title: Physical Activity Self-Efficacy and Fitness: Family Environment Relationship Correlates and Self-Esteem as a Mediator among Adolescents Who Are Overweight or Obese.
abstract: Little is known regarding how dimensions of the family social environment relate to fitness levels and physical activity self-efficacy (PASE) among adolescents who are overweight or obese and whether these relationships are mediated by self-esteem.
  
  
  
  Potential associations were evaluated between relationship subdomains (cohesion, conflict, expressivity) of the Family Environment Scale (FES), self-esteem (Rosenberg Self-Esteem Scale, RSES), and PASE and fitness, using recovery heart rate [RHR, beats per minute (bpm)] from a 3-minute submaximal step test at baseline. Participants were 108 adolescents who were overweight or obese and were seeking weight-loss treatment as part of the Healthy Kids, Healthy Weight 12-week multidisciplinary pediatric weight management program. Structural equation modeling (SEM) was used to simultaneously evaluate paths between these variables and test for mediation.
  
  
  
  In multivariable models, higher FES cohesion (β = -2.18, s.e. = 0.98; p = 0.02), expressivity (β = -1.97, s.e. = 0.99; p < 0.05), and PASE (β = -0.64, s.e. = 0.33; p < 0.05) scores were associated with lower RHR, which represents higher fitness. Furthermore, higher FES conflict scores were associated with lower RSES scores (β = -0.83, s.e. = 0.29; p < 0.01), and FES conflict (β = -0.63, s.e. = 0.22; p < 0.01) and RSES (β = 0.33, s.e. = 0.07; p < 0.01) were associated with PASE scores. In a good-fitting multivariate SEM [Comparative Fit Index (CFI) = 1.00; Standardized Root Mean Square Residual (SRMR) = 0.02; Tucker-Lewis index (TLI) = 1.22; Root Mean Squared Error of Approximation (RMSEA) <0.01], RSES mediated the relationship between FES conflict and PASE (sum of indirect paths: β = -0.30, s.e. = 0.11; p < 0.01) scores.
  
  
  
  Our results highlight the importance of the relationship domain of the family environment on self-esteem, PASE, and physical fitness in adolescents who are overweight or obese.
authors.affiliation: 1 Department of Epidemiology and Biostatistics, Case Western Reserve University , Cleveland, OH.
authors.forename: Nora L
authors.initials: NL
authors.lastname: Nock
authors.affiliation: 1 Department of Epidemiology and Biostatistics, Case Western Reserve University , Cleveland, OH.|2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Ievers-Landis
authors.affiliation: 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dajani
authors.affiliation: 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Darryl
authors.initials: D
authors.lastname: Knight
authors.affiliation: 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rigda
authors.affiliation: 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Sumana
authors.initials: S
authors.lastname: Narasimhan
authors.affiliation: 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Naveen
authors.initials: N
authors.lastname: Uli
mesh_terms: D000293:Adolescent; D001828:Body Image / Q000523:psychology; D002648:Child; D003430:Cross-Sectional Studies; D015444:Exercise / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D050177:Overweight / Q000523:psychology*; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D010809:Physical Fitness / Q000523:psychology*; D000297:Psychology, Adolescent; D011788:Quality of Life; D012649:Self Concept; D020377:Self Efficacy; D012931:Social Environment; D012944:Social Support