in youth (age 5-18 years) were identified via electronic database searches and reference scanning. Selected studies were reviewed for quality and content and findings were tabulated. Results Seven published interventions were found. All were school-based but differed substantially in dietary outcome, target population, measures, methods of mediation analyses, and theoretical framework. Interventions were relatively unsuccessful in changing mediators. Self-efficacy and outcome expectations were the mechanisms most consistently associated with dietary behavior change. However, only outcome expectancies were identified as mediators in multiple interventions. Conclusions and implications Few interventions have assessed the validity of theoretical mechanisms of dietary behavior change in youth. The variability in the design and target populations across studies makes it impossible to draw conclusions regarding the validity of theories and mediators of dietary behavior change in youth. Future intervention trials need to focus on the identification of effective procedures for mediator change and adopt a more rigorous and systematic approach to theory testing. This is likely to result in more effective interventions.

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An overview of systematic reviews found suboptimal reporting and methodological limitations of mediation studies investigating causal mechanisms
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Validity and Reliability of Behavior and Theory-Based Psychosocial Determinants Measures, Using Audience Response System Technology in Urban Upper-Elementary Schoolchildren
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“Motivational and self-regulation factors from these theories are significant mediating variables for behavioral changes in youth and adults.(10,52) Specific questions were derived from previous studies(5,50) and pilot tests.”
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Factors Associated With Healthy Lifestyle Behaviors Among Adolescents
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A systematic review of mediators of physical activity, nutrition, and screen time in adolescents: Implications for future research and clinical practice
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School-based obesity prevention interventions: Practicalities and considerations
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Potential moderators and mediators of intervention effects in an obesity prevention program for adolescent boys from disadvantaged schools
Lubans, D. R., Morgan, P. J., & Callister, R. (2012) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2012.03.011 · Cited by 31
Culturally-grounded diabetes prevention program for obese Latino youth: Rationale, design, and methods
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“As such, self-efficacy is a commonly assessed mediator in interventions targeting obesity-related behaviors with support for this construct as an important mechanism underlying dietary andPA behavior change among youth [38,39].”
Background
Health behavioral theories used to explain dietary behaviors in adolescents: a systematic review
Philippi, S. T., Guerra, P. H., & Leme, A. C. B. (2016) · Nutrire · doi:10.1186/s41110-016-0023-9 · Cited by 22
“Therefore, it is difficult to draw a conclusion with respect to this issue [24].”
BackgroundResultInfluential
Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods
van Stralen, M. M., de Meij, J. S. B., Velde, S. J. T., van der Wal, M. F., van Mechelen, W., Knol, D. L., & Chinapaw, M. J. M. (2012) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-9-131 · Cited by 27
“been noted in previous literature [19,41,42].”
Bone Health Nutrition Issues in Aging
Plawecki, K., & Chapman‐Novakofski, K. (2010) · Nutrients · doi:10.3390/nu2111086 · Cited by 28
“Similar to demonstrating a physiological mechanism for how nutrients affect health, investigations into educational strategies must investigate how behavioral theories mediate dietary change [58].”
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The “Healthy Habits, Healthy Girls” randomized controlled trial for girls: study design, protocol, and baseline results
Leme, A. C. B., & Philippi, S. T. (2015) · Cadernos de Saúde Pública · doi:10.1590/0102-311x00136014 · Cited by 35
Nutrition Education in the K-12 Curriculum: The Role of National Standards - Workshop Summary
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Understanding the behavioral linkages needed for designing effective interventions to increase fruit and vegetable intake in diverse populations.
Baranowski, T. (2011) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2011.07.014 · Cited by 26
Self-citation
Diseño y validación de dos escalas para medir la actitud hacia la alimentación y la actividad física durante la adolescencia
Lima‐Serrano, M., Lima‐Rodríguez, J. S., & Sáez-Bueno, Á. (2012) · Revista Española de Salud Pública · doi:10.1590/s1135-57272012000300005 · Cited by 23
Effects of a group-based exercise and self-regulatory intervention on obese adolescents’ physical activity, social cognitions, body composition and strength: A randomized feasibility study
Wilson, A., Jung, M. E., Cramp, A. G., Simatovic, J., Harry Prapavessis, A., & Clarson, C. L. (2012) · Journal of Health Psychology · doi:10.1177/1359105311434050 · Cited by 29
“Furthermore, OEs have been found to mediate dietary and physical activity behaviour change among youth (Cerin et al., 2009; Zakarian et al., 1994).”
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Evidence of the adoption and implementation of a statewide childhood obesity prevention initiative in the New York State WIC Program: the NY Fit WIC process evaluation
Sekhobo, J. P., Egglefield, K., Edmunds, L. S., & Shackman, G. (2011) · Health Education Research · doi:10.1093/her/cyr100 · Cited by 21
“Related to the second objective, several behavioral theories, including the Health Belief Model and Social Cognitive Theory [13–16], were used to help identify constructs that correspond to proximal and distal process indicators or mediating outcomes [17, 18] that could be expected as a result of activities implemente…”
Method
Interventions for increasing fruit and vegetable consumption in children aged five years and under
Hodder, R. K., O’Brien, K. M., Tzelepis, F., Wyse, R., & Wolfenden, L. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008552.pub7 · Cited by 318
The Impact of Web-Based HOT (Healthy Outcomes for Teens) Project on Risk for Type 2 Diabetes: A Randomized Controlled Trial
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“A review conducted by Cerin et al. 23 suggested that interventions aimed at youth will improve their efﬁcacy by targeting key constructs of either the SCT or the theory of planned behavior.”
Influential
Psychosocial measures used to assess the effectiveness of school-based nutrition education programs: review and analysis of self-report instruments for children 8 to 12 years old.
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Strengthening the rigour of population-wide, community-based obesity prevention evaluations
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“Despite the benefits of such research, few trials have examined such relationships in obesity prevention research generally((89)).”
A Systematic Review on Mediation Studies of Self-Compassion and Physical Health Outcomes in Non-Clinical Adult Populations
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Incorporating Behavioral Techniques into a Serious Videogame for Children
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Mediating effects of home-related factors on fat intake from snacks in a school-based nutrition intervention among adolescents.
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Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior
Baranowski, T., Beltran, A., Chen, T. A., Thompson, D. I., O’Connor, T. M., Hughes, S. O., Diep, C. S., & Baranowski, J. C. (2014) · Public Health Nutrition · doi:10.1017/s1368980014001220 · Cited by 16
Self-citation
Staying in school for lunch instead of eating in fast-food restaurants: results of a quasi-experimental study among high-school students
Beaulieu, D., & Godin, G. (2012) · Public Health Nutrition · doi:10.1017/s1368980012000821 · Cited by 18
“tions among youngsters did not identify a mediating role of self-efficacy((63,64)).”
Background
Reliability of self-report measures of correlates of obesity-related behaviours in Hong Kong adolescents for the iHealt(H) and IPEN adolescent studies
Cerin, E., Sit, C. H. P., Barnett, A. H., Huang, Y., Gao, G. Y., Wong, S. H., & Sallis, J. F. (2017) · Archives of Public Health · doi:10.1186/s13690-017-0209-5 · Cited by 18
“In contrast, the evidence for many other individual-level factors, such as attitudes towards a behaviour or perceived barriers to engaging in a particular behaviour, is inconsistent or lacking [19, 20, 24].”
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Predicting use of effective vegetable parenting practices with the Model of Goal Directed Behavior
Diep, C. S., Beltran, A., Chen, T. A., Thompson, D. I., O’Connor, T. M., Hughes, S. O., Baranowski, J. C., & Baranowski, T. (2014) · Public Health Nutrition · doi:10.1017/s1368980014002079 · Cited by 27
“Behavioural theories provide a framework for understanding and systematically studying feeding behaviours((26,27)).”
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Behavioral Mediators of Weight Loss in the SHED-IT Community Randomized Controlled Trial for Overweight and Obese Men
Young, M. D., Lubans, D. R., Collins, C. E., Callister, R., Plotnikoff, R. C., & Morgan, P. J. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9657-0 · Cited by 17
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Influences on Children's Dietary Behavior, and Innovative Attempts to Change It
Baranowski, T., Diep, C. S., & Baranowski, J. (2013) · Annals of Nutrition and Metabolism · doi:10.1159/000351539 · Cited by 15
Self-citation
Psychologische Aspekte der Adipositas
Warschburger, P. (2011) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-011-1264-7 · Cited by 22
The Digital Education to Limit Salt in the Home Program Improved Salt-Related Knowledge, Attitudes, and Behaviors in Parents
Khokhar, D., Nowson, C. A., Margerison, C., West, M. L., Campbell, K. J., Booth, A., & Grimes, C. A. (2018) · Journal of Medical Internet Research · doi:10.2196/12234 · Cited by 18
“The program focused on constructs that have previously been shown to be related to dietary intake in children, such as self-efficacy [29], intentions (ie, goal setting) [30,31], reinforcements [32], and knowledge [33].”
Mediating Mechanisms of Theory-Based Psychosocial Determinants on Behavioral Changes in a Middle School Obesity Risk Reduction Curriculum Intervention, Choice, Control, and Change
Gray, H. L., Contento, I. R., Koch, P. A., & Noia, J. D. (2016) · Childhood Obesity · doi:10.1089/chi.2016.0003 · Cited by 13
“Reviews on mediating mechanisms of school-based EBRB interventions have indicated that effective mediators are behavior specific.(3,10) For example, knowledge and attitude,(19) outcome expectancies, and stages of change(20) were significant mediators for fruit and vegetable intake changes in school children and adoles…”
Background
School-based obesity-prevention interventions in low- and middle-income countries: do they really work?
Baranowski, T. (2012) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.112.043349 · Cited by 14
“Few mediating variable analyses have been reported (10); lack of significant findings of mediation in our own work has inhibited our submission of such manuscripts for publication.”
BackgroundSelf-citation
A test of cognitive mediation in a 12-month physical activity workplace intervention: does it explain behaviour change in women?
Plotnikoff, R. C., Pickering, M. A., Rhodes, R. E., Courneya, K. S., & Spence, J. C. (2010) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-7-32 · Cited by 14
“Further, a recent study [40] that reviewed mediators of dietary behavior change observed that interventions were relatively unsuccessful in changing mediators.”
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The Mechanisms Underlying the Relationship Between Self‐Compassion and Psychological Outcomes in Adult Populations: A Systematic Review.
Wang, J., Drossaert, C. H. C., Knevel, M., Chen, L., Bohlmeijer, E. T., & Schroevers, M. J. (2025) · Stress and Health · doi:10.1002/smi.70090 · Cited by 15
“Following Cerin et al. (2009), studies scoring 0–3 were considered low‐quality, four to six medium‐quality, and seven to nine high‐quality.”
Theoretical Mediators of Diabetes Risk and Quality of Life Following a Diabetes Prevention Program for Latino Youth With Obesity
Soltero, E. G., Ayers, S. L., Avalos, M. R. A., Peña, A., Williams, A. N., Olson, M. L., Konopken, Y. P., Castro, F. G., Arcoleo, K. J., Keller, C. S., et al. (2021) · American Journal of Health Promotion · doi:10.1177/08901171211012951 · Cited by 20
“Future iterations of the intervention should improve the operationalization of this construct to ensure that intervention strategies effectively target this mediator to avoid misinterpretations of the effectiveness of theoretical mediators.(41) Future studies should also more rigorously evaluate theoretical mediators…”
Background
The improvement of dietary behaviors among Iranian adolescent girls: a theory-based randomized controlled trial
Shirazi, M. G., Kazemi, A., Kelishadi, R., & Mostafavi, F. (2019) · Health Education Research · doi:10.1093/her/cyz004 · Cited by 13
Understanding how pain education causes changes in pain and disability: protocol for a causal mediation analysis of the PREVENT trial
Lee, H., Moseley, G. L., Hübscher, M., Kamper, S. J., Traeger, A. C., Skinner, I., & McAuley, J. H. (2015) · Journal of physiotherapy · doi:10.1016/j.jphys.2015.03.004 · Cited by 17
Cultural adaptation and psychometric properties of social cognitive scales related to adolescent dietary behaviors
Leme, A. C. B., & Philippi, S. T. (2014) · Cadernos Saúde Coletiva · doi:10.1590/1414-462x201400030006 · Cited by 20
Hispanic parents of overweight and obese children and their outcome expectations for children's television viewing: a qualitative study.
Rodriguez, B. D. R., Hilmers, A., & O'Connor, T. M. (2013) · Journal of nutrition education and behavior · doi:10.1016/j.jneb.2013.04.263 · Cited by 12
Quality assessment practice in systematic reviews of mediation studies: results from an overview of systematic reviews
Vo, T., Cashin, A. G., Superchi, C., Tu, P. H. T., Nguyen, T., Boutron, I., MacKinnon, D. P., VanderWeele, T. J., Lee, H., & Vansteelandt, S. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.12.013 · Cited by 14
“Table 2 – Characteristics of mediation quality assessment tools in the literature Journal First Author, Year Format Scope defined OA a Item & weights b Scoring range c SSI d Dev/Val/Rel e Freq f Details on the tool construction Preventive Medicine Lubans, 2008 (16) Scale No SS: 0-3: L; 4-6: M; 7-8: H 8, BQ Equal 0 – 8…”
Method
Salt Reduction Intervention in Families Investigating Metabolic, Behavioral and Health Effects of Targeted Intake Reductions: Study Protocol for a Four Months Three-Armed, Randomized, Controlled “Real-Life” Trial
Bjoernsbo, K. S., Riis, N. L., Andreasen, A. H., Petersen, J., Lassen, A. D., Trolle, E., Frederiksen, A. K. S., Munk, J. K., & Toft, U. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16193532 · Cited by 14
“Within these constructs, we focused on, knowledge [36], self-efficacy [37], intentions (i.”
Background
Effect of education based on Pender`s health promotion model on nutrition behavior of adolescent girls
Naserpoor, F., Zamani-Alavijeh, F., Shahri, P., & Malehi, A. S. (2018) · Journal of Research & Health · doi:10.29252/jrh.8.5.394 · Cited by 11
Status of Dietary Life Related Knowledge, Self-Efficacy, Food Preference and Dietary Behavior of Preschoolers in Kyunggi Area
Lee, A. R., Ye, L.-Y., Kim, H. J., Kim, K. A., & Kim, K. W. (2016) · doi:10.5720/kjcn.2016.21.3.274 · Cited by 11
“Cerin 등의 연구[28]에서 유아와 어린이의 식이자아효능감이 식행동 변 화에 긍정적인 영향을 준다는 것으로 나타나 본 연구결과와 유사하였다.”
Nutrition Science and Behavioral Theories Integrated in a Serious Game for Adolescents
Majumdar, D., Koch, P. A., Gray, H. L., Contento, I. R., Islas-Ramos, A. D. L., & Fu, D. (2015) · Simulation & Gaming · doi:10.1177/1046878115577163 · Cited by 13
Associations among measures of energy balance related behaviors and psychosocial determinants in urban upper elementary school children
Bandelli, L. N., Gray, H. L., Paul, R., Contento, I. R., & Koch, P. A. (2016) · Appetite · doi:10.1016/j.appet.2016.09.027 · Cited by 16
Self-efficacy and cues to action: Two main predictors of modified version of diet quality index in Iranian adolescents
Keshani, P., Salehi, M., Kaveh, M., & Faghih, S. (2018) · Progress in nutrition · doi:10.23751/pn.v20i2.6711 · Cited by 9
“A systematic review study, identified self-efficacy as one of the mechanisms most consistently associated with dietary behavior changes (28).”
Background

Authors: Cerin, E., Barnett, A., & Baranowski, T.
Affiliations: Agricultural Research Service (US)
ORCID: Cerin, Ester
Barnett, Anthony
Baranowski, Tom
Venue: Journal of Nutrition Education and Behavior
Publisher: Elsevier BV
Published: 2009-09
Volume: 41
Issue: 5
Pages: 309-318
ISSN: 1499-4046 (ISSN-L)
DOI: 10.1016/j.jneb.2009.03.129
OpenAlex: W2106714104
Cited by: 176
References: 0
Citations by year: 2025: 3 · 2024: 8 · 2023: 2 · 2022: 7 · 2021: 10 · 2020: 7 · 2019: 8 · 2018: 7 · 2017: 12 · 2016: 19 · 2015: 11 · 2014: 17 · 2013: 14 · 2012: 17
FWCI: 16.46
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Nutrition Education and Behavior (publishedVersion)
PubMed (publishedVersion)
Research Bank (Australian Catholic University) (submittedVersion)
The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords: dietary behavior change, youth, school-based intervention, mediation analysis, theory testing, self-efficacy, outcome expectations, theoretical mechanisms, nutrition education
MeSH terms: Adolescent, Behavior Therapy, Child, Child, Preschool, Diet, Feeding Behavior, Female, Humans, Male, Models, Theoretical, Obesity, Patient Education as Topic, Health Behavior

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Testing Theories of Dietary Behavior Change in Youth Using the Mediating Variable Model with Intervention Programs

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