Original Article

Social Support for Physical Activity for High Schoolers in Rural Southern Appalachia

Authors: Pooja Shah, BSPH, Jodi L. Southerland, DrPH, Deborah L. Slawson, PhD, RD, LDN


Objective: Social support for physical activity (PA) has been shown to enhance PA levels in adolescents. Although social support has been examined extensively in the literature, less is known about the role of social support for PA for high school adolescents in rural southern Appalachia. PA is important because adolescent obesity is greater in Appalachia than in the rest of the United States.

Methods: This was a qualitative secondary analysis of focus groups conducted in 2013–2014 among parents, teachers, and high school students (N = 77) in 6 counties across rural southern Appalachia. Beets’ typology of social support was used to categorize themes.

Results: Participants discussed instrumental supports, including providing transportation and paying fees, enrolling child in recreation/sports, and providing PA equipment at home. Performing PA with adolescents and modeling, watching/supervising, and prioritizing PA were identified as conditional supports. Several motivational supports were identified: encouragement, force, and the admiration of people who are active. Participants also identified key informational supports, including discussing the importance/health benefits of PA, how to be physically active, and general advice/information. Barriers to PA engagement (eg, body image issues, bullying, competitive nature of PA opportunities) and the role of referent groups (eg, family, peers, teachers) emerged as important concepts in the discussion.

Conclusion: This study identifies opportunities and practical ways for families and schools to provide, build, and strengthen supports for PA among adolescents in rural Appalachia.

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1. Ogden CL, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief 2015;(219):1-8.
2. US Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report. 2008. https://health.gov/paguidelines/report/pdf/CommitteeReport.pdf. Published June 2008. Accessed September 30, 2018.
3. US Department of Health and Human Services, 2008; Physical Activity Guidelines for Americans. https://health.gov/paguidelines/pdf/paguide.pdf. Accessed August 13, 2018.
4. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance-United States, 2015. MMWR Surveill Summ 2016;65(No. SS-6):1-174.
5. Telama R. Tracking of physical activity from childhood to adulthood: a review. Obes Facts 2009;2:187-195.
6. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005;111:1999-2012.
7. Dietz WH. Overweight in childhood and adolescence. N Engl J Med 2004;350:855-857.
8. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press; 2004.
9. Duncan SC, Duncan TE, Strycker LA. Sources and types of social support in youth physical activity. Health Psychol 2005;24:3-10.
10. Laird Y, Fawkner S, Kelly P, et al. The role of social support on physical activity behaviour in adolescent girls: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2016;13:79.
11. Mendonça G, Cheng LA, Mélo EN, et al. Physical activity and social support in adolescents: a systematic review. Health Educ Res 2014;29:822-839.
12. Pender N, Sallis J, Long B, et al. Health-care provider counseling to promote physical activity. In: Dishman RK, ed. Advances in Exercise Adherence. Champaign, IL: Human Kinetics;1994:213-235.
13. Davison K, Jago R. Change in parent and peer support across ages 9 to 15 yr and adolescent girls’ physical activity. Med Sci Sports Exerc 2009;41:1816-1825.
14. Yao CA, Rhodes RE. Parental correlates in child and adolescent physical activity: a meta-analysis. Int J Behav Nutr Phys Act 2015;12:10.
15. Beets MW, Cardinal BJ, Alderman BL. Parental social support and the physical activity-related behaviors of youth: a review. Health Educ Behav 2010;37:621-644.
16. Wright MS, Wilson DK, Griffin S, et al. A qualitative study of parental modeling and social support for physical activity in underserved adolescents. Health Educ Res 2010;25:224-232.
17. Dowda M, Dishman RK, Pfeiffer KA, et al. Family support for physical activity in girls from 8th to 12th grade in South Carolina. Prev Med 2007;44:153-159.
18. Walker N. Factors Influencing Healthy Eating and Physical Activity Behaviors of Adolescents in Appalachia [dissertation]. Johnson City: East Tennessee State University; 2016.
19. Marshall JL, Thomas L, Lane NM, et al. Health disparities in Appalachia. https://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=138. Published August 2017. Accessed October 5, 2019.
20. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance-United States, 2017. MMWR Surveill Summ 2018;67:1-479.
21. Wang L, Slawson DL, Relyea G, Southerland JL, Wang Y. Prevalence of and risk factors for adolescent obesity in Southern Appalachia, 2012. Prev Chronic Dis 2014;11:E222.
22. Slack T, Myers CA, Martin CK, et al. The geographic concentration of US adult obesity prevalence and associated social, economic, and environmental factors. Obesity (Silver Spring) 2014;22:868-874.
23. Beatty K, Hale N. NORC Researchers. Health Disparities Related to Obesity in Appalachia: Practical Strategies and Recommendations for Communities. Washington, DC: Appalachian Regional Commission; 2019.
24. Shah PM. Social Support for Physical Activity for High Schoolers in Rural Appalachia
25. Heaton J. Secondary analysis of qualitative data: an overview. Historical Soc Res 2008;33:33-45.
26. Long-Sutehall T, Sque M, Addington-Hall J. Secondary analysis of qualitative data: a valuable method for exploring sensitive issues with an elusive population? J Res Nurs 2011;16:335-344.
27. Berg B, Lune H. Qualitative Research Methods for the Social Sciences. 8th ed. Boston: Pearson Higher Education; 2011.
28. Mason J. Qualitative Researching. 2nd ed. London: Sage Publishing; 2002.
29. Ulin PR, Robinson ET, Tolley EE. Qualitative Methods in Public Health: A Field Guide to Applied Research. San Francisco: Jossey-Bass; 2005.
30. Slawson DL, Dalton WT, III Dula TM, et al. College students as facilitators in reducing adolescent obesity disparity in Southern Appalachia: team up for healthy living. Contemp Clin Trials 2015;43:39-42.
31. Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985.
32. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.
33. Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods 2006;5:80-92.
34. Crabtree B, Miller W. Doing Qualitative Research. 1st ed. Thousand Oaks, CA: Sage Publications; 1999.
35. Boyatzis R. Thematic Analysis. 1st ed. Thousand Oaks, CA:Sage Publications;1998.
36. Gellar L, Druker S, Osganian SK, et al. Exploratory research to design a school nurse-delivered intervention to treat adolescent overweight and obesity. J Nutr Educ Behav 2012;44:46-54.
37. Sallis JF, Alcaraz JE, McKenzie TL, et al. Parental behavior in relation to physical activity and fitness in 9-year-old children. Am J Dis Child 1992;146:1383-1388.
38. Martins J, Marques A, Sarmento H, et al. Adolescents’ perspective on the barriers and facilitators of physical activity: a systematic review of qualitative studies. Health Educ Res 2015;30:742-755.
39. Hamilton K, White KM. Extending the theory of planned behavior: the role of self and social influences in predicting adolescent regular moderate-to-vigorous physical activity. J Sport Exerc Psychol 2008;30:56-74.
40. Voorhees CC, Murray D, Welk G, et al. The role of peer social network factors and physical activity in adolescent girls. Am J Health Behav 2005;29:183-190.
41. Smith AL. Peer relationships in physical activity contexts: a road less travelled in youth sport and exercise psychology research. Psychol Sport Exerc 2003;4:25-39.
42. Beets MW, Vogel R, Forlaw L, et al. Social support and youth physical activity: the role of provider and type. Am J Health Behav 2006;30:278-289.
43. Thompson VJ, Baranowski T, Cullen KW, et al. Influences on diet and physical activity among middle-class African American 8- to 10-year-old girls at risk of becoming obese. J Nutr Educ Behav 2003;35:115-123.
44. Heaton J, et al. http://sru.soc.surrey.ac.uk/SRU22.html. Published Autumn 1998. Accessed October 5, 2019.
45. Rew L, Koniak-Griffin D, Lewis MA, et al. Secondary data analysis: new perspective for adolescent research. Nurs Outlook 2000;48:223-229.