Physical activity (PA) declines sharply for girls as they enter adolescence, especially for Black girls in the United States (Barr-Anderson et al., 2017; Centers for Disease Control and Prevention [CDC], 2015; Dishman et al., 2019; Kimm et al., 2002). In Kimm et al.’s (2002) longitudinal study, for example, none of the Black girls engaged in leisure PA outside of school when they reached 16 years. This downward trend in PA continues throughout adulthood (CDC, 2015). While Black girls and women’s PA data vary, the consensus is that it is low (American Heart Association [AHA], 2016; CDC, 2015; Davis et al., 2016; Whitt-Glover et al., 2007). Sedentary behaviors are associated with debilitating metabolic conditions that lower the overall quality of life and increase the risk of premature death, compounding the problem of low PA rates (AHA, 2016).
School-influence studies on PA are limited for Black girls, and the methods of PA interventions in the literature tend to only modify physical education (PE) programming (Camacho-Miñano et al., 2011; Dishman et al., 2019). Furthermore, peer-led PA studies conducted on youth focus on White students, typically outside of the United States or on younger children and adolescent girls (13–15 years), irrespective of race (Baranowski et al., 2003; Barbeau et al., 2007; Camacho-Miñano et al., 2011; O’Kane et al., 2020; Owen et al., 2018; Sebire et al., 2018), ignoring the importance of cultural representations of Black people as researchers and participants in PA interventions for older adolescents (14–18 years). Black girls are also excluded across peer-led PA intervention studies, as no peer-led interventions explicitly focus on Black adolescent girls. Furthermore, the dearth of PA interventions that include Black adolescent girls has had negligible impact. Camacho-Miñano et al.’s (2011) systematic review of randomized controlled PA interventions revealed that only one of the six interventions focused on Black girls promoted PA and positive health outcomes. The low rate of effective interventions focused on Black girls highlights the need for alternative approaches for sustainable change.
While researchers overlook Black girls in peer-led PA interventions, there are positive results with school-based peer-led PA programs among White adolescent girls. In the United Kingdom, for example, adolescent girls aged 13–15 years engaged in a 10-week, peer-led PA intervention in which peer leaders provided healthy messaging on PA and health behaviors, positively increasing PA engagement (Sebire et al., 2016). In another peer-led PA study, also in the United Kingdom, after 7 weeks of mentor and peer-led PA messaging, the group that also participated in the after-school PA component had significant increases in moderate-to-vigorous activity compared with the group who did not (Owen et al., 2018), illustrating the positive impact of an after-school peer-led PA intervention. However, while these interventions had promising results, the peer leaders did not lead the PA sessions but encouraged peers to engage in PA. Unfortunately, no PA interventions have empowered peer leaders to administer the PA component. Along with evidence that Black peers strongly influence one another (Quimby et al., 2018; Tolan et al., 2002), these factors indicate that peer-led PA is critical among Black adolescent girls.
Despite evidence that peer groups are more critical to Black girls than White (Quimby et al., 2018; Tolan et al., 2002), health and PE studies that focus on Black girls have not explored the role that peers have in decision making in PA (Camacho-Miñano et al., 2011; Young et al., 2006). Given this, peer-led PA programs focusing on Black girls could potentially prevent overweight, obesity, and sedentary lifestyles while providing leadership skills, personal development, and economic opportunities, yet such approaches are not evident. Therefore, to promote PA participation among Black adolescent girls and combat the declining health trends, this quasi-experimental pretest and posttest study attempted to determine the impact of a peer-led PA program on Black adolescent girls’ health and PA. Results will inform the effectiveness and sustainability of a peer-led PA program for Black girls.
With increased rates of overweight and obesity among Black adolescent girls and racial inequities evident in PE content and programming (Blackshear & Culp, 2023; CDC, 2015; Ryan & Sinay, 2019; Walton-Fisette & Sutherland, 2020), there is an urgency to develop culturally relevant PA programs that have a long-term impact. Unfortunately, traditional PA interventions have been ineffective in promoting health and PA among Black girls (Camacho-Miñano et al., 2011). Furthermore, the call to incorporate culturally relevant, peer-led PA interventions has not materialized (Barr-Anderson et al., 2017; Camacho-Miñano et al., 2011). Therefore, transformative approaches are required to combat current adverse health and PA trends disproportionately affecting Black girls. As such, this study aims to determine the effect of a culturally relevant, peer-led PA intervention among Black adolescent girls on PA engagement, body composition, cardiovascular endurance, and muscular endurance outcomes. As such, the proposed intervention is a step toward reducing inequality in health, PA, and research for Black adolescent girls.
Expected Outcomes
We expect a consistent increase in PA participation and engagement, improved cardiovascular and muscular fitness, and changes in body composition. We hope to provide a culture of safety and community and foster a positive experience, including increased quality of life and a desire to continue with BLinG-Health and/or PA outside of school.
Theoretical Frameworks
The diffusion of innovations theory (DOI) guides this research. Diffusion, often interchanged with persuasion, is a process that involves four elements: (a) innovation, (b) communication through specific channels, (c) over time, and (d) among members of a social system (Rogers, 1983, p. 11). Expanding on the tenets of DOI and highlighting its usage in the current study, innovation is an idea or practice that is new or perceived as new (peer-led PA) using communication channels (peer leaders) to share the importance of the new idea over a period of time (8 weeks) to establish buy-in or the adoption of new beliefs or behaviors (PA) among their Black adolescent girl peer group attending the same school (social system) (Rogers, 1983). A central DOI component of the current study is the peer leader’s ability to engage in the five-step innovation–decision process of knowledge, persuasion, decision, implementation, and confirmation (Rogers, 1983) through understanding exercise performance and group fitness instruction (knowledge), the ability to instruct (persuade) peers to make a (decision) about continuing or discontinuing (confirmation) PA engagement by leading group fitness instruction (implementation).
DOI has shown effectiveness in peer-led interventions among adolescent girls (Sebire et al., 2019), as peers have a strong social influence on behavior change, including health and PA behaviors (Rogers, 1983; Sebire et al., 2019). In Sebire et al.’s (2019) peer-led PA study, for example, outcomes were positive using a DOI framework that focused on middle school-aged adolescent girls. Lacking from employing DOI, however, is the lack of focus on Black youth (Sebire et al., 2019).
Along with DOI, the current research employs the socioecological framework that recognizes that multiple factors, including family, home life, peers, community, schools, laws, and policies, work together and impact children’s health outcomes (Bronfenbrenner, 1979; Wold & Mittelmark, 2018), complementing the interaction effects across DOI among the group’s social systems or peers within the same school environment (Rogers, 1983). The socioecological framework aims to illustrate the interaction between the levels rather than use each level independently (Bronfenbrenner, 1979). Evidence of this interaction is the school and community where the intervention transpires, the participant’s agreement (assent), and the family’s agreement (consent) for participation among peers engaged in a pilot health and physical activity program (policies). Furthermore, the socioecological perspective is most effective in studies in school settings (Camacho-Miñano et al., 2011).
The current study also recognizes racism as a root cause framework (RRC), which acknowledges and focuses on the need to:
- a.Focus on one racialized group rather than combining groups that overgeneralize and tend to foster racist-deficit narratives. The current study centers Black adolescent girls attending the same school, recognizing the historical and contemporary systems that negatively impact Black girls in America, especially the public school system.
- b.Change policies, systems, and environments rather than trying to change people, as these policies and settings are often exclusive, countercultural, and incredibly harmful. We offered a peer-led, PA after-school program, thus the initiative to change the environment by offering a nonsport-related PA option after school.
- c.Ensure new policies are institutionalized and sustainable, resulting in appropriate funding of groups and schools grossly underfunded, which is an aim of the current pilot study.
- d.Shift resources, power, and opportunities to repair historical injustices (Malawa et al., 2021; Purnell et al., 2021). An intentional shift in power from adults to students is evident in the delivery of the PA program along with the current study’s attempts to repair historical injustices impacting the school. We will also request the city to shift summer youth employment funding already allocated to use during the academic year to support BLinG-Health.
While PA investigations widely employ the socioecological framework, the use of DOIs, and RRCs in health promotion and PA research is limited. Promising, however, DOI’s favorable outcomes in peer-led PA among White girls (Sebire et al., 2019) warrant further exploration of its efficacy among Black girls. Hence, incorporating DOI with older (16–18 years) Black adolescent girls advances the understanding and use of DOI for health promotion and PA interventions. Furthermore, the socioecological model is the most robust framework for PA interventions focused on girls (Camacho-Miñano et al., 2011). This study focused heavily on the peer aspect of these frameworks due to the significant effect of peer influence during adolescence, especially among Black teens (Quimby et al., 2018; Tolan et al., 2002). To our knowledge, this is the first study to consider DOI, the socioecological perspective, and RRC. Thus, we found it is critical to combine these frameworks as other models have not aided in reducing health and PA inequities affecting Black girls. In addition, these frameworks further highlight the need for alternative approaches when working with Black adolescent girls, especially as Black peers have a powerful influence and the understanding that racism is a public health threat (American Public Health Association [APHA], 2021; Quimby et al., 2018; Tolan et al., 2002).
Methods
Cultural Relevance
Culturally relevant teaching, coined by Dr. Gloria Ladson-Billings (2022), is an approach that emphasizes the importance of incorporating students’ cultural backgrounds and experiences into the learning process. It aims to create a classroom environment that is inclusive, empowering, and reflective of the diverse identities and perspectives of students. One aim of BLinG-Health was to create cultural relevancy for the participants. We achieve this through the representation of Black women leading the study, the branded name BLinG-Health, the affirming messages at the end of each workout session, and the inclusion of racism as a root cause.
The principal investigator (PI), for example, resides in the same community as the school, which establishes a deeper understanding and connection with the local culture, traditions, and social dynamics. This proximity also allows for a more nuanced and authentic exploration, enhancing cultural relevance and ensuring a more comprehensive and accurate portrayal of the community’s experiences and perspectives. Cultural relevancy is also in the name BLinG-Health. Bling is a common term used in many Black communities and hip-hop music (e.g., Hotline Bling by Drake) with multiple meanings, including shiny or flashy things (gold, platinum, and diamonds), and dressing impeccably well (Burton, 2011; Gentaur, 2003; IncogNegro [FC], 2003), which has its origins in Africa’s gold mining (Burton, 2011). In the BLinG-Health logo, created by a Black woman designer, Victoria Green, we incorporate the diamond as the dot on the i (see Figure 1). Further highlighting cultural relevance in the name is the intention of positioning Black first to highlight its positivity and culturally rich heritage, which is often associated with negativity. In addition, we use girls instead of women, as Black girls are grossly viewed as adults, positioning them as threats rather than the children that they are, thus lacking safe spaces for them just to be (Perillo et al., 2023).
BLinG-Heath logo.
Citation: Women in Sport and Physical Activity Journal 32, 1; 10.1123/wspaj.2023-0078
We also used images of a Black girl engaged in various physical activities on the BLinG-Health recruitment flyers. At the end of each workout session, we included affirming messages using the call and response approach, also rooted in African Black culture (Jamison, 2015), including “my Black is beautiful; I am loved and supported; You are healthy; Your body is beautifully perfect (Balanced Black Girl, 2021; Harris, 2020).”
Design
We employed an 8-week, pre-, and posttest quasi-experimental research design at a City Public High School in Maryland to examine the impact of a peer-led, school-based PA intervention program focused on Black adolescent girls on PA engagement, body mass index (BMI), waist circumference, cardiovascular endurance, and muscular endurance. This design also included open-ended questions to get ongoing feedback from participants on feasibility and process evaluation. We implemented four phases of the five-phase PA intervention program, which consisted of eight girls/young women (16–18 years) who self-identified as Black. According to the school system’s public data report, the choice school was 85% Black, with 66% economically disadvantaged.
Measures
Questionnaire
Participants completed a study-designed demographic questionnaire that gathered age, race, gender, current PA engagement, athletic status, family structure, and socioeconomic status data.
PA Engagement
Peer leader participants signed the attendance sign-in sheet on the clipboard and handed it to participants for sign-in each session. The attendance sheet included four open spaces to write in the dates as the days of the week varied. Peer leaders returned the attendance sheets to the PI or research assistant (RA).
Anthropometrics
We assessed participants’ height and weight using a stadiometer and electronic scale to compute BMI for teens—the same as the adult BMI calculator. In addition, we taught (and closely supervised) participants how to measure waist and hip circumference to compute the hip-to-waist ratio. We chose this protocol to avoid touching participants and to educate them on self-assessment in these areas. We used the American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription (ACSM, 2018) for all anthropometric measures, with the understanding that there are culturally inappropriate and appropriate health measures for girls and women of African descent identified in the literature (Kabakambira et al., 2018; Katzmarzyk et al., 2013; Sumner et al., 2008, 2011). Furthermore, current body composition measures are based on the White male body or of White European descent (Katch & McArdle, 1983; Alexis, 2021), further illustrating the application of RRC, as current body composition metrics are sexist and racist, fostering perceived and exacerbated health disparities for Black females (Kabakambira et al., 2018; Konkel, 2015; Laxy et al., 2018). Unfortunately, however, we used inequitable measures given precedence in other studies that focus on Black girls (Lanza et al., 2013), thus allowing for comparative analysis yet illustrating the lack of simplistic culturally sensitive measures that take racial, cultural, gendered, or intersectional differences into account (ACSM, 2018; Katch & McArdle, 1983; Alexis, 2021).
Fitness Assessments
Participants completed the Cooper 12-min run/walk test to measure cardiovascular fitness and the push-up test to measure upper body strength (ACSM, 2018). The 12-min run/walk was chosen for its simplicity and realistic application for girls to perform independently that they can continue in their adult lives. The primary purpose was to assess whether there was an increase in the distance covered rather than maximal oxygen consumption (VO2max) outcomes, although predicted VO2max was analyzed despite the limitations when used on youth; however, the Progressive Aerobic Capacity Endurance Run (Cooper Institute, 2017), the most commonly used cardiovascular assessment for youth, has other limitations, including the dependence on a 20-m space and audio beeps, which may be unrealistic in a real-world application, especially in underresourced communities. Additionally, students perceive the Progressive Aerobic Capacity Endurance Run as cruel and intentionally drop out early, although not fatigued (Safron & Landi, 2022). In contrast, 12 min is perceived as more manageable and allows participants to run at their pace/fitness level and walk as needed. For complete implementation procedures and VO2max chart, see the American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription (ACSM, 2018).
Focus Groups
A semistructured focus group for participants and peer leaders for process evaluation occurred immediately after the postfitness assessments during a group dinner to culminate the end of the program, which coincided with the end of the school year; however, these data are presented elsewhere.
BLinG-Health—Black Leadership in Girls Health (Branded Name)
Phase 1
We obtained the University and the City Public School’s Institutional Review Board approvals. School personnel helped identify peer leaders. Desired peer leaders exhibited a mature development stage and served as role models or Big Sisters who led the PA group fitness sessions for students in Grades 9, 10, and 11. We obtained parental consent and participant assent. Peer leaders engaged in a 12-hr microfitness training program led by the Black woman PI and Black woman RA consisting of the health-related fitness components, principles of fitness, basic anatomy, and exercise physiology, group fitness instruction along with the Interactive Fitness Trainers of America (IFTA)’s Fitness Tabata Training—supporting the knowledge element of DOI. IFTA was chosen due to its certification opportunities for youth, the PI’s relationship with the organization, and its willingness to discount the certification cost. We covered the cost of IFTA’s Tabata training and certification for the peer leaders supporting RRC’s commitment to fund and shift resources to communities underresourced. Peer leaders received certificates after demonstrating competency in leading/teaching the group fitness sessions.
Tabata is a type of high-intensity interval training workout that aims to yield the most benefits quickly. For each exercise, participants engaged in eight rounds of strenuous exercise for 20 s, followed by 10 s of rest (Cronkleton, 2020), but the rounds gradually increased over the 8 weeks. We chose Tabata for its simplicity of 20 s of work and 10 s of rest intervals and the flexibility of choosing a variety of movements and exercises with and without equipment. Also supporting the simplicity of Tabata, peer leaders used Tabata music tracks purchased on iTunes that have embedded cueing and countdowns; however, peer leaders had the option to use an interval timer as they became more confident in cueing and instruction.
Phase 2
Fitness leaders and school personnel helped identify and recruit participants in Grades 9, 10, and 11 (ages 16–17 years). The study was promoted through PE courses and a Women’s History Month kick-off assembly highlighting the interplay of the individual, school, and community in the socioecological framework. Girls interested in participating signed up with the lead PE teacher or using the BLinG-Health quick response code shared during the assembly. Athletes (except fitness leaders), and girls who did not identify as Black were excluded from the study. However, non-Black girls could participate in the program if space permitted. In addition to obtaining parental consent and participant assent, we administered a physical activity readiness questionnaire. Any “yes” response to the health questions that identified reasons one should not engage in exercise, or a high-risk disease profile may require medical clearance or exclusion from participation. In addition to peer leaders and participants completing a Physical Activity Readiness Questionnaire, in the event of an emergency, the PI and RA were trained and certified in first aid and cardiopulmonary resuscitation, and they or a peer leader was to contact school personnel and call the emergency assistance number (e.g., 911). As stated in the consent/assent forms, participants who became pregnant were to notify the PI and/or RA to ensure appropriate PA modifications and data analysis. Baseline open-ended questions helped identify any barriers or reasons participants may not be active and determine whether and how we could modify the intervention or eliminate barriers and provide culturally relevant programming (e.g., music preference and transportation). Open-ended questions included (a) How do you feel about engaging in PA? (b) What do you need to engage in a weekly PA program? (c) What are your thoughts on being led by students? (d) What type of music do you enjoy? (e) What days and times of the week do you have free time? and (f) What are things that may inhibit your ability to participate? Participants and school personnel received a T-shirt, leggings, water bottle, and custom BLinG-Health bracelets across Phases 2 and 3.
Phase 3
Participants underwent baseline fitness and health assessments in the school corridor and dance classroom. The PI and RA took the participant’s weight and height on the SECA digital scale and stadiometer in the following order. The PI and RA explained and demonstrated how to measure waist and hip circumference. After the demonstration, the PI and RA closely monitored and verbally guided participants’ measuring techniques. The PI and RA looked at the measurements and recorded two to three trials on the participants’ coded data sheets. After anthropometrics were taken and recorded, the PI and RA administered the 12-min run followed by the push-up test. After data were entered, the PI stored all data in a secured cabinet. Peer leaders took attendance every session, as attendance in after-school intervention programs tends to decline over time (Owen et al., 2018), impacting efficacy and outcomes. Peer leaders led 20- to 45-min group fitness sessions for 8 weeks after school 3 days a week, which included a study-designed workout template that included an outline for a warm-up, high-intensity interval training workout routine, cooldown, and culturally relevant affirmations (e.g., You are strong, beautiful, and valuable; Stand in your greatness; and Prioritizing my health is important to me). If a peer leader was absent, the PI or RA led the session, which occurred on one occasion. The duration of the workouts gradually increased from 20 min to 45 min. After each workout, participants received snacks (e.g., fruit, granola bar, and chips), as students in urban, inner-city high schools have reported hunger as a barrier to attending after-school PA programs. Providing snacks has also shown to increase participation in after-school PA programs (Maljak et al., 2014). Participants were sent a weekly schedule and class reminder via text and email the day before. Participants received tank tops, sports bras, and shorts at the midpoint of Phase 3.
Phase 4
Postintervention measures (body composition, 12-min run/walk, and push-up test) were taken at the end of the 8 weeks. Participants engaged in a focus group for process evaluation and identifying attitudes toward PA after the 8-week intervention. The focus group consisted of semistructured interviews for participants and peer leaders for process evaluation and to gain insight into improving the program from Black adolescent girls’ perspectives. Sample questions include: (a) Tell us about your experience in the PA program, (b) What did you enjoy? (c) What did you dislike? (d) What would you change? and (e) Would you let us know if you would like to be a peer leader? We coded response-based themes for interpretation; however, a complete analysis is in a separate paper. Peer leaders were to receive a $500 stipend at the end of 8 weeks for leading at least 80% of the sessions, addressing the third and fourth pillars of RRC; however, we prorated the rate according to the percentage of classes taught, discussed in the “Results” section. Participants received $50–$100, and the school received needed/desired school items up to $1,500.00 (e.g., tents for outdoor school functions; coats, scarves, hats, and gloves for students) to support the school and shift resources that address historical and current injustices of underfunded schools and communities in predominately Black communities. Participants, caregivers, and school personnel received copies of the presubmitted manuscript and had opportunities to modify or request edits. No changes were requested or made.
Findings
Data Analysis
Baseline and postintervention descriptive statistics were analyzed using mean, SD, and frequency data to assess PA participation and the link to fitness and health outcomes. We kept observational field notes on each participant’s datasheet and in a notebook, potentially impacting quantitative results. We converted imperial standard units to metric units. T tests were used to determine the significance of the pretest/posttest intervention of within-group comparisons. In addition to conducting t test analyses to compare pre- and posttest assessments, given the low participant number for analysis, a percent change analysis was conducted to illustrate differences. Cohen’s d was calculated to determine the intervention’s effect size (see Table 1). Last, correlation analysis determined the relationship between attendance frequency, fitness, and health outcomes.
Pre- and Postbody Weight, BMI, Waist Circumference, Hip-to-Waist Ratio
| Pre, M (SD) | Post, M (SD) | t | p | Cohen’s d | % Change | |
|---|---|---|---|---|---|---|
| Body weight (kg) | 57.15 (21.56) | 58.16 (21.78) | −.09 | .93 | −.05 | −1.75 |
| BMI (kg/m2) | 22.64 (7.18) | 22.07 (7.31) | −.10 | .91 | −.06 | 2.52 |
| Waist circumference (cm) | 73.03 (15.01) | 69.57 (12.32) | .47 | .65 | .25 | 4.73 |
| Hip-to-waist ratio | 0.76 (0.04) | 0.74 (0.02) | 1.11 | .29 | .60 | 2.63 |
Note. BMI = body mass index. n = 7.
Descriptive
Eight Black adolescent girls (M = 16.43; SD = 0.53) participated with three peer leader participants and five participants; however, one peer leader stopped attending during Week 5, as she was a senior. Seniors finished school 3 weeks before students in Grades 9–11. We excluded this peer leader participant’s baseline health, fitness data, and demographic reporting. One participant was in Grade 9, three in 10, and three in 11. Fifty percent of the girls reported they were from two-parent, heterosexual households, 38% from single-mother-led households, and 12% reported living in a multigenerational family consisting of a mother and grandparents. Fourteen percent of participants reported that their families were low middle income, 43% were middle income, 14% were upper middle income, and 29% preferred not to respond. Eighty-six percent (n = 6) of participants reported not engaging in PA before the intervention, and 100% (n = 7) completed the program with a mean attendance rate of 68% (SD = 28), ranging from 23% to 100%.
Anthropometrics: Body Weight, BMI, Waist Circumference, and Hip-to-Waist Ratio
After the pretest/posttest comparison, body weight increased while BMI, waist circumference, and hip-to-waist ratio decreased, but all were insignificant. Effect sizes were small for all anthropometric measures (see Table 1).
While not statistically significant, by the end of the intervention, all participants were low risk in hip-to-waist ratio, moving two participants from moderate to low risk. Forty-three percent (n = 3) of participants were underweight, 43% (n = 3) were normal weight, and 14% (n = 1) were obese. Despite 71% (n = 5) of participants losing inches in waist circumference, including the participant with the highest BMI losing four inches around the waist, there was no change in health category from pre-to-post with 14.3% (n = 1) having very low metabolic risks, 71.4% (n = 5) having low metabolic risk, and 14.3% (n = 1) at high metabolic risk (see Table A1 in Appendix). Strong, nonsignificant negative correlations were shown between attendance and waist circumference (−0.72) and hip circumference (−0.72), but weak and nonsignificant correlations between attendance and hip-to-waist ratio.
Fitness Assessments: 12-min Run/Walk, Predicted VO2max, and Push-Ups
A significant difference in cardiovascular fitness was evident in the 12-min run/walk assessment (M2–M1 = 209.22 m, p = .023; 17.8% increase; see Table 2). One participant wore platform gym shoes at baseline, and another intentionally ran slower to not crease her shoes during the postassessment. Although there was a significant increase in the 12-min run and predicted VO2max, participants’ cardiovascular fitness was low pre- and postassessments, with 100% in the poor category during baseline and 71% in the poor category with 29% moving up to below average postintervention (see Table A1 in Appendix).
Pre- and Postfitness Assessments: 12-min Run/Walk, Predicted VO2max, and Push-Ups
| Pre, M (SD) | Post, M (SD) | t | p | Cohen’s d | % Change | |
|---|---|---|---|---|---|---|
| 12-min run/walk (m) | 1174.82 (225.31) | 1384.04 (289.68) | −2.97 | .025* | −.772 | 17.8 |
| Predicted VO2max (ml·kg–1·min–1) | 37.63 (5.02) | 42.23 (6.71) | −2.97 | .025* | −.771 | 12.22 |
| Push-ups | 10.1 (5.1) | 14.9 (3.65) | −3.44 | .013* | −.924 | 47.5 |
Note. VO2max = maximal oxygen consumption, n = 7.
*Significance p < .05.
A significant difference was also evident in muscular endurance via the push-ups (M2–M1 = 4.8, p = .013; 47.5% increase). Effect sizes were large in cardiovascular and muscular fitness, with −0.77 and −0.92, respectively (see Table 2). Participants moved from fair to good, with 50% moving up one category (see Table A2 in Appendix). Weak-to-moderate negative nonsignificant correlations were shown between attendance and the 12-min run (−0.09) and push-ups (−0.45).
Discussion
Despite an original plan to implement a 12-week intervention, participants improved their cardiovascular and muscular fitness in only 8 weeks, as shown in the 12-min run/walk and push-up assessments. Although participants improved the distance covered and VO2max, their cardiovascular fitness was poor and below average, with only two participants moving up from the poor to below average category, suggesting that more frequency, intensity, and/or time would garner greater increases. Participants showed more robust increases in muscular endurance by increasing from fair to good, with 50% of participants moving up in one fitness category. This outcome is attributed not only to an increase in regular PA engagement but to one peer leader instrumental in the push-up outcomes, as she was vigilant in having the group work on push-up form during every workout she led—showcasing the positive impact that Black peers can have on each other as supported in Quimby et al.’s (2018) findings on positive peer pressure among Black adolescents on fostering positive self-esteem and parental relationships. The engagement of this peer leader illustrates DOI’s persuasion, implementation, and confirmation elements on her social system of peers (Rogers, 1983). Future considerations may include examining leadership style despite the formulaic nature of the workout sessions.
While the participant size was small, only one participant did not complete the study, garnering an 88% retention rate, which is exceptional when compared with other studies with after-school PA programs and peer-led PA interventions (Maljak et al., 2014; Owen et al., 2018). A testament to the program’s benefit is that one participant attending only 23% of the sessions due to another after-school commitment improved in all fitness and anthropometric measures. Results show that engaging in 1–3 days (45-min sessions) of exercise positively affected health and fitness, which can contribute to participants meeting 75% of the PA recommendations for youth at 60 min per day (U.S. Department of Health and Human Services, 2018) on the days they engage. Furthermore, during one session, the participant who attended 23% of the time stated with a smile, “I worked out yesterday because I had all this energy,” illustrating a potential benefit of the BLinG-Health program beyond school. Unfortunately, data on PA engagement outside of school were not gathered but should be considered.
Countering negative narratives that lump Black youth bodies, especially Black girls, as overweight and/or obese, most participants had normal and low BMIs before and after the intervention. We wanted to employ an adjusted BMI scale more appropriate for Black females (CDC, 2022; Kabakambira et al., 2018; Katzmarzyk et al., 2013; Sumner et al., 2008, 2011); however, all but one participant reported a normal or underweight BMI under the current measures. While “underweight” could raise concerns of undernourishment or ill health, all participants were above 16—the BMI marker associated with the risk of poor health—illustrating the limitations of using BMI (ACSM, 2018; CDC, 2022). Two participants expressed gratitude for the weight they lost despite weight loss not being a focus of the program. Interestingly, the participants voluntarily sharing weight loss during and after the intervention did not lose weight but lost inches in waist and hip circumference, suggesting a body composition change by lowering body fat and increasing muscle through PA engagement, thus lowering metabolic disease risks (ACSM, 2018). However, understanding that a direct measure of body composition (e.g., dual-energy X-ray absorptiometry) is ideal for more accurate results, doing so is expensive, time-consuming (ACSM, 2018), and counter to the long-term feasibility and mission of the program.
Challenges and Limitations
Various delays occurred, which put the intervention weeks behind—a challenge when conducting school-based PA interventions. Although exercise frequency impacts physiological responses, attending more often did not foster more significant outcomes. A major challenge was returning the parental consent forms, for which we used the paper method. Participants; however, preferred the paper method over an electronic method. In the future, we plan to go to the community and meet families rather than have them come to the school. Two participants also did not have consistent cell phone usage during the program and had to rely on other participants and email for notification updates. Another challenge was paying the girls in cash; however, we accomplished this but had to transport the participants to and from the University’s Foundation with the help of another teacher. Additional funding sources with ease of access are being sought through state- and city-level opportunities. Other challenges included changes in school schedules and ongoing peer leader training and support due to the delayed start of the pilot, thus shortening Phases 1 and 3.
Notably, the small sample size limits the data analysis’s generalizability and statistical power. In addition, while participants learned how to take waist and hip measurements, there is increased error inherent in having each participant measure with little practical experience. Another limitation is that the RA and PI were not faculty or staff at the school, which would have made implementing BLinG-Health easier. A faculty sponsor or a permanent BLinG-Health trainer is under consideration.
Relationships
While all faculty and staff were supportive, the lead PE teacher significantly promoted the program and encouraged participation. School leadership and the lead PE teacher would like the program to continue—evident of the socioecological framework given the multiple layers of influence required for implementation and RRC’s goal of sustainability. Given the close monitoring needs of the pilot, the RA, PI, or both were present during each session and built a good rapport with faculty, staff, participants, and other students, thus establishing trustworthiness. However, the RA’s and PI’s presence could have an interactive irreplicable effect. Participants, faculty, and front-office staff stated missing the RA and PI when they were not present, highlighting the established relationships and sense of community fostered by showing up as promised, communication (text and email reminders), and by attending other school functions (e.g., the school play and athletic events).
Needs and Expansion
Notably, boys expressed an interest in the program, and two served as helpers after we gained approval from the participants, which has sparked ideas on how to assist the boys with PA programming beyond the school’s athletic programs—especially, as Black teenaged boys are also neglected in PA interventions (Howe et al., 2011). Women teachers also expressed an interest in attending, which we will try to include after the full adoption of the program. As we hoped, the participants expressed wanting to continue. Based on the pilot experience, one change for BLinG-Health is to pay peer leaders weekly or biweekly to address economic needs, operate as actual employment, and increase motivation rather than delayed gratification, further supporting RRC. However, for sustainability and in lieu of peer leader pay, we plan to offer students service-learning credit, a district-wide requirement.
We also provided additional gifts based on the participants’ sharing unsolicited needs, including feminine products and deodorant, which we presented to them at the end of the program using Black women-owned products (e.g., Femly and The HoneyPot), further supporting cultural relevance. The participants’ needs and observations of school needs are instrumental in BLinG-Health’s expansion to become a holistic nonprofit school-based program addressing the multidimensions of health—inclusive and in addition to PA. In addition, a BLinG-Health junior group fitness certification is under development for easier dissemination and to tailor to the needs of adolescents. Last, the school requested that BLinG-Health become a permanent feature, thus the institutionalization and sustainability resulting from the pilot program supporting Tenet three of RRC.
Conclusions
While culturally appropriate health and PA approaches are starting to emerge (Chard et al., 2020), there remains a gap among Black women researchers, designers, and content creators working with Black girls in high school settings. The research on Black girls also tends to embrace deficit thinking or heavily emphasize weight loss (Robinson et al., 2003; Story et al., 2003) rather than moving for health, fun, leadership, sisterhood, and community with a potential to foster interests in health and PA fields where Black women are grossly underrepresented (Blackshear & Culp, 2022; Pennington, 2023). At the time of print and to our knowledge, current studies have not collectively considered racism as a root cause, DOI, and culturally relevant practices. Furthermore, this is the first adolescent peer-led PA program in the United States designed by a Black woman PI for Black girls in schools. Understanding that Black representation in health and PA research is vital in fostering better health outcomes among Black youth and Black communities, we recognize the importance of supportive allies that provide opportunities for youth to engage in group fitness delivery (IFTA) and funding support from agencies, organizations, and corporations (The Pfizer Foundation: Matching Gifts Program) committed to health equity for all. A peer-led PA program designed for Black adolescent girls in a public high school is feasible with appropriate funding, promotion, and student and faculty buy-in. Empowering Black adolescent girls/young women to lead group fitness sessions among peers may enhance PA engagement and health outcomes. As such, schools should consider culturally relevant programming designed by Black scholars to increase Black girls’ opportunities to engage in PA.
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Pre- and Postbody Weight, Body Mass Index, Waist Circumference, and Hip-to-Waist Ratio Health Classifications
| Waist circumference classifications (n = 7) | Pre | Post |
|---|---|---|
| Very low | 14.3% (n = 1) | 14.3% (n = 1) |
| Low | 71.4% (n = 5) | 71.4% (n = 5) |
| High | 14.3% (n = 1) | 14.3% (n = 1) |
| Very high | 0% (n = 0) | 0% (n = 0) |
| Body mass index classifications | ||
| Underweight | 29% (n = 2) | 43% (n = 3) |
| Normal weight | 57% (n = 4) | 43% (n = 3) |
| Overweight | 0% (n = 0) | 0% (n = 0) |
| Obese | 14% (n = 1) | 14% (n = 1) |
| Hip-to-waist ratio classifications | ||
| Low risk | 71.4% (n = 5) | 100% (n = 7) |
| Moderate risk | 25.6% (n = 2) | 0% (n = 0) |
| High risk | 0% (n = 0) | 0% (n = 0) |
Pre- and Postfitness Assessments: 12-min Run/Walk, Predicted VO2max, and Push-Up Categories
| 12-min run classifications (n = 7) | Pre | Post |
|---|---|---|
| Poor | 100% (n = 7) | 71% (n = 5) |
| Below average | 0% (n = 0) | 29% (n = 2) |
| Push-up classifications | ||
| Poor | 43% (n = 3) | 14% (n = 1) |
| Fair | 43% (n = 3) | 43% (n = 3) |
| Good | 14% (n = 1) | 29% (n = 2) |
| Very good | 0% (n = 0) | 14% (n = 1) |
Note. VO2max = maximal oxygen consumption.
