Kibum Cho

Date of Graduation


Document Type


Degree Type



College of Physical Activity and Sport Sciences


Sport and Exercise Psychology

Committee Chair

Emily M Jones

Committee Co-Chair

Sean Bulger

Committee Member

Alfgeir Kristjansson

Committee Member

Christa Lilly

Committee Member

William Neal

Committee Member

Andrea Taliaferro


Background/Purpose: The study was a three-year, multi-component, school-based health programs implemented in two middle schools in an Appalachian county. The purpose of this study was to: (a) examine the association between healthy weight and physical activity, sedentary behavior, and nutrition and (b) explore predictors affecting changes in physical activity, sedentary behaviors, and nutrition. Methods: The sample consisted 1,620 subjects with 3,263 observations aged 11 to 16 years, who enrolled in the Children's Health Opportunities Involving Coordinated Efforts in Schools (CHOICES) Project in 2012-2014. Each subject was observed at least one time point. Two main analyses were conducted, a logistic regression and linear mixed model. All data were analyzed using the SAS program (version: 9.4). Results: Gender, Moderate to Vigorous Physical Activity (MVPA), and nutrition were associated with healthy weight, while grade, year, screen time were not associate with healthy weight. Boys increased time spent in physical activity over time while girls had no change in physical activity. Girls decreased screen time over time, while boys slightly increased screen time. Girls and boys decreased screen time as BMI percentile increased. Girls and boys increased school work (homework) as BMI percentile increased. None of the variables were significantly related to total consumption of vegetables and fruits. Conclusion: This study indicates the importance of Social Ecological Model (SEM) for assessment of obesity prevalence by emphasizing individual, interpersonal, organizational, and community level and it is recommended that school-based interventions and programming consider those levels to promote behavioral changes for adolescent health in the Appalachian region.