Health-Promoting Behaviors in School-Age Children

Objective: The objective was to predict health-promoting behaviors (HPB) among children. Based on the Pender Health Promotion Model, we posed the following question: Does affective state (self-esteem, depression) serve as a mediator for social support (from teachers and parents) and context (neighborhood safety) as predictors of HPB (healthy eating, physical activity)? Methodology: A secondary analysis of longitudinal data used the Coordinated Community Student Survey in a sample of 1,444 fourth- to sixth-grade students recruited from schools in a Midwestern state (male=42%, Caucasian American=72%, African American=17%). Results: Results of the meditational model indicated that both neighborhood safety and social support had an indirect effect on HPB via affective state. Neighborhood safety and social support were both significant predictors of affective state (p≤ .05), and these variables did not significantly predict HPB directly. Affective state was a significant predictor of HPB (p=.01), and the Sobel test indicated that affective state was a significant mediator between neighborhood safety (p≤ .001) and social support (p≤ .001) Conclusions: The results suggest that efforts designed to instill HPB must be based on public health models grounded in systems approaches rather than one-solution causal models. Individual children will be responsive to attempts to instill HPB will depend on the extent to which prevention efforts are capable of improving affective state so that children can be receptive to HPB messages. Nursing preventive-intervention, health care providers, and researchers should be multifaceted, focusing on enhancing self-esteem and reducing depression, while working to build support systems that enhance HPB in children.