SPECIAL ARTICLE
Calibration and Validation of the Youth Activity Profile: The FLASHE Study

https://doi.org/10.1016/j.amepre.2016.12.010Get rights and content

Introduction

This study describes the calibration and validity of the Youth Activity Profile (YAP) for use in the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The calibrated YAP was designed to estimate minutes of moderate to vigorous physical activity (MVPA) and sedentary behavior (SB).

Methods

The YAP was calibrated/validated in adolescents (aged 12–17 years) using cross-sectional data from the FLASHE study. Participants wore a GT3X+ ActiGraph on the dominant wrist for 7 days and then completed the YAP. Calibration was conducted for school (n=118); out of school (n=119); weekend (n=61); and SB (n=116) subsections of the YAP and by regressing percentage time in MVPA/SB (%MVPA/%SB) on each respective YAP subsection score, age, and the interaction between these two. The final algorithms were applied to independent samples (n=39–51) to examine validity (median absolute percentage error, equivalence testing).

Results

The final algorithms explained 15% (school); 16% (out of school); and 12% (weekend) of the variability in GT3X+ %MVPA and 7% of the variability in GT3X+ %SB. The calibrated algorithms were applied to independent samples and predicted GT3X+ minutes of MVPA/SB, with median absolute percentage error values ranging from 12.5% (SB section) to 32.5% (weekend section). Predicted values obtained from the YAP were within 10%–20% of those produced by the GT3X+.

Conclusions

The YAP-predicted minutes of MVPA/SB resulted in similar group estimates obtained from an objective measure. The YAP offers good utility for large-scale research projects to characterize PA/SB levels among groups of youth.

Introduction

A variety of measures have been used to assess physical activity (PA) levels in youth but they each have inherent advantages and disadvantages.1 Methods found to be the most accurate also tend to be the most expensive or complicated to use.2 Therefore, this interplay among accuracy, feasibility, and scope of the measure typically determines the selection of the most appropriate tool for a given research application.3, 4, 5

Questionnaires measuring PA are known to be susceptible to a variety of sources of error, yet they provide key advantages for many types of PA research.6, 7, 8 Questionnaires are particularly well suited for large-scale applications at the national or community level because they provide detailed profiles of activity behavior while capturing important contextual information (e.g., type, location). A vast array of PA questionnaires is available in the literature for assessing youth; however, only a few have been found to have acceptable measurement properties.7, 9 This can be partially explained by the combination of the unique patterns of youth activity10 and also the limitations in the design of the instruments as well as the lack of context-related cues to facilitate accurate recall.11 For example, a review from Biddle and colleagues9 identified only three questionnaires of PA (of 89 total) as having potential for refinement and use in large-scale applications, and two of these (i.e., the Youth Risk Behavior Surveillance Survey and Physical Activity Questionnaire for Children/Adolescents) include reference to context in their design (i.e., context-related items). A limitation of these two instruments though is that neither can be readily converted into meaningful outcome measures. The Physical Activity Questionnaire for Children/Adolescents, for example, uses a simple 5-point scale with narrative choices ranging from rarely to often to capture levels of activity in different settings. The items capture useful information about PA levels but cannot be used to estimate time spent in moderate to vigorous PA (MVPA) or adherence to public health guidelines.

The authors developed the Youth Activity Profile (YAP) to specifically address these limitations. A unique advantage of the YAP is that it was designed to facilitate calibration of both reported PA and sedentary behavior (SB) into more-accurate and -useable estimates. The calibration of SB is a unique feature of the YAP, considering that the availability of related measures for youth populations are still quite limited.12, 13 Calibration is a standard step in the process used to obtain meaningful information from accelerometry-based activity monitors and it offers the same potential for improving the accuracy and utility of report-based measures. Through calibration, a crude estimate from a report-based measure such as the YAP can be re-scaled to replicate estimates of PA behavior obtained by more objective monitor-based methods.5, 8, 14, 15 Calibration of report-based measures is especially important for surveillance work and other large-scale applications because it helps to minimize the large disparities that have commonly been observed when comparing estimates with monitor-based measures.16, 17 The calibration approach has been tested with the YAP and demonstrated that predicted values and accelerometer estimates of MVPA were correlated by 0.19–0.75 (depending on the period of the day) and were deemed equivalent at the 10%–30% level. However, this study was done with a sample of 291 youth from Midwest U.S.18, 19; therefore, additional work is needed to determine if the YAP calibration approach holds in a different sample and independently of the activity monitor/measurement methodology used.

The present study addresses this need by evaluating the predictive utility of the YAP algorithms in a sample of adolescents involved in the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The authors specifically calibrated the YAP against wrist-worn ActiGraph measures of MVPA and SB and validated the algorithms in an independent sample also enrolled in FLASHE.

Section snippets

Study Design and Participants

The FLASHE study (http://cancercontrol.cancer.gov/brp/hbrb/flashe.html) was a cross-sectional national study focused on assessing diet and PA behaviors (and their correlates) among adolescent children (aged 12–17 years). The calibration/validation of the YAP was conducted in a randomly selected subsample of adolescents in FLASHE (n=628). Participants were asked to wear an ActiGraph GT3X+ on the dominant wrist for 7 full days (waking hours and sleep) and complete (self-administered) the YAP via

Results

The results are described separately for the calibration and validation phase, and for each of the key segments of the week: school, out of school, and weekend.

Discussion

This study examined the utility of a streamlined calibration method for re-scaling the YAP to match objective data from wrist-worn ActiGraph data. The value of the present calibration is that the YAP estimates are designed to correspond with wrist-worn ActiGraph data that are used within segments of the FLASHE sample. The YAP and the proposed calibration algorithms can be implemented in other national or community projects where it is unfeasible to collect objective data to assess youth PA

Acknowledgments

This article is part of a theme issue supported by the National Institutes of Health. The findings and conclusions in this article are those of the author(s) and do not necessarily represent the official position of the National Institutes of Health. Leslie A. Lytle, Ph.D. and Louise C. Mâsse, Ph.D. served as Guest Editors of the theme issue.

The Family Life, Activity, Sun, Health, and Eating (FLASHE) study was funded by the National Cancer Institute under contract number HHSN261201200039I

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