Social Mechanisms for Promoting Physical Activity in After School Programs for Underserved Middle School Youth: A Feasibility Trial
Phase: NA
Conditions: Physical Activity, Obesity Prevention
Sponsor: University of South Carolina

 
Cover Page 
 
 
Study Title: Social Mechanisms for Promoting Youth Physical Activity: Applying a 
Developmental Framework for Improving Youth Health-Based Interventions (NIH R21 
HD077357) 
 
Principle Investigator: Nicole Zarrett, PhD, Assistant Professor, Department of Psychology, 
College of Arts and Sciences (803-777-2970; zarrettn@mailbox.sc.edu) 
 
Document Type: Study Protocol including Statistical Analysis Plan 
 
Document Date (last approved): September 12, 2016 
 
Board Approval #: Pro00037559 
 
 

 
University of South Carolina 
Human Subjects Research Proposal 
 
Study Title: Social Mechanisms for Promoting Youth Physical Activity: Applying a 
Developmental Framework for Improving Youth Health-Based Interventions 
 
Principle Investigator: Nicole Zarrett, PhD, Assistant Professor, Department of Psychology, 
College of Arts and Sciences (803-777-2970; zarrettn@mailbox.sc.edu) 
 
Table of Contents: 
A. Abstract 
B. Specific Aims/Hypotheses 
C. Background and Significance 
D. Research Design and Methods 
E. Data Analysis 
F. Human Subjects 
G. References 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
A. Abstract 
Physical inactivity has been identified as a primary contributor of childhood obesity and 
related diseases, with underserved youth (minority and low-income status) at greatest 
risk of inactivity and its health consequences. However, physical activity (PA) 
interventions have attained limited-to-no sustained behavior change and thus, have 
rarely affected targeted physiological or anthropometric health outcomes. Despite 
substantial research noting the importance of social influences and goals (e.g., being 
with, and making friends) on PA motivation and participation, PA-based interventions 
have almost exclusively emphasized approaches centered on constructs related to 
physical ability (e.g., mastery, self-efficacy). To date, little research has focused on 
understanding the contributions that social goal orientations and need for 
connectedness make toward promoting sustained youth PA. We argue that during 
adolescence, when orientation towards social relationships is strongest, the desire for 
social connections is a primary goal of action underpinning youth PA behavior and thus, 
a key mechanism to target for sustained behavior change. Thus, the proposed study will 
address limitations in previous research by targeting the social mechanisms needed 
within afterschool programs (ASPs) to promote sustained increases in youth PA. 
Application of social development research, Achievement Goal Theory, and Self-
Determination Theory provides the conceptual framework for addressing key social 
mechanisms: 1) Friendship (and the development of PA-based social skills); 2) Group 
Belonging (peer connection), and; 3) Connection with ASP Staff. Primary components 
of the study include “Get to know you” sessions aimed at providing youth guided social 
opportunities to foster friendship-building skills, and to promote acceptance, 
cooperation, contribution, and friendship affiliation, and infusing a novel socially-oriented 
PA curriculum within ASP free play sessions. A total of 8 afterschool programs that 
serve a primarily underserved population will be asked to participate in the program. 
During the spring of year 1, (phase 1), staff and youth interviews, youth surveys, and 
systematic observations of ASP sites were conducted to develop the program 
curriculum and staff training (previously approved by IRB – Pro00031648). During this 
upcoming Fall of year 1 we plan to test our curriculum during an 8-week pilot (1 
intervention and 1 control ASP (N=60 youth). During year 2 (Fall, 2015), after 
addressing measurement and/or implementation challenges identified in our Y1 pilot, a 
randomized study (3 intervention and 3 control ASPs) will be implemented to test the 
feasibility of the intervention approach (N=200 youth). Feasibility of our intervention 
should demonstrate that intervention youth report greater perceived connectedness and 
affiliation goal orientation toward PA from baseline to post-intervention. Observations of 
ASPs will test changes in the social climate from pre- to post-intervention and process 
evaluation will assess dose and fidelity. It is hypothesized that: 1) youth in the 
intervention (vs. comparison) will demonstrate greater improvements in positive PA 
affect, cognitions, and behaviors, and BMI from baseline to post-intervention, and; 2) 
targeted social mechanisms will mediate the effects of the intervention on changes in 
PA outcomes. 
 
 
 

 
B. Specific Aims 
Physical inactivity has been identified as a primary contributor of childhood obesity and related 
diseases,1-7 with underserved youth (minority and low-income) at greatest risk of inactivity and 
its health consequences.6,7 However, physical activity (PA) interventions have attained limited-
to-no sustained behavior change and thus, have rarely affected targeted physiological or 
anthropometric health outcomes.8-12 Extensive research on sport participation shows highly 
engaged youth report an affiliation orientation towards PA, identifying social reasons and goals 
(e.g., being with, and making friends) as their primary motivations for participation, and defining 
PA competence as achieving these social goals.13-15 Despite substantial research noting the 
importance of social goals on PA-based self-determined motivation16-18 and participation,19-21 
PA-based interventions have almost exclusively emphasized approaches centered on 
constructs related to physical ability (e.g., mastery, self-efficacy).22 To date, little research has 
focused on understanding the contributions that affiliation orientations (social goals) make 
toward promoting sustained youth PA.23,24 We argue that adolescents’ desire for social 
connections is a primary goal of action underpinning their PA behavior and thus, a key 
mechanism to target for sustained behavior change. The Active by Choice Today (ACT) 
program, conducted by our investigative team is one of the first afterschool programs (ASPs) to 
implement a climate-based intervention based on Self-Determination theory which shows 
significant improvements in PA in underserved youth.25-28 However, limited sustained effects 
found post-intervention, and data from interviews with ACT staff and youth28 which indicated the 
presence of several interpersonal barriers (e.g., cliques, teasing) to program effectiveness, 
suggests additional social climate components still need to be addressed. Systematic 
observations of ASPs using an observational tool that the PI has developed and tested29-31 and 
additional interviews conducted with ASP staff and youth further suggests that targeting youth 
social goals (e.g., building friendships through PA) and social competencies (e.g., friendship-
building skills) may be particularly effective for increasing and sustaining the PA of underserved 
youth. Thus, the proposed study aims to test the feasibility of expanding on the social climate 
approach of ACT to include three key “PA affiliation orientation” elements for increased and 
sustained youth PA: 1) Friendships (conceptualizing PA success/competence in terms of having 
close, mutual relationships with other individuals); 2) Group Belonging (defining competence in 
terms of feeling liked and accepted by peers), and; 3) Staff Acceptance/Connection (viewing 
success as feeling connected to, supported, and encouraged by staff).13-15 These elements have 
not been explored in prior research and we believe by enhancing ACT to include them in the 
resultant ACT2-Connect intervention will lead to sustained positive PA affect, cognitions, and 
behaviors in underserved youth. Comparison of ASPs receiving the 8-week “Connect” 
intervention (N=3 ASPs) with ASPs randomized to receive the general ASP curriculum (control 
condition; N=3 ASPs) will yield preliminary data on the effectiveness of social mediators for 
improving moderate-to-vigorous (MV)PA and preventing obesity among at-risk youth that can 
inform future intervention design and youth programming policy. Results of this proposed project 
will provide the basis for conducting a large scale efficacy trial.  
 
Specific Objectives: 
Develop and test the feasibility of the “Connect” intervention for increasing PA affect, cognition, 
and MVPA of underserved youth within ASPs. The effects of the intervention on youth body 
mass index (BMI) trajectories will also be explored and will have implications for impacting BMI 
as the targeted outcome of a larger R01 trial. 
 
Primary Aims (Program Development and Feasibility): 
1. Through qualitative interviews with staff and youth at ASP sites serving at-risk youth assess: 
a) conceptual constructs most relevant for facilitating and supporting youth PA social goals; b) 

 
barriers present within ASPs for meeting PA social goals (addressed in Phase 1, previously 
approved by IRB: Pro00031648). 
2. Explore the feasibility of the Connect program. The Connect program will be documented to 
be feasible as shown by: 1) youth’s greater perceived connectedness and PA affiliation goal 
orientation from baseline to post-intervention; 2). changes in targeted social climate components 
from baseline to post-intervention as measured by systematic observations, 3) staff perceptions 
of feasibility and acceptability of program as measured by a baseline and follow-up readiness 
assessment, and; 4) adequate dose and fidelity of program implementation as indicated by 
weekly process evaluations.   
 
Secondary Aims (Document the preliminary impact of the Connect program on PA 
outcomes): 
1. Assess whether youth in the social climate program (vs. comparison) demonstrate greater 
increases in positive PA affect, cognitions, and MVPA from baseline to 12-weeks post-
intervention. 
2. Explore whether youth in the social climate program (vs. comparison) demonstrate healthier 
BMI trajectories (e.g., slight reduction) from baseline to 12-weeks post-intervention.  
3. Assess whether changes in targeted social mechanisms will mediate the effects of the 
intervention on changes in PA affect, cognitions, and MVPA from baseline to post-intervention.	  
	  
C. Background and Significance 
 
Physical Activity for the Prevention of Obesity and Related Disease 
Recognized as the primary health threat for young people, national reports indicate that 34% of 
youth (40% of African American adolescents) are now considered overweight or obese1 with 
minority and low-income youth at greatest risk for obesity and related diseases.1,6-7 Sustained 
levels of moderate-to-vigorous (MV)PA, have been shown to have a strong effect on youth 
weight status, cardiorespiratory fitness, metabolic health, and body composition.1-5 Despite the 
benefits of PA, 50 - 92% of youth still do not meet national guidelines of 60 minutes of daily PA 
and PA declines as much as 50% between the elementary and middle school years32,33 with 
greatest declines and lowest levels of PA observed among African American females.34 Efforts 
to increase PA has become a national priority, however previous PA studies have been unable 
to sustain behavior change and thus, have rarely affected targeted physiological or 
anthropometric health outcomes.8-12 This may be, in part, because youth intervention 
approaches have rarely considered youth social developmental needs. We argue that 
adolescents’ desire for social connections is a primary goal of action underpinning their PA 
behavior and thus, a key mechanism to target for sustained behavior change. The proposed 
study will expand on previous research by testing the feasibility of a social-climate 
intervention within under-resourced afterschool programs (ASPs) that promotes 
increases in youth daily MVPA through targeting three primary PA social affiliation goals: 
1) Friendship, 2) Group Belonging, and 3) Staff Acceptance. 
 
Need for a Social Climate Approach for Promoting Youth PA 
For decades, correlational research within PE and sport settings has shown youth report social 
reasons and goals (e.g., friendship opportunities, being part of a team, coach behaviors) for 
initial and continued engagement in PA.13-21 During early adolescence, orientation towards 
social connections, salience of social feedback, and need for self-preservation within social 
contexts is more prominent than during any other period of the lifespan.35-37 Despite the 
developmental needs of adolescents, and the theoretical and empirical evidence of the 
importance of social factors for promoting PA, these factors have been minimally incorporated 
within intervention design, less well-defined than mastery or autonomy supports, and rarely are 

 
the targeted or primary mechanism for increasing PA. Rather, PA interventions have typically 
focused on education and behavior modification components (e.g., self-monitoring) as primary 
mechanisms for promoting sustained PA.38-50 Some studies have targeted contextual 
modifications within PA settings (e.g., teacher support, choice of “enjoyable” activities)42,48,50-57 
however, with an emphasis on promoting PA self-efficacy and skill development rather than 
socially-relevant goals, they have contributed little to understanding whether these contextual 
changes affect key PA social mechanisms, and have shown minimal impact on sustained PA 
behavioral change.12 Lastly, a small set of studies have been centered on addressing 
adolescents’ broader PA social experiences,52,56,57 with only a single study56 linking PA to 
socially-relevant goals (exploring the importance of dance in African American culture) as a 
central aim. Although these studies have evidenced some effects on indicators of physical 
health they have exclusively targeted females and have included minimal measurement of 
changes in important social mechanisms.  
 
INNOVATION 
Expanding on Climate-based PA Interventions for Youth 
The climate-based approach for our feasibility trial is based on a novel theoretical framework 
(Figure 1) that expands on the social motivational constructs highlighted by SDT58 and 
Achievement Goal Theory (AGT).59 Along with the need for competence and autonomy, SDT 
highlights the need for positive social interactions for improving long-term life style changes. 
According to SDT, the basic human need for social connection and meaningful interpersonal 
relationships should stimulate goal-directed behaviors to satisfy it. However, the social-
contextual features needed to meet youth relatedness needs have been less well-defined in 
previous PA interventions.23,60,61 AGT asserts that individuals want to and will strive to display 
competence in the way they define it,59 and that adolescents commonly define PA competence 
in terms of different social relationships (e.g. peer acceptance, close friendships).15 However, 
facilitating and supporting PA orientations that define PA competence in terms of developing 
positive relationships with others is a key motivational component for sustained PA that has 
been missing from other PA interventions. 
 
The proposed study addresses the limitations of previous youth PA interventions by targeting 
youth social goal orientations towards PA as the primary mechanism for promoting PA affect, 
cognitions, and behaviors in underserved youth. There are two distinct types of social goal 
orientations towards PA. The first orientation emphasizes affiliation experiences with the 
opportunity to socialize and develop relationships the primary goals for youth engagement in 
PA.23,24 The second orientation emphasizes social validation and stresses social status and 
approval from significant others as the primary goals for participating in PA.23,24 An affiliation 
orientation, which has been associated with help seeking, positive affect, and engagement at 
school, has been shown to be more favorable than a social validation orientation.62,63 Previous 
research has demonstrated three specific components of affiliation orientation that are 
particularly representative of the types of social relationships important to adolescents within 
physical domains:1) Friendships (conceptualizing success/competence in terms of having close, 
mutual relationships with other individuals); 2) Group Belonging (similar to SDT’s relatedness 
component, represents youth tendencies to define competence in terms of feeling liked and 
accepted by a group of peers), and; 3) Staff Acceptance (which tailored to ASPs, can be defined 
as viewing success as feeling connected to, supported, and encouraged by staff).13-15,64 
Extensive research on participation motivation in sport, physical education, and exercise shows 
highly engaged youth and adults report social reasons as their primary motivations for PA 
participation (viewing PA as an avenue for being with, and making friends, attaining peer 
acceptance/approval, and feeling connected to a group).16-23,65-67, Together, this research 
suggests that facilitating and supporting an affiliation orientation towards PA during adolescence 

 
may function as a protective factor for sustaining PA throughout adulthood.	  However,	  no PA 
interventions to date have targeted social goal orientations as the key mechanism to promote 
sustained PA.  
 
The goal of the proposed project is to test the feasibility of a social climate intervention that 
facilitates and supports PA affiliation goals as the primary mechanism through which youth will 
improve and sustain their PA affect, cognitions, and behaviors (see Figure 1). Youth focus 
groups and staff interviews, along with findings of previous research13-15,60,61,64 and systematic 
observations29-31 were used in phase 1 to identify social climate features needed to facilitate and 
support youth’s key PA affiliation goals: friendship, group belonging, and staff 
acceptance/connection.  
Staff Behaviors
Peer Behaviors
PA Types/Choices
Physical Env
Program Structure
PA Social Goal 
Orientation:
1.Friendship
2.Group Belonging 
3.Staff Acceptance
PA Behaviors 
(MVPA)
PA Cognitions
(perceived ability 
and value)
PA Affect 
(enjoy/worry)
1. Sustained Changes in: 
a. MVPA
b. PA Affect
c. PA Cognitions
2. BMI Trajectories
Figure 1. Program Structure and Conceptual Model
 
 
D. Research Design and Methods 
Preliminary Studies. Previous work by Drs. Zarrett (PI) and Wilson (co-I)25-28 on the ACT 
climate-based afterschool intervention (Wilson, PI) provide preliminary support for testing the 
feasibility of a social climate intervention for promoting MVPA in underserved youth. ACT, a 
novel program focused on increasing intrinsic motivation through involving students in the 
development and choice of physical activities offered (autonomy) and improving their sense of 
belonging (group cohesion) and PA mastery, is one of the first afterschool programs to 
implement a climate-based intervention based on Self-determination theory (SDT)58 which 
shows significant improvements in PA in underserved youth.25 Follow up data based on 
qualitative interviews also show significant staff changes that support a climate-based 
intervention approach.28 However, limited sustained effects found post-intervention25 indicated 
additional social climate components still need to be addressed. In particular, follow-up 
interviews with ACT youth and program staff conducted by the PI indicated there were key 
social barriers (self-consciousness, teasing, cliques) that undermined youth PA motivation and 
interfered with program effectiveness.28 Although ACT addressed the social environment (e.g., 
belonging), findings suggest a need for more targeted approaches aimed at developing youth’s 
intrapersonal assets (social skills for developing and maintaining friendships), enhancing youth’s 
interpersonal PA supports, and reorienting youth PA attitudes so that they view social benefits 
(developing friendships, a sense of group belonging, staff connection) as the primary 
goal/purpose and achievement of PA. No PA intervention to date has been designed to test 
these specific social goals. The proposed study addresses the limitations of past work by 
identifying social mechanisms of the afterschool climate for targeting changes in PA social 
orientations (Friendship, Belonging, Staff Connection) using qualitative methods and an 
observation tool that the PI has developed and tested. Preliminary observational studies 

 
assessing the PA social-motivational climate of summer camp29,30 and ASP31 settings conducted 
by the PI indicated ‘positive peer interactions’ was a primary predictor of youth higher rates of 
MVPA [F(1,329)=8.43, p<.01]. Moreover, findings indicated a clear deficit in observed instances 
of important social resources for PA (e.g., < 3% observed instances of staff verbal praise or PA 
promotion; 20% of activities were inclusive; 11% involved staff PA participation; 14% involved 
positive peer interactions).29-31 The PI also conducted interviews and focus groups with 7 of the 
ASP sites (26 staff, 102 youth) to identify an initial set of social motivators and barriers for youth 
PA within each site and the program’s “readiness” for implementing the proposed intervention. 
Findings indicated the majority of staff (84%) view PA as a primary mission of their ASP 
(Freq=36; 24 staff; 6 programs), but also report several socially-based challenges to get youth 
active including “cliques, peer pressure, social norms” (freq=10; 7 staff; 4 programs) and youth 
“poor PA self-concept” (e.g., self-conscious, shy, afraid to mess up; Freq=9; 8 staff; 5 
programs). Further, “finding better ways to motivate youth to participate with peers in PA” (5 
staff; 4 programs) emerged as a common theme when staff were asked about ways to improve 
the program. These findings contribute to our understanding of the strengths and needs of 
ASPs, and the key mechanisms for inducing youth PA behavior change that will inform the 
proposed intervention design. 
 
Study Design of Proposed Connectedness Feasibility Trial 
The proposed project will be a prospective, randomized controlled trial comparing a social 
climate program to a general ASP. 
The proposed project will be 
implemented over a 2 year period 
(see Figure 2). A planning phase 
occurred during the first six months in 
order to conduct staff interviews, 
youth focus groups, and systematic 
observations of each ASP, hire staff, 
pilot survey measures, and revise 
intervention materials and evaluation 
tools based on observations, surveys, 
and interview and focus group 
feedback (addressed in phase 1 IRB 
application). During the fall of year 1, 
an 8-week pilot will be tested in 1 ASP 
(N=30) and compared to a general 
health curriculum school-based 
control (N=30). Results of the pilot 
study will be used to inform any 
necessary modifications of the 
intervention approach or 
measurement protocol for year 2. 
During year 2, a randomized study (3 
intervention and 3 control ASPs) will 
be implemented to test the feasibility 
of the intervention approach (N=200 
youth). A 12-week follow-up, will test 
the sustained effects of the social 
climate intervention on ASP PA climate, youth PA affect, cognitions, behaviors, and BMI 
 
Primary Aim 1 (COMPLETED PHASE 1): Interviews/Focus Groups and Youth Survey 
Figure 2. Project Timeline 
YEAR 1 
YEAR 2 
 
April-Sept 2014 
- Interviews/Focus Groups      
- Observations 
- Intervention development 
- ASP program recruitment 
- Hire and Train Staff 
 
Aug-Oct 2015 
- Intervention/Measurement   
  Staff Training 
- Baseline Data Collection 
  (2 ASPs) 
- Intervention Implement  
  cohort 1 
 
 
Sept-Dec 2014 
- Pilot Baseline Data     
  Collection  
- Pilot Intervention (1 ASP   
  vs. 1 control)  
 
Oct-Dec 2015 
- Baseline Data Collection  
  for cohort 2 (2 more ASPs) 
- Intervention Implement 
  (cohort 2) 
 
 
Feb-Apr 2015 
- Post-measures in Pilot   
  ASPs 
-  Data cleaning 
-  Hire Project Staff for Y2 
 
Jan-March 2016 
- Post-measures for cohorts  
  1 and 2 
- Baseline data collection for  
  cohort 3 (2 ASPs) 
- Intervention implement   
  (Cohort 3) 
 
April-July 2015 
 -Data analysis 
- Revisions to intervention   
  and measurement 
- ASP Recruitment for Y2  
 
April-May 2016 
- Post-measures cohort 3 
- Data Management/   
  Analysis  
-Manuscript Preparation 

 
Measures. During year 1, we conducted staff interviews (SIs) and youth focus groups (FGs; 
youth ages 9-14) in ASP sites to assess 1) key physical (e.g., equipment allocation), structural 
(e.g.,PA preferences, activities offered), interpersonal (e.g., peer behaviors), and intrapersonal 
supports (e.g., social skills) needed to promote and support a social affiliation orientation 
towards PA (friendship, group belonging, and staff connection goals), 2) program barriers 
impeding the development and achievement of these social goals, and 3) input on the design 
and feasibility of initially- developed program components. Through content analysis (NVivo) we 
identified key themes related to improving social affiliation that were used to inform the 
development and implementation of the social climate intervention.  
 
Targeted Population, Recruitment, and Retention. We aim to recruit 8 middle-school ASPs 
located within a 70 mile radius of Columbia that serve a primarily underserved population of 
middle school youth (6th–8th grade) youth. All ASP sites will need to include 1 hour of daily 
PA/freeplay as one component of the curriculum and be similar in size, percentage of youth per 
site on free or reduced lunch, race, and gender. One ASP will be asked to participate in the pilot 
during year 1 and will be compared to a school-based control (youth in the control will receive 
our general health curriculum administered in their health class during the school day). During 
year 2, six ASPs will be randomized to the treatment or control (general health curriculum) 
conditions after baseline data collection. ASP staff and all youth enrolled in the program will be 
asked to participate in the study. To be eligible, youth must 1) be enrolled in the ASP, 2) have 
parental consent and assent to participate, and 3) be available for baseline and post-
intervention measurement. Youth will be excluded from participation only if they have a medical 
condition that would interfere with the program’s prescribed PA.  
 
Overview of Intervention.  
Drawing from theory and previous correlational13-21,64-72 and qualitative research,60,61 along with 
our preliminary studies in ASPs25-31 we have identified key components for establishing a 
positive PA social climate that will inform the initial development of the intervention (see 
Appendix A). The intervention will target multiple levels of the ASP setting including staff- and 
peer- behaviors, program structure (e.g., activities), and the physical environment. Initial 
essential elements were derived from common themes identified across these levels including: 
1) moral, emotional, and social goal-oriented support and skill development (e.g., friendship-
building skills) 2) collaborative, cooperative play centered on friendship and informal-fun; 3) 
equal treatment and access, and; 4) inclusive and engaging for both youth and staff. The 
primary components of the study include: 1) “Get to know you” sessions aimed specifically at 
providing youth guided social opportunities to foster friendship building skills, and to promote 
acceptance, cooperation, contribution (to self and others), and friendship affiliation, and; 2) 
infusing a novel socially-oriented PA curriculum within ASPs’ free play sessions (see Appendix 
B). The intervention will take place during ASPs’ 1.5 hour “free play” component 2 times per 
week for 8 weeks. Dr. Thom McKenzie (Consultant), Dr. Dawn Wilson (co-I), and a staff of 
Physical Educators will assist the PI in designing all program activities to meet the criteria of 
the essential elements.  
 
The “Get to Know You” small group sessions (30 minutes) will be designed to specifically 
increase friendship building skills, and a value and efficacy for contributing to the health and 
well-being of oneself and others.  It will involve interactive student-led discussions and activities 
that are designed to foster the intra- and interpersonal assets needed to build and support 
friendships, group cohesion, and staff connections through PA. For example, in small (staff-
assigned) groups, staff will challenge youth with fun team building activities and icebreakers, 
youth will be encouraged to share ideas (e.g., brainstorm sessions on best methods for teaching 
friends new activities; how to be a good friend, active listener), personal stories, preferences, 

 
and goals (e.g., their happiest/scariest memory, favorite PA to do with a friend), and activities 
(e.g., they will each be asked to bring in a favorite activity to teach their peers). They will also 
collaborate each program day to develop a campaign to encourage others to be active (e.g., 
family members, friends, teachers). This will include developing fliers/posters, and logos, 
performing and recording an entertaining media/video clip, and designing their own 
choreography for a dance or martial arts routine that they will teach and then perform with their 
targeted group (families, friends, teachers) at a ‘family and friends’ night, to further empower 
youth to exercise their newly developed PA-based social skills and goals, build social 
connections through PA outside of ASP time, and help sustain PA behaviors post-intervention. 
(See Appendix C for “Get-To-Know You” curriculum) 
 
The PA component (60 minutes). Youth will participate in one of three socially-oriented 
physical activities that will be offered based on student preference ratings obtained the week 
prior. Studies by our group25-28 show that student motivation is increased by allowing students to 
vote for their PA preferences among a list of activities. To promote a PA affiliation orientation, 
available games to choose from will be novel, inclusive, emphasize teamwork, and centered on 
social goals that involve components of the “get to know you” sessions. (See Appendix D for 
PA curriculum) 
 
The Comprehensive (general) Health Comparison Program (60minutes). (See Appendix E 
for comprehensive health curriculum). The comparison programs (ie., during health class for 
year 1 pilot; 3 ASP in year 2) will receive a comprehensive health curriculum within their 
programs that is designed to increase youth knowledge and skills across a wide variety of 
health-based behaviors. The curriculum includes interactive components addressing stress 
management and reduction (yoga and breathing exercises), media literacy and cyber safety, 
self-discipline (achievement and goal setting, martial arts), risk prevention, and building a 
positive self-esteem and positive thinking.     
 
Zarrett (PI) and Wilson (co-I) will oversee the intervention team which will consist of a program 
coordinator, 2 certified PA activity leaders, and, at minimum, 10 trained intervention staff. 
Program staff of each participating ASP will also be involved in all aspects of the intervention. 
The PI and the program coordinator will monitor the daily activities of the intervention and 
comparison programs. All intervention staff will be required to attend a 3-day training course on 
implementing one of the two programs (intervention or comprehensive comparison) and a 1-day 
booster session at midpoint. To ensure sustainability of the program’s climate and activities 
post-intervention, ASP staff will also play a primary role in implementing program components. 
All ASP staff will be provided a program manual, two 2-hour trainings prior to program 
implementation in which the intervention team and physical educators will teach ASP staff 
the program’s essential elements and the associated PA games and leadership strategies, and 
a 1 hour booster at midpoint. Three 15-minute youth “training” sessions conducted by the 
intervention team will help guide youth in deriving ground rules for promoting teamwork, respect, 
and a sense of  social responsibility.  
 
 
Potential Challenges and Alternative Strategies. Given all study components occur in ASPs 
(where all study participants typically attend daily), and previous work with these same ASP 
partners resulted in over 95% youth/staff participation, recruitment and retention difficulties are 
not anticipated. However, we will partner with the program directors to assist in recruitment 
(e.g., getting parent consent). A follow-up mechanism in which we place “check-in” phone calls 
to study participants, and the provision of small incentives for completing baseline and post-
intervention measures, will be employed as strategies to ensure retention. To ensure adherence 

 
to intervention protocol an internal process evaluation will be implemented each week for 
corrective feedback and adjustment as needed, and a booster training session for all staff will 
be implemented at mid-point. There is little-to-no communication across ASP sites (each site 
has their own staff and serve youth from distinctly separate schools), however to limit cross-
contamination between study sites we will enlist the help of the program directors who have 
previous experience with other RCTs and possess a strong understanding of the importance of 
having distinct intervention and control conditions. These strategies have been highly successful 
in our previous studies.25-27 
 
Study Measures  
All study measures will be collected by trained and certified staff blind to group assignment. The 
PI will hire a Program Coordinator to assist with oversight and training of measurement staff. 
Measurement certification entails reviewing protocols and demonstrating agreement with the 
Coordinator on anthropometrics, systematic observations, survey protocols, and PA 
assessments. Our team has experience developing and using these protocols in large scale 
studies.25 See Appendices for all measures. 
 
Primary Aim 2. Feasibility  
To test the feasibility of intervention implementation, process evaluations that monitor dose 
and fidelity will be conducted within both the intervention and control conditions once a week by 
an independent process evaluator for the duration of the program (see Appendix B). Through 
observation and use of a quantitative checklist and rating scales, the process evaluator will 
assess whether there are any changes in the structure, delivery, or climate of the control 
condition (e.g., whether youth are consistently provided at least 1 hour of daily free play), and 
whether the social climate of intervention ASPs achieve the program’s essential elements. 
Systematic observations will be conducted using the System for Observing Children’s Activity 
and Relationships during Play (SOCARP; see Appendix F)73,74 and a modified version of the 
System for Observing Fitness Instruction Time (SOFIT) that includes a social climate 
observation tool that has been developed and tested by the PI (MCOT-PA).29-31 Teams of two 
coders will make continuous observations of daily activities throughout 5 program days at each 
ASP. Observations will be used to assess changes in key social climate features for promoting 
youth affiliation goals. Staff structured interviews (Readiness Assessment) will assess staff 
perceptions of the feasibilility and acceptability of the intervention program components 
conducted at baseline, mid-point, and post-intervention. This readiness assessment is 
developed to correspond with a multi-component theory of organizational readiness that 
addresses both program motivations and capacities75 including motivation for implementing the 
CONNECT intervention, innovation-specific capacity for CONNECT, and general capacity, and 
has been previously piloted with principals, teachers, and technology specialists for a school-
based technology intervention. We have adapted the assessment to fit within the afterschool 
program structure and PA goals of our intervention (see Appendix H).  
 
The Social Motivational Orientations Scale for Sport (SMOSS)23 will be used to assess 
changes in participants' degree of social affiliation orientation (7 items) and social validation 
orientation (8 items) toward PA (5-point scale, M=2.44; SD=1.04). The SMOSS is well-
validated,23,76 correlated with PA value, enjoyment, and perceived ability, and has adequate 
internal consistency (reliability coefficients range from .77 to .87). The Motivation for Physical 
Activities Measure (MPAM) assesses five motives for participating in PA: Fitness, 
Appearance, Competence/Challenge, Social, Enjoyment. The scale has been used to predict 
various behavioral outcomes, such as attendance, persistence, or maintained participation in 
some sport or exercise activity, and to predict mental health and well-being and has 
demonstrated strong internal consistency (alphas above .87 for each of the subscales) 77 The 

 
Task and Ego Orientation in Sport Questionnaire (TEOSQ) assesses youth task (mastery) 
or ego (performance) orientations towards PA and is predictive of value, intrinsic interest and 
enjoyment in PA (reliability coefficients range from .71 to .87)78. The Need for Relatedness 
Scale79 will assess feelings of social connections to others within the ASP setting and has been 
previously validated using other SDT constructs80-82 (reliability coefficients range from .86 to .92; 
5-pt scale, M=3.74; SD=.75). The Perceived teacher support scale83-85 (reliability coefficient 
=.84; 5-pt scale, M=3.22; SD=1.05) and The Peer Motivational Climate in Youth Sport 
Questionnaire86 (reliability coefficients range from .69 to .82; 7-pt scale, M=3.18, SD=1.32) will 
be used to measure youth perceptions of staff and peer connections. Validity of both measures 
has been supported in previous work and shown to correlate with PA enjoyment, effort, and 
prosocial and social responsibility goals.83-86 The Social Support and Exercise Survey will 
measure changes in youth family and friend social support for youth PA.87 (See Appendix G for 
Youth Survey Measures). 
 
Secondary Aims 1, 2, and 3: Youth MVPA, Cognitions, Affect, and BMI 
Youth Physical Activity (Accelerometer). Objective assessments of PA will be obtained on 
youth with omni-directional accelerometers (Acticals; Mini-Mitter, Bend, OR).88 Actical has 
demonstrated correlations between activity counts and energy expenditure of individuals 
measured concurrently with accelerometers (e.g., MTI Actigraph, Caltrac, Tritrac) in several 
studies.89 Youth will wear an accelerometer over 7 consecutive days to calculate PA at baseline, 
endpoint, and post-intervention. Data will be recorded in 30-s epochs to best capture short 
bouts of vigorous activity,90,91 and raw activity data will be converted into time spent in moderate 
(3-5.9 METS), vigorous (6-8.9 METS), and MVPA (3-8.9 METS) based on activity count 
thresholds for children identified by Puyau et al.88 Dr. Zarrett (PI) and Dr. Wilson (Co-I) have 
been involved in multiple trials using accelerometer to measure PA in youth.25-27  
 
PA Cognitions will be measured by youth perceptions of their physical ability (5-pt scale, 
M=3.68; SD=.97) and value of PA (5-pt scale, M=3.81; SD=1.18) using four items derived from 
the expectancy-value model that have been well-validated in youth minority populations92-94 
(reliability coefficients range from.76 to .94). PA Affect will be measured by the extent to which 
adolescents engaged and enjoyed PA activities using The Intrinsic Interest Scale95 (reliability 
coefficients from .83 to .94; 5-pt scale, M=3.7, SD=1.0) and the degree to which youth are 
concerned about performing well during PA using the worry subscale of The Sport-Anxiety 
Scale-2 (reliability coefficient = .89; test-retest = .90; sum score range 4 to 20; M= 12.12; SD= 
3.85).96 All PA cognition and affect measures have been shown to be correlated with the 
SMOSS and other measures of interest to the study (e.g., PA effort, ability).23,76,96 Body Mass 
Index. Height and weight will be measured at baseline and post intervention using a Shorr 
Height Measuring Board and a SECA 880 digital scale. Sex- and age-standardized BMI (zBMI) 
will be calculated for youth using CDC 2000 reference curves. (See Appendix G for Youth 
Survey measures). 
 
Covariates. Demographic data will be collected on adolescents at baseline including self-report 
age (date of birth), race/ethnicity, and gender. Free /reduced lunch status will be derived from 
school/program records.  The Positive Youth Development Scale (PYD-VSF; reliability 
coefficients from .72 to .90)97 and The Strengths and Difficulties Questionnaire (SDQ; test-retest 
reliability=.80)98,99 will be used to measure indicators of positive development (e.g., connection, 
competence) and the presence of depressive symptoms because of previous research 
indicating an association between well-being/depression and youth PA and obesity. Lastly, the 
Self-Regulation Questionnaire- Prosocial (SRQ-Prosocial) assesses individual differences in 
prosocial behaviors, friendship, interpersonal skills, and exercise (reliability coefficients from 
.61-.85).100 

 
E. Analysis Plan 
This proposal is a feasibility test of the social climate intervention and will gauge a plausible 
effect size of the program for a larger R01 application. To that end, we will examine several 
subjective and objective markers of program success such as changes in targeted social 
mechanisms within youth and the ASP climate, and explicit PA outcomes. We will also explore 
the potential effects of the intervention on youth BMI. Although only minimal change in BMI 
would be plausible given the length of the current proposal, our findings will have implications 
for impacting BMI as the targeted outcome of a larger R01 trial.     
 
Primary Aim 1. (ADDRESSED). The first aim of the study is to conduct qualitative interviews 
with program staff and youth to identify conceptual constructs most relevant for fostering youth 
PA affiliation orientation. Interviews and focus groups will be transcribed, coded, and analyzed 
(QSR NVivo) to identify common themes for these study goals. A coding scheme composed of 
“levels” of categorization or manageable “themes,” will be developed to guide the manner in 
which the qualitative data will be analyzed. Ultimately, these themes will be used to summarize 
the data. Data will be coded by two coders and inter-rater reliability estimates will be assessed. 
Prior to analysis, raters will meet to discuss each coding disagreement until consensus is met 
regarding final codes. The PI has extensive experience in using QSR NVivo to conduct content 
analysis of themes (see our previous work).28 
 
Primary Aim 2.The second primary aim of the study is to assess whether youth in the 
intervention demonstrate greater change in the 3 PA social affiliation mechanisms from baseline 
to post-intervention. Gains in these social mechanisms will be assessed with repeated 
measures ANCOVA models in which time (baseline to end of program and baseline to post-
intervention) is a within subject factor and treatment is a between subjects factor for social 
mechanism variables measured in both conditions. Analyses will control for demographics, 
baseline BMI, and any other variables for which there are baseline differences between 
treatment and control groups (e.g., PYD, depression). To examine overall changes in social 
mechanisms within the intervention alone, similar repeated measures ANCOVAs will be used, 
with the between subjects treatment factor dropped. The test of interest will be the within 
subjects factor of time, with affiliation goals expected to improve over time. Process Evaluation, 
used to assess the quantity (dose) and quality (fidelity) of program implementation, will also 
serve as feasibility assessments. Our group has extensive experience with “dose-response” 
analyses.27 Weekly observational assessments of program facilitation, using standardized 
ratings developed for other studies,101-103 will be reduced to a total score, indicating overall 
fidelity to the activity observed.  
 
Secondary Aims. Secondary Aims 1 and 2 tests the a-priori hypothesis that youth in the 
intervention (vs. comparison) will have greater improvements in PA affect, cognitions, and 
MVPA and healthier BMI (z-score) trajectories (e.g., slight reduction; less increase) from 
baseline to post-intervention. This study will also provide us with information on the effect size 
that might be expected to power an efficacy trial after completion of the R21 project. Greater 
improvements will be assessed with several repeated measures ANCOVA models in which time 
(baseline to post-) is a within subject factor and treatment is a between subjects factor for PA 
variables measured in both conditions. Analyses will control for demographics (and BMI for PA 
outcomes) and other variables for which there are baseline differences between treatment and 
control groups. Multiple imputation protocols104,105 will be used to address missing accelerometer 
data (see our previous work).25  
 
Secondary Aim 3 explores whether changes in youth PA social orientations mediate the effect 
of the intervention on changes in adolescent PA outcomes. This hypothesis will be tested with a 

 
multiple mediator model (estimated path model) where the indirect effect of the program on PA 
through social mechanisms will be examined. Bootstrapped estimates of the mediated effect will 
be examined in line with recommendations from methodological research.106,107 Both the total 
indirect effect of all variables together and specific mediated effects of each variable will be 
examined. 
 
 

 
F. Human Subjects 
Protection of Human Subjects 
Risks to the Subjects 
Human Subjects involvement and Characteristics.  Subjects will be healthy male and 
female adolescents and adults. To be eligible, adolescents must 1) be currently enrolled in the 
afterschool program, 2) have parental consent to participate, and 3) agree to study participation 
and random assignment, and 4) be available for baseline and post-intervention measurement.  
Adolescents will be excluded from participation if 1) have a medical condition that would 
interfere with the prescribed physical activity intervention plan, 2) are developmentally delayed 
such that the intervention materials will not be appropriate or, 3) are in treatment for a 
psychiatric disorder. To be eligible, adults must 1) be part of the afterschool staff, 2) have no 
medical condition or disorder that would limit participation, 3) be available and able to participate 
in the interviews and/or the intervention phase for the study period. 
 
Sources of Material.  All data will be obtained for research purposes only. Data 
collected for adolescents will be demographic (age, race, date of birth), anthropometrics (height 
and weight), behavioral (physical activity as measured by accelerometer estimates), and 
psychosocial surveys related to changes in physical activity affect, cognitions, behaviors, and 
general well-being. Data collected for adults will include demographics (age, race, etc.), and 
structured interviews to ask about their views on the best methods for engaging staff in program 
goals and for adopting the intervention into their pre-existing program and assess what supports 
are needed to increase the quality of implementation and sustainability of the program post-
intervention. Distinct program dimensions measured include motivation for implementing the 
CONNECT intervention, innovation-specific capacity for CONNECT, and general capacity (see 
Appendix H). The interview protocol also includes measurement of staff motivation, value, and 
perceived efficacy for implementing the intervention curriculum and PA more generally. 
Interviews will be tape recorded and transcribed and names will not be included with the 
participants’ recorded responses.   
 
Potential Risks.  There is little risk involved in participating in this study. Typical to any 
Physical Education class (PE) subjects who participate in the intervention may experience some 
discomfort such as minor physical strains and sprains associated with engaging in physical 
activities during the intervention. Activities offered in both the health class and the afterschool 
program are similar in risk to the typical activities offered in the class/afterschool program. There 
is little risk associated with wearing the accelerometers in the study. Adolescents will be 
monitored to determine if they are experiencing any discomfort as a result of wearing the 
devices. There is also little risk to filling out the questionnaires – the majority of questions are 
centered on PA (social) preferences and perceptions about their experiences in the program, 
and are not anticipated to trigger negative emotional states. Adolescents will be encouraged to 
skip a question or stop filling out the questionnaire if they feel any discomfort with questions 
asked. Numbers will be provided to each adolescent so that their questionnaire cannot be 
identified, and the names-to-numbers list will be kept separate from participants’ recorded 
responses. The data collected from youth will be kept confidential in all circumstances unless 
information acquired about a child’s wellbeing indicates the child may be at harm. In such a 
case, we would privately contact the parent and refer the child to the school counselor for 
further assessment. This breach of confidentiality is articulated in the consent form.  
 
Adequacy of Protection Against Risks 
 

 
 
Recruitment and Informed Consent. All program staff from each of the 7 afterschool 
programs (the health program control administered during the school day in y1 will be excluded) 
will be asked to participate in the interview component of the study (N=21). Informed consent 
will be sought from each adult for participation in this project.   
 
A total of 298  students in the select afterschool programs will be recruited to participate in the 
study (Y1 Pilot study = 98 students; Y2 Intervention = 200 students).  Adolescents will be 
excluded from participation if they 1) have a medical condition that would interfere with the 
prescribed physical activity intervention plan, 2) are developmentally delayed such that the 
intervention materials will not be appropriate or, 3) are in treatment for a psychiatric disorder.  
Informed consent will be sought from each child’s parent/guardian for participation in this 
project.  Assent forms will also be completed by all students prior to participating in the study.  
Parents and children will be encouraged to ask any questions they might have regarding the 
procedures.  There will be no coercion to participate or prejudice against those who choose not 
to take part in the study.  We will submit an application to the University of South Carolina 
Institutional Review Board for approval of study procedures and the informed consent protocol.  
No data collection will take place prior to IRB approval. 
 
Protection Against Risk.  There is little risk associated with wearing the physical 
activity monitors in this study. Adolescents will be monitored to determine if they are 
experiencing any discomfort as a result of wearing the devices.  Safety and prevention of injury 
while wearing the monitors will be considered.  Likewise, there is little risk associated with 
participating in the physical activities. Risks are parallel to a typical PE class and are similar to 
the risk of the typical activities offered in the class/afterschool program.  Staff from the 
University of South Carolina will be available to assist with any minor injuries as a result 
participating in the physical activities during the program. All school-based ASP staff are trained 
in CPR and intervention staff will be trained by PA leaders (hired PE teachers) on injury 
prevention during the pilot study and randomized intervention study.  The majority of staff 
interview questions and youth questionnaires will be centered on PA (social) preferences and 
perceptions about their experiences in the program and the proposed intervention, and are not 
anticipated to trigger negative emotional states (see above for details). Participants will be 
encouraged to skip a question or dismiss themselves from the interviews or questionnaires if 
they feel any discomfort with questions asked. Data will be kept completely confidential unless a 
child provided information that indicates he/she may be at harm (e.g., depression). In such a 
case, we will privately contact the school counselor and caregiver. Numbers will be provided to 
each participant so that they are not addressed by name in the recorded interview, and the 
names-to-numbers list will be kept separate from participants’ recorded responses. Similarly, 
youth names will be kept separate from their questionnaires, and the names-to-numbers list will 
be stored in locked file cabinets. Data collected in this study will be accessed only by the 
investigators and designated staff persons.  Staff that collect study measurements will be 
trained and supervised by the PI and program coordinator on the proposed project.  Data will be 
stored in locked file cabinets that only study staff can access. Additionally, electronic participant 
databases will be password protected and stored at the University of South Carolina.  
Afterschool program personnel will not have access to the data.  We have used these 
procedures on several research studies to successfully protect against risk.  
 
Potential Benefits of the Proposed Research to the Subjects and Others. The goal of the 
proposed study is to assess the feasibility of developing an afterschool program climate that 
increases and sustains youth moderate-to-vigorous physical activity and improves youth body 
mass index (BMI) trajectories through meeting youth social developmental needs. The findings 
from this study will provide the information necessary to conduct a large scale efficacy trial that 

 
could have important implications for increasing the potential impact of afterschool-based health 
interventions for preventing obesity.  
 
Adult participants in this study will learn valuable information about how to improve the 
afterschool climate to support student engagement in physical activity, and will be provided 
valuable strategies and tools that they can implement within their programs. Psychosocial 
benefits for both students and adults include improved relationships within the program 
(including between staff, between students, and between staff and students), improved 
afterschool program supports for health initiatives, and valuable opportunities and strategies for 
improved physical activity.  Physical benefits of the proposed research for youth (and, indirectly, 
adults) will include weight control, building muscle mass, reducing fat, lowering blood pressure, 
and reducing psychosocial symptoms of depression and anxiety. Thus, increasing physical 
activity in adolescents (and, indirectly adults through intervention implementation) may have 
important public health implications for reducing chronic disease and increasing longevity and 
quality of life in this population. The benefits of the proposed research to the adult and 
adolescent participants outweigh the potential risks.  
 
Importance of the Knowledge to be Gained. Results will fill knowledge gaps and provide 
feasibility for a larger afterschool-based efficacy trial that will implement a social climate that 1) 
facilitates youth perceived connectedness and affiliation goal orientations during PA; 2) 
improves youth PA-related affect, cognitions and behaviors to reduce youth body mass index 
(BMI), and 3) sustains behavior changes post intervention for continued improvements in BMI 
trajectories. The results from this study will have important implications for increasing the 
effectiveness of afterschool interventions/programs for obesity prevention among underserved 
youth. 
 
Data Safety Monitoring Board and Plan. A data and safety monitoring committee (DSMB) 
consisting of a variety of experts in conducting large-scale PA interventions and measuring the 
quality of afterschool programs for youth will be convened at the beginning of the study to 
provide input and guidance on the study evaluation and intervention procedures including 
quality assurance and safety issues related to the study design. Robert Brustad, PhD., 
Professor of Sport and Exercise Science at the University of Northern Colorado, has agreed to 
serve on the committee as Chair. He will help elect two additional members, who will also be 
independent to the University. The committee members will provide input and feedback through 
email and regularly scheduled conference calls during implementation of the intervention twice 
per year. Adverse event information will be recorded at all assessments points and during the 
intervention on standard forms and will be reported to the DSMB.  Consistent with NIH and USC 
IRB policy, adverse events will be promptly reported in writing to the NIH and IRB. 
 
 

 
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