Associations of Acculturation and Social Support with Physical Activity among South Asian Female Adolescents in the United States

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Shah, Pooja Tandon, Namratha R. Kandula This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6967449/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Dec, 2025 Read the published version in BMC Pediatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Background This study aimed to examine relationships between acculturation, social support and physical activity (PA) among South Asian American female adolescents. Methods This study used baseline data from the South Asians Active Together (SAATH) trial, which included 126 South Asian females aged 11–16 years residing in the Chicago area. Participants wore a wrist ActiGraph accelerometer for 7 days and completed surveys assessing acculturation and PA-related psychological constructs, including parental and peer support, self-efficacy, attitudes, and perceived barriers. Multivariable linear regressions examined associations of acculturation categories (bicultural, Asian, Western, and separated) and parental and peer support scores with PA-related outcomes, adjusting for age, weight status, maternal education, and neighborhood resources. Results Participants on average engaged in 20 minutes/day of moderate- and vigorous-intensity PA (MVPA; 95% CI = 16–24). Participants in Asian and bicultural acculturation categories reported higher parental PA support than those in the Western acculturation category ( p = 0.02). Compared to participants in the bicultural category, those in the Asian category reported greater perceived barriers to PA ( p = 0.02). Higher parental support was associated with greater PA self-efficacy ( p < 0.01) and lower perceived barriers ( p < 0.01). Higher peer support was associated with more positive PA attitudes ( p < 0.05). However, acculturation, parental support, or peer support was not significantly associated with MVPA levels. Conclusions Findings suggest that promoting PA-supportive parenting practices may enhance PA self-efficacy and reduce barriers to PA, while peer support may foster positive PA attitudes among South Asian American female adolescents. Trial registration: ClinicalTrials.gov identifier: NCT04400253. https://clinicaltrials.gov/study/NCT04400253 May 21, 2020. parenting peer support immigrants Indian Pakistani ActiGraph accelerometers Background The South Asian (SA) population —comprising individuals with ethnic origins from Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka— is one of the fastest-growing ethnic groups in the United States (US) [ 1 ]. This population experiences disproportionally higher rates of obesity, diabetes, and cardiovascular disease, compared to East Asian and non-Hispanic White populations in the US [ 2 – 5 ]. Regular physical activity (PA) is a well-established behavior strategy for improving cardiovascular health across age, sex, and ethnic groups [ 6 – 8 ]. Despite its benefits, SA adults in the US, particularly women, engage in significantly lower levels of PA, compared to other ethnic groups [ 3 ]. Emerging evidence suggests that this pattern extends to SA youth . Promoting PA early in life from youth provides a “triple benefit”: enhancing youth health, establishes lifelong behavioral habits, and influencing future generations [ 9 , 10 ]. UK studies have consistently reported lower PA levels in SA children, especially females, compared to their White and Black peers [ 11 – 14 ]. Despite the rapid growth of the SA population and their documented high cardiovascular risks [ 5 , 15 – 17 ], PA data among SA American youth remain scarce. Existing studies often aggregate SA youth under broader Asian American categories [ 18 , 19 ], potentially masking important subgroup disparities due to the heterogeneity within the Asian American population [ 20 , 21 ]. In general, female adolescents engage in less PA than male adolescents, with PA levels declining throughout adolescence [ 22 ]. Beyond gender and age, parental and peer support have been identified as important determinants of youth PA behavior [ 23 – 27 ]. For SA adolescents from immigrant families, cultural context may uniquely influence PA behavior. Acculturation—a multidimensional process involving psychological, behavioral, and cultural adaptation to a new environment [ 28 ]—can shape perceptions and attitudes related to PA. In a prior qualitative study [ 29 ], SA female adolescents described family perception viewing exercise as an “American behavior” and a community belief that that “if you are thin, you don’t need to exercise.” Gender-based constraints and a lack of role models were also identified as barriers to PA. These findings underscore the need to consider cultural, familial, and social contexts in understanding PA behavior in this population. This study builds on a multilevel framework [ 30 ] designed to guide the investigation of disparities in cardiovascular health, such as PA, dietary practices, and obesity, among SA immigrants. This framework integrates socio-cultural, interpersonal, and individual determinants relevant to health outcomes of SA immigrants. Adapting this multilevel framework to examine youth behavioral health [ 31 ], the present study investigated relationships between acculturation and social support and PA among SA female adolescents. We hypothesized that a bicultural identity (i.e., integration of SA and American cultural values), parental support for PA, and peer support for PA would be positively associated with PA. Among PA constructs, we examined accelerometer-measured PA levels and PA-related psychological constructs, including self-efficacy, attitudes, and barriers. Method Study design and sample This cross-sectional study utilized baseline data from the South Asians Active Together (SAATH) randomized control trial. The trial protocol and statistical analysis plan can be accessed in https://clinicaltrials.gov/study/NCT04400253 . The SAATH study was a two-arm trial designed to determine the effectiveness of a community-based, dyadic PA intervention on moderate and vigorous-intensity PA (MVPA) among SA mother-daughter dyads [ 31 ]. Eligibility criteria for mothers included self-identifying as SA, being sedentary (self-reported PA < 150 minutes/week), having a female child aged 11–16 years, having no medical conditions that preclude PA, being without current pregnancy, and living in the Chicago metro area, and speaking English, Gujarati, Hindi, or Urdu. The eligibility criteria for daughter participants included being 11–16 years of age, living in the same household with an enrolled mother, having no medical conditions that preclude PA, and speaking English, Gujarati, Hindi, or Urdu. These languages were chosen to reflect the primary languages spoken within SA subgroups in the Chicago area. SAATH participants were recruited and enrolled into the study between August 2020 and September 2023 through community outreach and partnerships with local community and health care organizations. The trial was planned for in-person data collection in community partner sites. However, during and after the COVID-19 pandemic, data collection was conducted either in-person or via video-conference. Participants who did not have valid baseline accelerometry data were excluded from the SAATH trial (n = 10). The sample for the present study included the 126 SAATH daughter participants. This study adheres to CONSORT guidelines. Study Outcomes The primary outcome was MVPA measured using wGT3X-BT ActiGraph accelerometers. During the assessment visit, participants were instructed to wear the device on their non-dominant wrist for 7 consecutive days. Accelerometer data were downloaded and processed using the ActiLife software version 6.4. Non-wear time was defined using the Choi algorithm [ 32 ] and excluded from data analysis. Participants with at least 3 valid days of accelerometry data were considered to have valid accelerometer data [ 33 ]. A valid day was defined as having ≥ 500 wear minutes [ 34 , 35 ]. Time spent in MVPA (minutes/day) was calculated, applying a validated cutpoint for moderate-intensity of ≥ 818 vector magnitude counts per 5 seconds [ 36 ]. The secondary outcomes included PA-related psychological constructs: self-efficacy, attitudes, and perceived barriers. Self-efficacy was assessed using the 6-item scale measuring self-efficacy for overcoming PA barriers [ 37 ]. These items included “a) I can be physically active during my free time on most days; I can be physically active during my free time on most days b) even if I could watch TV or play video games instead, c) even if it is very hot or cold outside, d) even if I have to stay home, and e) no matter how busy my day is; f) I have the coordination I need to be physically active during my free time on most days. Each item was rated on a 4-point Likert scale (scored 1 = disagree a lot to 4 = agree a lot). A self-efficacy score was calculated by averaging the item scores, in which a higher score indicated greater self-efficacy. Attitudes toward PA were assessed using a 5-item PA attitude scale, adopted from the Family Life, Activity, Sun, Health, and Eating (FLASH) study [ 38 ]. These items included “If I were to be physically active most days of the week it would a) be fun; b) help me cope with stress; c) help me make new friends; d) make me more good looking; and e) make me better in sports, dance, or other activities.” Each item was rated on a 5-point Likert scale (scored 1 = strongly disagree to 5 = strongly agree). An attitude score was calculated by averaging the item scores, in which a higher score reflected more positive attitudes toward PA. To assess perceived barriers, we adopted the 5-item FLASH barrier scale [ 38 ]: I don’t exercise as much as I like to because: a) I don’t like sweat”; b) “I don’t like to exercise”; c) “I don’t want to mess up my hair”; d) “My family does not like to exercise”; and e) “I’m not athletic.” In addition, two barrier items were added based on prior qualitative research findings regarding PA barriers of SA female adolescents [ 29 ]: f) “The way I dress makes it hard” and g) “I don’t like to exercise around boys/men.” Each item was rated on a 5-point Likert scale (scored 1 = strongly disagree to 5 = strongly agree). A barrier score was created by averaging the item scores, with higher scores indicating greater perceived barriers. Primary Exposures Acculturation. To indicate participants’ acculturation category, the primary variable was created using 2 value-based acculturation items (items 22 and 23) from the Suinn-Lew Asian Self-Identity Acculturation Scale. (SL-ASIA) [ 39 – 41 ]: “Rate yourself on how much you believe in Asian values” (Asian value question) and “Rate yourself on how much you believe in American values” (American value question). Each item was rated on a 5-point scale (scored 1 = do not believe to 5 = strongly believe). We used these value-based items over behavioral competency-based items (items 24 and 25; reflecting external behavior and social integration), because they reflect internal cognition and emotional orientation toward cultural values, which are presumed to be more closely aligned with psychological dimensions of PA. In accordance with the SL-ASIA scoring guidance [ 41 ], participants were categorized into four acculturation categories: Asian-identified, Western-identified, bicultural, or neither (separated). Specifically, participants who responded as 4 or 5 to the Asian value question and 4 and 5 to the Western value question or those who responded 3 to both questions were categorized as bicultural. Participants who responded as 1 or 2 to the Asian value question and 1 and 2 to the Western value question were categorized as separated. Social support. We examined both parental and peer support using adolescent self-reports. Adolescent-reported parental support was prioritized due to stronger associations with youth PA than parent-reported [ 42 , 43 ]. The Activity Support Scale for Multiple Groups (ACTS-MG) questionnaire was used to assess parental support [ 44 , 45 ]. The ACTS-MG questionnaire included 4 subscales: 3 items of maternal modeling (e.g., “My mother exercises or plays a sport”; “My mother and I do active things together”), 3 items of paternal modeling, 3 items of logistic support (e.g., “My parents take me to places where I can be active, like to team sport practices and meets, the park, the swimming pool, gym, etc.”; “My parents watch me play sports or do other activities like martial arts and dance”), and 3 items of screen time restrictions (e.g., “My parents let me use the computer or other electronic devices as much as I want for things that aren’t homework like paying games, surfing the internet, and sending emails”). Each item was rated on a 4-point Likert scale (scored 1 = really false to 4 = really true). The screen time restriction items were reverse-scored. Maternal modeling, paternal modeling, logistic support, and screen time restriction scores were created by averaging their respective item scores. Then, the scores of the four subscales were averaged to generate the overall parental PA support score. To assess peer support, we used the 5-item Friend Support subscale from the Patient-Centered Assessment and Counseling for Exercise (PACE) [ 46 ]. Sample items included “My friends encourage me to do sports or physical activities” and “My friends do PA or play sports with me.” The items were rates on a 5-point Likert scale (scored 1 = strongly disagree to 5 = strongly agree). A peer support score was created by averaging the 5 item scores. Other Exposures as Covariates We considered exposures in sociocultural context as well as individual and interpersonal context as covariates, guided by the multi-level framework in family context [ 31 , 47 ]. Sociocultural Context. In investigating the relationship between acculturation and social support and PA, we accounted for sociocultural context. In the cultural background construct, we considered maternal ethnic identity (“How do you identify”?: options of Bangladesh, India, Nepal, Pakistan, Sri Lanka, America, or other) and language spoken at home (SA language only, English only, or both). In the socioeconomic position construct, we considered family income ( $ 0 to < $ 35,000, $ 35,000 to < $ 75000, $ 75,000 to < 100,000, or $ 100,000 or more) and maternal education attainment (less than high school, some college, bachelor’s degree, or graduate or professional school). To account for neighborhood context, neighborhood resources were assessed using the child opportunity index (COI). COI is a composite index to capture neighborhood resources and conditions critical for children’s healthy development at a census tract level [ 48 ]. Higher COI represents a neighborhood with greater opportunity. By matching the census tract geoid of participants’ home address and COI data from the COI 3.0 database, each participant was assigned to one of the five Chicago metropolitan COI categories (i.e., very low, low, moderate, high, and very high). Due to small sample sizes in some categories, we combined “very low” and “low” categories, and “high” and “very high” categories. Individual and interpersonal context. Age and weight status were considered, as prior studies [ 49 , 50 ] have shown that adolescents reduce PA with age and adolescents with obesity engaged in lower PA in adolescence. Height (cm) and weight (kg) were measured using a calibrated scale and used to calculate body mass index (BMI; weight in kg divided by height in meters squared). Weight status was categorized as normal weight (< 85th percentile), overweight (85th to < 95th percentile), and obese (≥ 95th percentile) based on BMI percentile [ 51 ]. Statistical Analysis All analyses were conducted using SAS 9.4 (Cary, North Carolina, USA). There was no missing data. Descriptive analyses, including frequency and distribution analyses, were performed. Bivariate analyses, including ANOVA and Spearman correlation coefficient analysis, were conducted between the exposure and outcome variables. For subsequent multivariable modeling, we selected PA outcome variables that showed a significant association (p < 0.05; two-sided) with at least one primary exposure variable (acculturation category, parental support score, peer support score) in the bivariate analyses. Cronbach’s alpha was calculated to assess the internal consistency of self-efficacy, attitude, and barrier scale items. Multivariable linear regression models were built to examine associations of acculturation and social support with PA outcome variables. We selected a set of covariates that were found to be significantly associated with PA outcomes in bivariate analyses. To explore a potential effect modification between acculturation and parental support, we tested an interaction term between those two variables. Results Among 126 participants, average age was 13.5 years (standard deviation [SD] = 1.7). The median number of valid accelerometer wear days were 7 days (interpersonal quartile range of 3 to 7). Average accelerometer wear minutes were 978 minutes/day (SD = 262). Average daily MVPA was 20 minutes/day (95% confidence interval [CI] = 16–24). Nine of 126 participants (7.1%) met recommended MVPA guidelines of ≥ 60 minutes/day [ 6 ]. Seventy-seven participants (61.1%) were born in the US (Table 1 ). In maternal ethnic origin, 84 mothers (66.7%) were Indian origin and 40 (31.8%) were of Pakistani origin. The PA variables did not differ between Indian and Pakistan origins (21 ± 24 vs. 18 ± 15 for MVPA; 2.8 ± 0.6 vs. 3.0 ± 0.6 for PA efficacy scores; 3.9 ± 0.6 vs. 4.0 ± 0.6 for PA attitude scores; 2.1 ± 0.7 vs. 2.3 ± 0.9 for PA barrier scores). As shown in Table 2 , 50 participants (39.7%) were categorized as bicultural, 55 (43.7%) as Asian-identified, 16 (12.7%) as Western-identified, and 5 (4.0%) as separated. Cronbach alpha was 0.77 for self-efficacy scale items, 0.58 for attitude scale items, and 0.72 for barrier scale items. PA self-efficacy scores and parental PA support scores significantly differed among the four acculturation categories (Table 2 ). Ad hoc pairwise comparisons found that the Asian and bicultural acculturation groups had significantly higher parental support than the western acculturation group. Table 1 Participant characteristics Socio-cultural context Frequency, n (%) Total 126 (100) Birthplace USA 77 (61.1) Outside USA 49 (38.9) Maternal country of origin India 84 (66.7) Pakistan 40 (31.8) Bangladeshi 1 (0.8) Sri Lankan 1 (0.8) Language spoken at home Both English and SA language 100 (79.4) SA language only 18 (14.3) English only 8 (6.4) Maternal education level High school or lower 29 (23.0) Some college 21 (16.7) Bachelor’s degree 44 (34.9) Graduate or professional school 32 (25.4) Maternal marital status Married 120 (95.2) Divorced, widowed, or separated (4.8) Household income $ 0 to < $ 35,000 34 (27.0) $ 35,000 to < $ 75,000 29 (23.0) $ 75,000 or higher 33 (26.2) Missing 30 (23.8) Child Opportunity Index Low 20 (15.9) Medium 60 (47.6) High 46 (36.5) Weight status Underweight or normal weight 90 (71.4) Overweight 15 (11.9) Obese 21 (16.7) Table 2 Unadjusted means of physical activity and social support variables by acculturation categories Total (n = 126) Bicultural (n = 50) Asian (n = 55) Western (n = 16) Separated (n = 5) ANOVA P-value Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) Mean (95% CI) PA variables MVPA, minutes/day 20 (16, 24) 22 (15, 28) 21 (15, 27) 12 (6, 18) 15 (0, 32) 0.54 α PA self-efficacy score (1 to 4) 2.9 (2.8, 3.0) 2.9 (2.8, 3.1) 2.9 (2.8, 3.1) 2.6 (2.3, 2.8) 2.3 (1.3, 3.3) 0.01 PA attitude score (1 to 5) 3.9 (3.8, 4.0) 3.8 (3.7, 4.0) 4.0 (3.8, 4.1) 3.9 (3.5, 4.3) 3.8 (2.4, 5.1) 0.64 PA barrier score (1 to 5) 2.2 (2.0, 2.3) 2.0 (1.8, 2.2) 2.2 (2.0, 2.4) 2.5 (2.0, 3.0) 2.4 (0.8, 4.0) 0.08 Social support variables Parental support (1 to 4) 2.8 (2.7, 2.8) 2.8 (2.6, 2.9) 2.8 (2.7, 3.0) 2.4 (2.1, 2.6) 2.6 (2.2, 3.0) 0.02 b Peer support (1 to 5) 4.0 (3.9, 4.1) 4.0 (3.8, 4.2) 4.0 (3.9, 4.2) 3.8 (3.5, 4.0) 3.7 (2.9, 4.5) 0.30 ANOVA, analysis of variance across four groups; CI, confidence interval; MVPA, moderate and vigorous-intensity physical activity; PA, physical activity. α Log-transformed MVPA was used for ANOVA. b Analysis of Variance (ANOVA) ad hoc pairwise comparison p-value < 0.05 between Asian and Western and between bicultural and western. Among social support variables investigated, the paternal modeling score was positively correlated with MVPA ( r = 0.18; p < 0.05; Table 3 ). The parental logistic support score and the peer support score were significantly positively correlated with the attitude score. All social support variables were significantly positively correlated with the self-efficacy score and significantly negatively correlated with the barrier score. In particular, the overall parenting support score was positively correlated with the self-efficacy score ( r = 0.45; p < 0.01) and negatively correlated with the barrier score ( r =-0.56; p < 0.01). Table 3 Unadjusted means of social support variables and their correlations with physical activity variables. Maternal modeling score Paternal modeling score a Parental logistic support score Parental screen time restriction score Parental support score b Peer support score Mean (95% CI) 2.74 (2.62, 2.86) 2.76 (2.61, 2.90) 2.88 (2.73, 3.04) 2.61 (2.47, 2.75) 2.75 (2.65, 2.84) 3.96 (3.86, 4.06) Correlation Coefficient r Log-MVPA, minutes/day 0.01 0.18* 0.12 -0.03 0.11 0.14 PA self-efficacy score 0.25** 0.29** 0.42** 0.23** 0.45** 0.20* PA attitude score -0.01 0.05 0.20* 0.03 0.11 0.26** PA barrier score -0.35** -0.43** -0.48** -0.26** -0.56* -0.29** CI, confidence interval; MVPA, moderate and vigorous-intensity physical activity; PA, physical activity. a Sample size n = 117; Nine participants not living with the father did not report paternal modeling. b The parental support score was created by averaging maternal modeling, paternal modeling, logistic support, and screen time restriction scores. *p < 0.05; **p < 0.01 Of the four PA variables investigated, we conducted multivariable modeling for self-efficacy, attitudes, and barrier outcomes, but not for accelerometer-measured MVPA, because those three PA psychological factors, but not MVPA, were found to be significantly associated with the primary exposure variables in bivariate analyses. After adjusted for covariates, multivariable regression model indicated that participants in the Asian acculturation category had significantly higher barrier scores, compared to participants in the bicultural acculturation category (β ± standard error [SE] = 0.3 ± 0.1; p = 0.02; Table 4 ). A one-point increase in the parental support score was associated with an additional 0.4-point increase in the self-efficacy score (SE = 0.1; effect size = 4.0 for changing parental support, for example, from “sort of false” to “sort of true”; p < 0.01) and with an additional 0.6-point decrease in the barrier score (SE = 0.1; p < 0.01). A one-point increase in the peer support score for PA was associated with an additional 0.2-point increase in the attitude score (SE = 0.1; p = 0.02). Table 4 Multivariable regression models to predict physical activity psychological constructs PA self-efficacy score PA attitude score PA barrier score β ± SE p β ± SE p β ± SE p Primary exposures in interpersonal and individual context Acculturation category Asian 0.1 ± 0.1 0.36 0.2 ± 0.1 0.10 0.3 ± 0.1 0.02 Western -0.1 ± 0.1 0.36 -0.1 ± 0.2 0.42 0.2 ± 0.2 0.33 Separated -0.5 ± 0.2 0.04 -0.03 ± 0.3 0.92 0.3 ± 0.3 0.23 Bicultural Ref. Ref. Ref. Ref. Ref. Ref. Parental support score 0.4 ± 0.1 < 0.01 0.1 ± 0.1 0.41 -0.6 ± 0.1 < 0.01 Peer support score 0.1 ± 0.1 0.42 0.2 ± 0.1 0.02 -0.2 ± 0.1 0.06 Child Growth and Development Age in years 0.01 ± 0.03 0.81 0.1 ± 0.04 0.10 0.03 ± 0.03 0.25 Weight status Obese -0.2 ± 0.1 0.20 -0.1 ± 0.1 0.41 0.3 ± 0.1 0.03 Overweight -0.1 ± 0.1 0.34 0.1 ± 0.2 0.62 -0.2 ± 0.2 0.24 Under or normal weight Ref. Ref. Ref. Ref. Ref. Ref. Social context Maternal education High school or lower -0.3 ± 0.1 0.05 -0.1 ± 0.2 0.48 0.3 ± 0.2 0.07 Some college -0.002 ± 0.1 0.99 -0.2 ± 0.2 0.29 0.2 ± 0.2 0.15 Bachelor’s degree -0.1 ± 0.1 0.23 -0.1 ± 0.1 0.59 0.2 ± 0.1 0.22 Graduate or professional school Ref. Ref. Ref. Ref. Ref. Ref. COI Low -0.1 ± 0.1 0.33 -0.2 ± 0.2 0.21 0.2 ± 0.2 0.14 Medium -0.03 ± 0.1 0.74 0.04 ± 0.1 0.72 0.1 ± 0.1 0.48 High Ref. Ref. Ref. Ref. Ref. Ref. Intercept 1.6 ± 0.5 < 0.01 1.9 ± 0.7 < 0.01 3.7 ± 0.6 < 0.01 β ± SE = estimate ± standard error; COI, child opportunity index; PA, physical activity; Ref., reference. Discussion This study identified potential protective and risk factors for PA in SA American female adolescents. In this sample from the Chicago, Illinois-metro area, SA American female adolescents engaged in an average of 20 minutes of MVPA per day, with only 7.1% meeting the recommended guidelines of 60 minutes per day [ 52 ]. Compared to participants categorized as bicultural acculturation, participants categorized as Asian acculturation reported greater barriers to PA. Participants categorized as separated acculturation exhibited lower self-efficacy for PA compared to those as bicultural acculturation category. Greater parental support for PA was associated with higher self-efficacy for overcoming PA barriers and lower perceived barrier to PA. Greater peer support for PA was associated with more positive attitude toward PA. Peer support also tended to be linked with lower perceived barrier to PA. PA in SA American female adolescents. To our knowledge, this is the first study to evaluate accelerometer-measured PA and its psychological factors among SA American female adolescents. Average MVPA (20 minutes/day; CI = 16–24) was lower than 25 minutes/day observed in a national representative sample of 308 females aged 12–15 years assessed in 2003–2004 [ 53 ]. Although research has not explicitly quantified the health benefits of additional 5 minutes/day of MVPA, a well-established dose-response relationship exists between MVPA and cardiovascular fitness, bone health, and adiposity reduction [ 6 ]. This study highlights potential disparities in PA levels that may contribute to the elevated cardiometabolic risks observed in SA females across the life course [ 54 ]. Acculturation and PA. Adolescence is a critical developmental stage for identity formation, including ethnic and cultural identity in racial/ethnic minority groups [ 55 ]. For immigrants in the US, acculturation strategies have been commonly classified as integration (also referred as biculturalism), assimilation (Western identity), separation (Asian identity), and marginalization (separated) [ 28 , 56 ]. Several studies have linked biculturalism to more adaptive functioning and favorable physical, psychological, and social outcomes, while separation acculturation strategy has been associated with negative outcomes, such as increased risk for suicide attempts, depression, and unhealthy behaviors in Asian adolescents [ 57 – 60 ]. In the current study, unadjusted means indicated that self-efficacy for PA was higher among SA female adolescents in bicultural or Asian acculturation categories, compared to those in a Western acculturation category. The positive association between bicultural identity and PA self-efficacy is aligned previous studies showing that biculturalism leads to favorable health outcomes. Interestingly, this result also indicates that holding Asian identity is positively associated with PA self-efficacy. However, this elevated self-efficacy for PA did not appear to translate into increased engagement in MVPA, as no association was observed between acculturation categories and accelerometer-measured PA. This intention-behavior gap is well-documented in PA psychology, suggesting possible explanations such as limited social and environmental support (lack of safe or accessible PA spaces and parental support) and competing demands and time constraints (e.g., school obligation, cultural or religious expectation) [ 61 , 62 ]. Our adjusted model accounting for parental support (discussed below) and other social-cultural factors, differences in PA self-efficacy by acculturation categories were no longer significant. Notably, our adjusted model also revealed that the Asian acculturation category was associated with a great perceived barrier to PA, compared to the bicultural category. As shown in our prior qualitative study findings [ 29 ], SA community’s cultural belief —such as viewing exercise as an “American behavior” or unnecessary for those who are thin—could play a stronger role in PA among Asian-identified females, compared to bicultural females. Qualitative research by Smith et al. also found that PA has a low priority over academic qualifications in SA families. Finally, the intention-behavior gap could also be partly due to the lack of variations in accelerometer-measured MVPA in this sample, having low MVPA across the acculturation categories. There is limited research on how distinct acculturation strategies influence PA among SA American youth. When examined as part of the broader, aggregated Asian category, findings have been mixed. Kwon et al. [ 18 ] reported that Asian American youth who primarily spoke English at home were more likely to engage in daily PA compared to those who primarily spoke a non-English language, based on data from in a nationally representative youth sample. In contrast, Unger et al. [ 19 ] reported that greater western acculturation (measured in a linear compendium) was associated with a lower frequency of PA among Asian youth in California. These inconsistent findings may be partially attributed to differences in how acculturation is conceptualized and measured across studies. Moreover, the lack of disaggregation by ethnic subgroups within the Asian American population complicates interpretation, as cultural norms and lived experiences vary substantially across Asian-origin groups. These limitations underscore the need for disaggregating data to better understand how acculturation influences PA behaviors in this growing and understudied population. Acculturation, social support, and PA. It is notable that SA female adolescents in the bicultural and Asian acculturation groups reported higher parental PA support, compared to those in the Western acculturation group. This finding may reflect that in SA culture, parents often play a central role in guiding and supporting their children’s behaviors, including PA behavior [ 63 ]. In contrast, female adolescents in the Western acculturation group might have adopted more individualistic values typical of Western culture, which could correspond to relatively less parental oversight or direct support around PA [ 64 ]. There is also the possibility that adolescents in the Western acculturation group experience more conflict with their immigrant parents or less family cohesion, which may impact perceptions of parental support [ 65 ]. Social support, such as parental and peer support, is critical in shaping PA behaviors through psychological mechanisms, such as improving self-efficacy, fostering a positive attitude, and reducing perceived barriers among children and adolescents [ 66 , 67 ]. Meta analysis that pooled studies from 74 countries showed positive association between parental and peer support and PA [ 68 ]. While this study found no association between parental and peer support and MVPA, greater parental support was associated with higher self-efficacy for overcoming PA barriers and lower perceived barriers to PA. These findings are consistent with prior studies on US adolescent populations, particularly among females [ 25 , 69 ]. Parental support is usually provided in the form of modeling, access to PA equipment, transport to sports venues, and reinforcement and encouragement of participation in PA [ 66 ]. Such instrumental and emotional support appears to play a critical role in improving self-efficacy for overcoming PA barriers and lowering perceived barriers to PA among SA female adolescents. Lower parental support and higher parental PA restriction for child PA have been observed among SA British families, compared to white British families, partly due to safety concerns and time constraint [ 70 – 72 ]. Addressing parental support in SA families may be a key strategy for promoting PA among SA American female adolescents. This study found no association between acculturation categories and peer support; however, greater peer support was associated with more positive attitudes toward PA. According to social cognitive theory [ 73 ], peer role modeling positively influences PA attitude and decision-making. Peer support is usually provided in the form of encouragement, appreciation, and join participation and fulfills an adolescent’s sense of belonging [ 66 ]. Such emotional support may help to develop positive attitude toward PA. Consistently with these prior studies [ 27 , 74 ], our study provides evidence that peer support is positively associated with PA attitudes among SA female adolescents. Strengths and Limitations. The strengths of the study include high-quality accelerometer measurement for PA assessment and the application of multi-level framework incorporating social-cultural, interpersonal, and individual factors. Limitations include the small sample sizes for western and separated acculturation groups, which may have reduced statistical power. This study was unable to examine PA-restrictive parenting practices (e.g., restriction for safety or weather) and their associations with acculturation and PA. Unmeasured confounders, such as mental health, may have introduced bias into the findings. Because this sample was drawn from the Chicago, IL-metro area, the results may not be generalized to other regions. Conclusions This study found that SA female adolescents identifying with an Asian acculturation perceived greater barriers to PA than those identifying with bicultural acculturation. Promoting PA-supportive parenting practices may enhance PA self-efficacy and reduce barriers to PA, while peer support may foster positive PA attitudes among SA American female adolescents. Abbreviations ACTS-MG, Activity Support Scale for Multiple Groups CI, confidence interval COI, child opportunity index FLASHE, Family Life, Activity, Sun, Health, and Eating MVPA, moderate and vigorous-intensity physical activity PA, physical activity PACE, Patient-Centered Assessment and Counseling for Exercise SA, South Asian SAATH, South Asians Active Together SL-ASIA, Suinn-Lew Asian Self-Identity Acculturation Scale. Declarations Ethics approval and consent to participate Northwestern University Institutional Review Board approved the study protocol. Informed consent and assessment were obtained from parents and participants. This study adhered to the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by National Cancer Institute (R01CA242520 and R01CA242520-S1), National Lung, Heart, Blood Institute (K24HL155897 and K24HL155897-03S1), and National Institute of Child Health and Development (R03HD113876). The work and conclusions of the paper are solely those of the authors. Authors’ contributions SK analyzed and interpreted data and drafted the manuscript. NK led the SAATH trial and contributed to manuscript writing. NS and PT critically reviewed the manuscript. All authors approved the final version of the manuscript for publication. Patients and the public were not directly involved in the design, conduct, or reporting of this trial. Acknowledgements REDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Protocol development reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. References United States Census Bureau. 2018 American Community Survey. 2019. https://www.census.gov/programs-surveys/acs.html . Accessed June 20, 2025. Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, et al. Atherosclerotic cardiovascular disease in south Asians in the United States: Epidemiology, risk factors, and treatments: A Scientific statement from the American heart association. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6967449","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488316585,"identity":"5551a8eb-f4af-4484-b1c4-c64e715690e6","order_by":0,"name":"Soyang Kwon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABG0lEQVRIiWNgGAWjYBADAyBmfABjIYvi1cIMIiTAyg4QqYVNgigt8u09hp8LfjEYGxzvPVZdUHGvzlwi+fDnDxX38hjYm7dJYDP9zBlj6Zl9DGYGZ86l3Z5xpljCckZamsSBM8XFDDzHyrBqkcgxkObtYbAxu5Fjdpu3LUHC4HaOGcPBtoTEBokcM2xa5GfkGP+GaSmGaMn//OHgP6AW+TdYtTAAVUrz/GAwA2lhhtrCIHGwAWQLD1YtBmeOlVnzNkgY24M8xXMmQXLD/WdmEmeOJSS28aQVW2ANsebNt3n+2BjOBAUdT0UCv8GZw48/VNQkJPazH954A5vDGDgMGBjbsDmADatyEGB/wMDwB6fsKBgFo2AUjAIGBgDE2mTUs+1jtQAAAABJRU5ErkJggg==","orcid":"","institution":"Northwestern University","correspondingAuthor":true,"prefix":"","firstName":"Soyang","middleName":"","lastName":"Kwon","suffix":""},{"id":488316586,"identity":"e867973a-c611-48b3-b511-1ea2b2f3fbc4","order_by":1,"name":"Nilay S. 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This population experiences disproportionally higher rates of obesity, diabetes, and cardiovascular disease, compared to East Asian and non-Hispanic White populations in the US [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Regular physical activity (PA) is a well-established behavior strategy for improving cardiovascular health across age, sex, and ethnic groups [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite its benefits, SA adults in the US, particularly women, engage in significantly lower levels of PA, compared to other ethnic groups [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmerging evidence suggests that this pattern extends to SA \u003cem\u003eyouth\u003c/em\u003e. Promoting PA early in life from youth provides a \u0026ldquo;triple benefit\u0026rdquo;: enhancing youth health, establishes lifelong behavioral habits, and influencing future generations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. UK studies have consistently reported lower PA levels in SA children, especially females, compared to their White and Black peers [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Despite the rapid growth of the SA population and their documented high cardiovascular risks [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], PA data among SA American youth remain scarce. Existing studies often aggregate SA youth under broader Asian American categories [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], potentially masking important subgroup disparities due to the heterogeneity within the Asian American population [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn general, female adolescents engage in less PA than male adolescents, with PA levels declining throughout adolescence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Beyond gender and age, parental and peer support have been identified as important determinants of youth PA behavior [\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For SA adolescents from immigrant families, cultural context may uniquely influence PA behavior. Acculturation\u0026mdash;a multidimensional process involving psychological, behavioral, and cultural adaptation to a new environment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u0026mdash;can shape perceptions and attitudes related to PA. In a prior qualitative study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], SA female adolescents described family perception viewing exercise as an \u0026ldquo;American behavior\u0026rdquo; and a community belief that that \u0026ldquo;if you are thin, you don\u0026rsquo;t need to exercise.\u0026rdquo; Gender-based constraints and a lack of role models were also identified as barriers to PA. These findings underscore the need to consider cultural, familial, and social contexts in understanding PA behavior in this population.\u003c/p\u003e\u003cp\u003eThis study builds on a multilevel framework [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] designed to guide the investigation of disparities in cardiovascular health, such as PA, dietary practices, and obesity, among SA immigrants. This framework integrates socio-cultural, interpersonal, and individual determinants relevant to health outcomes of SA immigrants. Adapting this multilevel framework to examine youth behavioral health [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], the present study investigated relationships between acculturation and social support and PA among SA female adolescents. We hypothesized that a bicultural identity (i.e., integration of SA and American cultural values), parental support for PA, and peer support for PA would be positively associated with PA. Among PA constructs, we examined accelerometer-measured PA levels and PA-related psychological constructs, including self-efficacy, attitudes, and barriers.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003eStudy design and sample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis cross-sectional study utilized baseline data from the South Asians Active Together (SAATH) randomized control trial. The trial protocol and statistical analysis plan can be accessed in \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/study/NCT04400253\u003c/span\u003e\u003cspan address=\"https://clinicaltrials.gov/study/NCT04400253\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. The SAATH study was a two-arm trial designed to determine the effectiveness of a community-based, dyadic PA intervention on moderate and vigorous-intensity PA (MVPA) among SA mother-daughter dyads [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Eligibility criteria for mothers included self-identifying as SA, being sedentary (self-reported PA\u0026thinsp;\u0026lt;\u0026thinsp;150 minutes/week), having a female child aged 11\u0026ndash;16 years, having no medical conditions that preclude PA, being without current pregnancy, and living in the Chicago metro area, and speaking English, Gujarati, Hindi, or Urdu. The eligibility criteria for daughter participants included being 11\u0026ndash;16 years of age, living in the same household with an enrolled mother, having no medical conditions that preclude PA, and speaking English, Gujarati, Hindi, or Urdu. These languages were chosen to reflect the primary languages spoken within SA subgroups in the Chicago area. SAATH participants were recruited and enrolled into the study between August 2020 and September 2023 through community outreach and partnerships with local community and health care organizations. The trial was planned for in-person data collection in community partner sites. However, during and after the COVID-19 pandemic, data collection was conducted either in-person or via video-conference. Participants who did not have valid baseline accelerometry data were excluded from the SAATH trial (n\u0026thinsp;=\u0026thinsp;10). The sample for the present study included the 126 SAATH daughter participants. This study adheres to CONSORT guidelines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome was MVPA measured using wGT3X-BT ActiGraph accelerometers. During the assessment visit, participants were instructed to wear the device on their non-dominant wrist for 7 consecutive days. Accelerometer data were downloaded and processed using the ActiLife software version 6.4. Non-wear time was defined using the Choi algorithm [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and excluded from data analysis. Participants with at least 3 valid days of accelerometry data were considered to have valid accelerometer data [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. A valid day was defined as having\u0026thinsp;\u0026ge;\u0026thinsp;500 wear minutes [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Time spent in MVPA (minutes/day) was calculated, applying a validated cutpoint for moderate-intensity of \u0026ge;\u0026thinsp;818 vector magnitude counts per 5 seconds [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe secondary outcomes included PA-related psychological constructs: self-efficacy, attitudes, and perceived barriers. Self-efficacy was assessed using the 6-item scale measuring self-efficacy for overcoming PA barriers [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. These items included \u0026ldquo;a) I can be physically active during my free time on most days; I can be physically active during my free time on most days b) even if I could watch TV or play video games instead, c) even if it is very hot or cold outside, d) even if I have to stay home, and e) no matter how busy my day is; f) I have the coordination I need to be physically active during my free time on most days. Each item was rated on a 4-point Likert scale (scored 1\u0026thinsp;=\u0026thinsp;disagree a lot to 4\u0026thinsp;=\u0026thinsp;agree a lot). A self-efficacy score was calculated by averaging the item scores, in which a higher score indicated greater self-efficacy.\u003c/p\u003e\u003cp\u003eAttitudes toward PA were assessed using a 5-item PA attitude scale, adopted from the Family Life, Activity, Sun, Health, and Eating (FLASH) study [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These items included \u0026ldquo;If I were to be physically active most days of the week it would a) be fun; b) help me cope with stress; c) help me make new friends; d) make me more good looking; and e) make me better in sports, dance, or other activities.\u0026rdquo; Each item was rated on a 5-point Likert scale (scored 1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). An attitude score was calculated by averaging the item scores, in which a higher score reflected more positive attitudes toward PA.\u003c/p\u003e\u003cp\u003eTo assess perceived barriers, we adopted the 5-item FLASH barrier scale [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]: I don\u0026rsquo;t exercise as much as I like to because: a) I don\u0026rsquo;t like sweat\u0026rdquo;; b) \u0026ldquo;I don\u0026rsquo;t like to exercise\u0026rdquo;; c) \u0026ldquo;I don\u0026rsquo;t want to mess up my hair\u0026rdquo;; d) \u0026ldquo;My family does not like to exercise\u0026rdquo;; and e) \u0026ldquo;I\u0026rsquo;m not athletic.\u0026rdquo; In addition, two barrier items were added based on prior qualitative research findings regarding PA barriers of SA female adolescents [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]: f) \u0026ldquo;The way I dress makes it hard\u0026rdquo; and g) \u0026ldquo;I don\u0026rsquo;t like to exercise around boys/men.\u0026rdquo; Each item was rated on a 5-point Likert scale (scored 1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). A barrier score was created by averaging the item scores, with higher scores indicating greater perceived barriers.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary Exposures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcculturation.\u003c/b\u003e To indicate participants\u0026rsquo; acculturation category, the primary variable was created using 2 value-based acculturation items (items 22 and 23) from the Suinn-Lew Asian Self-Identity Acculturation Scale. (SL-ASIA) [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]: \u0026ldquo;Rate yourself on how much you believe in Asian values\u0026rdquo; (Asian value question) and \u0026ldquo;Rate yourself on how much you believe in American values\u0026rdquo; (American value question). Each item was rated on a 5-point scale (scored 1\u0026thinsp;=\u0026thinsp;do not believe to 5\u0026thinsp;=\u0026thinsp;strongly believe). We used these value-based items over behavioral competency-based items (items 24 and 25; reflecting external behavior and social integration), because they reflect internal cognition and emotional orientation toward cultural values, which are presumed to be more closely aligned with psychological dimensions of PA. In accordance with the SL-ASIA scoring guidance [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], participants were categorized into four acculturation categories: Asian-identified, Western-identified, bicultural, or neither (separated). Specifically, participants who responded as 4 or 5 to the Asian value question and 4 and 5 to the Western value question or those who responded 3 to both questions were categorized as bicultural. Participants who responded as 1 or 2 to the Asian value question and 1 and 2 to the Western value question were categorized as separated.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSocial support.\u003c/b\u003e We examined both parental and peer support using adolescent self-reports. Adolescent-reported parental support was prioritized due to stronger associations with youth PA than parent-reported [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The Activity Support Scale for Multiple Groups (ACTS-MG) questionnaire was used to assess parental support [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The ACTS-MG questionnaire included 4 subscales: 3 items of maternal modeling (e.g., \u0026ldquo;My mother exercises or plays a sport\u0026rdquo;; \u0026ldquo;My mother and I do active things together\u0026rdquo;), 3 items of paternal modeling, 3 items of logistic support (e.g., \u0026ldquo;My parents take me to places where I can be active, like to team sport practices and meets, the park, the swimming pool, gym, etc.\u0026rdquo;; \u0026ldquo;My parents watch me play sports or do other activities like martial arts and dance\u0026rdquo;), and 3 items of screen time restrictions (e.g., \u0026ldquo;My parents let me use the computer or other electronic devices as much as I want for things that aren\u0026rsquo;t homework like paying games, surfing the internet, and sending emails\u0026rdquo;). Each item was rated on a 4-point Likert scale (scored 1\u0026thinsp;=\u0026thinsp;really false to 4\u0026thinsp;=\u0026thinsp;really true). The screen time restriction items were reverse-scored. Maternal modeling, paternal modeling, logistic support, and screen time restriction scores were created by averaging their respective item scores. Then, the scores of the four subscales were averaged to generate the overall parental PA support score.\u003c/p\u003e\u003cp\u003eTo assess peer support, we used the 5-item Friend Support subscale from the Patient-Centered Assessment and Counseling for Exercise (PACE) [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Sample items included \u0026ldquo;My friends encourage me to do sports or physical activities\u0026rdquo; and \u0026ldquo;My friends do PA or play sports with me.\u0026rdquo; The items were rates on a 5-point Likert scale (scored 1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). A peer support score was created by averaging the 5 item scores.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOther Exposures as Covariates\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe considered exposures in sociocultural context as well as individual and interpersonal context as covariates, guided by the multi-level framework in family context [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSociocultural Context.\u003c/b\u003e In investigating the relationship between acculturation and social support and PA, we accounted for sociocultural context. In the cultural background construct, we considered maternal ethnic identity (\u0026ldquo;How do you identify\u0026rdquo;?: options of Bangladesh, India, Nepal, Pakistan, Sri Lanka, America, or other) and language spoken at home (SA language only, English only, or both). In the socioeconomic position construct, we considered family income (\u003cspan\u003e$\u003c/span\u003e0 to \u0026lt;\u003cspan\u003e$\u003c/span\u003e35,000, \u003cspan\u003e$\u003c/span\u003e35,000 to \u0026lt;\u003cspan\u003e$\u003c/span\u003e75000, \u003cspan\u003e$\u003c/span\u003e75,000 to \u0026lt;\u0026thinsp;100,000, or \u003cspan\u003e$\u003c/span\u003e100,000 or more) and maternal education attainment (less than high school, some college, bachelor\u0026rsquo;s degree, or graduate or professional school). To account for neighborhood context, neighborhood resources were assessed using the child opportunity index (COI). COI is a composite index to capture neighborhood resources and conditions critical for children\u0026rsquo;s healthy development at a census tract level [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Higher COI represents a neighborhood with greater opportunity. By matching the census tract geoid of participants\u0026rsquo; home address and COI data from the COI 3.0 database, each participant was assigned to one of the five Chicago metropolitan COI categories (i.e., very low, low, moderate, high, and very high). Due to small sample sizes in some categories, we combined \u0026ldquo;very low\u0026rdquo; and \u0026ldquo;low\u0026rdquo; categories, and \u0026ldquo;high\u0026rdquo; and \u0026ldquo;very high\u0026rdquo; categories.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndividual and interpersonal context.\u003c/b\u003e Age and weight status were considered, as prior studies [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] have shown that adolescents reduce PA with age and adolescents with obesity engaged in lower PA in adolescence. Height (cm) and weight (kg) were measured using a calibrated scale and used to calculate body mass index (BMI; weight in kg divided by height in meters squared). Weight status was categorized as normal weight (\u0026lt;\u0026thinsp;85th percentile), overweight (85th to \u0026lt;\u0026thinsp;95th percentile), and obese (\u0026ge;\u0026thinsp;95th percentile) based on BMI percentile [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll analyses were conducted using SAS 9.4 (Cary, North Carolina, USA). There was no missing data. Descriptive analyses, including frequency and distribution analyses, were performed. Bivariate analyses, including ANOVA and Spearman correlation coefficient analysis, were conducted between the exposure and outcome variables. For subsequent multivariable modeling, we selected PA outcome variables that showed a significant association (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; two-sided) with at least one primary exposure variable (acculturation category, parental support score, peer support score) in the bivariate analyses. Cronbach\u0026rsquo;s alpha was calculated to assess the internal consistency of self-efficacy, attitude, and barrier scale items.\u003c/p\u003e\u003cp\u003eMultivariable linear regression models were built to examine associations of acculturation and social support with PA outcome variables. We selected a set of covariates that were found to be significantly associated with PA outcomes in bivariate analyses. To explore a potential effect modification between acculturation and parental support, we tested an interaction term between those two variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 126 participants, average age was 13.5 years (standard deviation [SD]\u0026thinsp;=\u0026thinsp;1.7). The median number of valid accelerometer wear days were 7 days (interpersonal quartile range of 3 to 7). Average accelerometer wear minutes were 978 minutes/day (SD\u0026thinsp;=\u0026thinsp;262). Average daily MVPA was 20 minutes/day (95% confidence interval [CI]\u0026thinsp;=\u0026thinsp;16\u0026ndash;24). Nine of 126 participants (7.1%) met recommended MVPA guidelines of \u0026ge;\u0026thinsp;60 minutes/day [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeventy-seven participants (61.1%) were born in the US (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In maternal ethnic origin, 84 mothers (66.7%) were Indian origin and 40 (31.8%) were of Pakistani origin. The PA variables did not differ between Indian and Pakistan origins (21\u0026thinsp;\u0026plusmn;\u0026thinsp;24 vs. 18\u0026thinsp;\u0026plusmn;\u0026thinsp;15 for MVPA; 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 vs. 3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 for PA efficacy scores; 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 vs. 4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 for PA attitude scores; 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 vs. 2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 for PA barrier scores). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, 50 participants (39.7%) were categorized as bicultural, 55 (43.7%) as Asian-identified, 16 (12.7%) as Western-identified, and 5 (4.0%) as separated. Cronbach alpha was 0.77 for self-efficacy scale items, 0.58 for attitude scale items, and 0.72 for barrier scale items. PA self-efficacy scores and parental PA support scores significantly differed among the four acculturation categories (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Ad hoc pairwise comparisons found that the Asian and bicultural acculturation groups had significantly higher parental support than the western acculturation group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocio-cultural context\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency, n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirthplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (61.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutside USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (38.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal country of origin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (66.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePakistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (31.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBangladeshi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSri Lankan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLanguage spoken at home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth English and SA language\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100 (79.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSA language only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnglish only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (6.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal education level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school or lower\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (23.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (34.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduate or professional school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (25.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal marital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120 (95.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced, widowed, or separated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0 to \u0026lt;\u003cspan\u003e$\u003c/span\u003e35,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (27.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000 to \u0026lt;\u003cspan\u003e$\u003c/span\u003e75,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (23.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75,000 or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (26.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (23.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild Opportunity Index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (15.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (47.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (36.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight or normal weight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (71.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (11.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnadjusted means of physical activity and social support variables by acculturation categories\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBicultural (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAsian (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWestern (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSeparated (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eANOVA P-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA variables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMVPA, minutes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (16, 24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (15, 28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (15, 27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (6, 18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15 (0, 32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.54\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA self-efficacy score (1 to 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.9 (2.8, 3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.9 (2.8, 3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9 (2.8, 3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.6 (2.3, 2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.3 (1.3, 3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA attitude score (1 to 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.9 (3.8, 4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.8 (3.7, 4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.0 (3.8, 4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.9 (3.5, 4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.8 (2.4, 5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA barrier score (1 to 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.2 (2.0, 2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0 (1.8, 2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2 (2.0, 2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 (2.0, 3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.4 (0.8, 4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial support variables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParental support (1 to 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8 (2.7, 2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.8 (2.6, 2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.8 (2.7, 3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.4 (2.1, 2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.6 (2.2, 3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeer support (1 to 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.0 (3.9, 4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.0 (3.8, 4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.0 (3.9, 4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.8 (3.5, 4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.7 (2.9, 4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eANOVA, analysis of variance across four groups; CI, confidence interval; MVPA, moderate and vigorous-intensity physical activity; PA, physical activity.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eα\u003c/sup\u003eLog-transformed MVPA was used for ANOVA.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003eAnalysis of Variance (ANOVA) ad hoc pairwise comparison p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 between Asian and Western and between bicultural and western.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong social support variables investigated, the paternal modeling score was positively correlated with MVPA (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The parental logistic support score and the peer support score were significantly positively correlated with the attitude score. All social support variables were significantly positively correlated with the self-efficacy score and significantly negatively correlated with the barrier score. In particular, the overall parenting support score was positively correlated with the self-efficacy score (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.45; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and negatively correlated with the barrier score (\u003cem\u003er\u003c/em\u003e=-0.56; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnadjusted means of social support variables and their correlations with physical activity variables.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaternal modeling score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePaternal modeling score\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eParental logistic support score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eParental screen time restriction score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eParental support score\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePeer support score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.74 (2.62, 2.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.76 (2.61, 2.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.88 (2.73, 3.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.61 (2.47, 2.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.75 (2.65, 2.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.96 (3.86, 4.06)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCorrelation Coefficient\u003c/b\u003e \u003cb\u003er\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLog-MVPA, minutes/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.18*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA self-efficacy score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.25**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.29**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.42**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.23**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.45**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.20*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA attitude score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.20*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.26**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePA barrier score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.35**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.43**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.48**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.26**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.56*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.29**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eCI, confidence interval; MVPA, moderate and vigorous-intensity physical activity; PA, physical activity.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003eSample size n\u0026thinsp;=\u0026thinsp;117; Nine participants not living with the father did not report paternal modeling.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003eThe parental support score was created by averaging maternal modeling, paternal modeling, logistic support, and screen time restriction scores.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf the four PA variables investigated, we conducted multivariable modeling for self-efficacy, attitudes, and barrier outcomes, but not for accelerometer-measured MVPA, because those three PA psychological factors, but not MVPA, were found to be significantly associated with the primary exposure variables in bivariate analyses. After adjusted for covariates, multivariable regression model indicated that participants in the Asian acculturation category had significantly higher barrier scores, compared to participants in the bicultural acculturation category (β\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error [SE]\u0026thinsp;=\u0026thinsp;0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A one-point increase in the parental support score was associated with an additional 0.4-point increase in the self-efficacy score (SE\u0026thinsp;=\u0026thinsp;0.1; effect size\u0026thinsp;=\u0026thinsp;4.0 for changing parental support, for example, from \u0026ldquo;sort of false\u0026rdquo; to \u0026ldquo;sort of true\u0026rdquo;; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and with an additional 0.6-point decrease in the barrier score (SE\u0026thinsp;=\u0026thinsp;0.1; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). A one-point increase in the peer support score for PA was associated with an additional 0.2-point increase in the attitude score (SE\u0026thinsp;=\u0026thinsp;0.1; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable regression models to predict physical activity psychological constructs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePA self-efficacy score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePA attitude score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePA barrier score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eβ\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary exposures in interpersonal and individual context\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcculturation category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWestern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBicultural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParental support score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeer support score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChild Growth and Development\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnder or normal weight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial context\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school or lower\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.002\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGraduate or professional school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eβ\u0026thinsp;\u0026plusmn;\u0026thinsp;SE\u0026thinsp;=\u0026thinsp;estimate\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error; COI, child opportunity index; PA, physical activity; Ref., reference.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study identified potential protective and risk factors for PA in SA American female adolescents. In this sample from the Chicago, Illinois-metro area, SA American female adolescents engaged in an average of 20 minutes of MVPA per day, with only 7.1% meeting the recommended guidelines of 60 minutes per day [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Compared to participants categorized as bicultural acculturation, participants categorized as Asian acculturation reported greater barriers to PA. Participants categorized as separated acculturation exhibited lower self-efficacy for PA compared to those as bicultural acculturation category. Greater parental support for PA was associated with higher self-efficacy for overcoming PA barriers and lower perceived barrier to PA. Greater peer support for PA was associated with more positive attitude toward PA. Peer support also tended to be linked with lower perceived barrier to PA.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003ePA in SA American female adolescents.\u003c/span\u003e To our knowledge, this is the first study to evaluate accelerometer-measured PA and its psychological factors among SA American female adolescents. Average MVPA (20 minutes/day; CI\u0026thinsp;=\u0026thinsp;16\u0026ndash;24) was lower than 25 minutes/day observed in a national representative sample of 308 females aged 12\u0026ndash;15 years assessed in 2003\u0026ndash;2004 [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Although research has not explicitly quantified the health benefits of additional 5 minutes/day of MVPA, a well-established dose-response relationship exists between MVPA and cardiovascular fitness, bone health, and adiposity reduction [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This study highlights potential disparities in PA levels that may contribute to the elevated cardiometabolic risks observed in SA females across the life course [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAcculturation and PA.\u003c/span\u003e Adolescence is a critical developmental stage for identity formation, including ethnic and cultural identity in racial/ethnic minority groups [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. For immigrants in the US, acculturation strategies have been commonly classified as integration (also referred as biculturalism), assimilation (Western identity), separation (Asian identity), and marginalization (separated) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Several studies have linked biculturalism to more adaptive functioning and favorable physical, psychological, and social outcomes, while separation acculturation strategy has been associated with negative outcomes, such as increased risk for suicide attempts, depression, and unhealthy behaviors in Asian adolescents [\u003cspan additionalcitationids=\"CR58 CR59\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. In the current study, unadjusted means indicated that self-efficacy for PA was higher among SA female adolescents in bicultural or Asian acculturation categories, compared to those in a Western acculturation category. The positive association between bicultural identity and PA self-efficacy is aligned previous studies showing that biculturalism leads to favorable health outcomes. Interestingly, this result also indicates that holding Asian identity is positively associated with PA self-efficacy.\u003c/p\u003e\u003cp\u003eHowever, this elevated self-efficacy for PA did not appear to translate into increased engagement in MVPA, as no association was observed between acculturation categories and accelerometer-measured PA. This intention-behavior gap is well-documented in PA psychology, suggesting possible explanations such as limited social and environmental support (lack of safe or accessible PA spaces and parental support) and competing demands and time constraints (e.g., school obligation, cultural or religious expectation) [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Our adjusted model accounting for parental support (discussed below) and other social-cultural factors, differences in PA self-efficacy by acculturation categories were no longer significant. Notably, our adjusted model also revealed that the Asian acculturation category was associated with a great perceived barrier to PA, compared to the bicultural category. As shown in our prior qualitative study findings [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], SA community\u0026rsquo;s cultural belief \u0026mdash;such as viewing exercise as an \u0026ldquo;American behavior\u0026rdquo; or unnecessary for those who are thin\u0026mdash;could play a stronger role in PA among Asian-identified females, compared to bicultural females. Qualitative research by Smith et al. also found that PA has a low priority over academic qualifications in SA families. Finally, the intention-behavior gap could also be partly due to the lack of variations in accelerometer-measured MVPA in this sample, having low MVPA across the acculturation categories.\u003c/p\u003e\u003cp\u003eThere is limited research on how distinct acculturation strategies influence PA among SA American youth. When examined as part of the broader, aggregated Asian category, findings have been mixed. Kwon et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported that Asian American youth who primarily spoke English at home were more likely to engage in daily PA compared to those who primarily spoke a non-English language, based on data from in a nationally representative youth sample. In contrast, Unger et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reported that greater western acculturation (measured in a linear compendium) was associated with a lower frequency of PA among Asian youth in California. These inconsistent findings may be partially attributed to differences in how acculturation is conceptualized and measured across studies. Moreover, the lack of disaggregation by ethnic subgroups within the Asian American population complicates interpretation, as cultural norms and lived experiences vary substantially across Asian-origin groups. These limitations underscore the need for disaggregating data to better understand how acculturation influences PA behaviors in this growing and understudied population.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAcculturation, social support, and PA.\u003c/span\u003e It is notable that SA female adolescents in the bicultural and Asian acculturation groups reported higher parental PA support, compared to those in the Western acculturation group. This finding may reflect that in SA culture, parents often play a central role in guiding and supporting their children\u0026rsquo;s behaviors, including PA behavior [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. In contrast, female adolescents in the Western acculturation group might have adopted more individualistic values typical of Western culture, which could correspond to relatively less parental oversight or direct support around PA [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. There is also the possibility that adolescents in the Western acculturation group experience more conflict with their immigrant parents or less family cohesion, which may impact perceptions of parental support [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial support, such as parental and peer support, is critical in shaping PA behaviors through psychological mechanisms, such as improving self-efficacy, fostering a positive attitude, and reducing perceived barriers among children and adolescents [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. Meta analysis that pooled studies from 74 countries showed positive association between parental and peer support and PA [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. While this study found no association between parental and peer support and MVPA, greater parental support was associated with higher self-efficacy for overcoming PA barriers and lower perceived barriers to PA. These findings are consistent with prior studies on US adolescent populations, particularly among females [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Parental support is usually provided in the form of modeling, access to PA equipment, transport to sports venues, and reinforcement and encouragement of participation in PA [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Such instrumental and emotional support appears to play a critical role in improving self-efficacy for overcoming PA barriers and lowering perceived barriers to PA among SA female adolescents. Lower parental support and higher parental PA restriction for child PA have been observed among SA British families, compared to white British families, partly due to safety concerns and time constraint [\u003cspan additionalcitationids=\"CR71\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. Addressing parental support in SA families may be a key strategy for promoting PA among SA American female adolescents.\u003c/p\u003e\u003cp\u003eThis study found no association between acculturation categories and peer support; however, greater peer support was associated with more positive attitudes toward PA. According to social cognitive theory [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e], peer role modeling positively influences PA attitude and decision-making. Peer support is usually provided in the form of encouragement, appreciation, and join participation and fulfills an adolescent\u0026rsquo;s sense of belonging [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Such emotional support may help to develop positive attitude toward PA. Consistently with these prior studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e], our study provides evidence that peer support is positively associated with PA attitudes among SA female adolescents.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eStrengths and Limitations.\u003c/span\u003e The strengths of the study include high-quality accelerometer measurement for PA assessment and the application of multi-level framework incorporating social-cultural, interpersonal, and individual factors. Limitations include the small sample sizes for western and separated acculturation groups, which may have reduced statistical power. This study was unable to examine PA-restrictive parenting practices (e.g., restriction for safety or weather) and their associations with acculturation and PA. Unmeasured confounders, such as mental health, may have introduced bias into the findings. Because this sample was drawn from the Chicago, IL-metro area, the results may not be generalized to other regions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study found that SA female adolescents identifying with an Asian acculturation perceived greater barriers to PA than those identifying with bicultural acculturation. Promoting PA-supportive parenting practices may enhance PA self-efficacy and reduce barriers to PA, while peer support may foster positive PA attitudes among SA American female adolescents.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACTS-MG, Activity Support Scale for Multiple Groups\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI, confidence interval\u003c/p\u003e\n\u003cp\u003eCOI, child opportunity index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFLASHE, Family Life, Activity, Sun, Health, and Eating\u003c/p\u003e\n\u003cp\u003eMVPA, moderate and vigorous-intensity physical activity\u003c/p\u003e\n\u003cp\u003ePA, physical activity\u003c/p\u003e\n\u003cp\u003ePACE, Patient-Centered Assessment and Counseling for Exercise\u003c/p\u003e\n\u003cp\u003eSA, South Asian\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSAATH, South Asians Active Together\u003c/p\u003e\n\u003cp\u003eSL-ASIA, Suinn-Lew Asian Self-Identity Acculturation Scale.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNorthwestern University Institutional Review Board approved the study protocol. Informed consent and assessment were obtained from parents and participants.\u0026nbsp;This study adhered to the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by National Cancer Institute (R01CA242520 and R01CA242520-S1), National Lung, Heart, Blood Institute (K24HL155897 and K24HL155897-03S1), and National Institute of Child Health and Development (R03HD113876). The work and conclusions of the paper are solely those of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSK analyzed and interpreted data and drafted the manuscript. NK led the SAATH trial and contributed to manuscript writing. NS and PT critically reviewed the manuscript. All authors approved the final version of the manuscript for publication. Patients and the public were not directly involved in the design, conduct, or reporting of this trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eREDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Protocol development reported in this publication was supported, in part, by the National Institutes of Health\u0026apos;s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnited States Census Bureau. 2018 American Community Survey. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.census.gov/programs-surveys/acs.html\u003c/span\u003e\u003cspan address=\"https://www.census.gov/programs-surveys/acs.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed June 20, 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVolgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, et al. Atherosclerotic cardiovascular disease in south Asians in the United States: Epidemiology, risk factors, and treatments: A Scientific statement from the American heart association. 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J Pediatr Psychol. 2017;42(5):569\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jpepsy/jsw103\u003c/span\u003e\u003cspan address=\"10.1093/jpepsy/jsw103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"parenting, peer support, immigrants, Indian, Pakistani, ActiGraph accelerometers","lastPublishedDoi":"10.21203/rs.3.rs-6967449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6967449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study aimed to examine relationships between acculturation, social support and physical activity (PA) among South Asian American female adolescents.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study used baseline data from the South Asians Active Together (SAATH) trial, which included 126 South Asian females aged 11\u0026ndash;16 years residing in the Chicago area. Participants wore a wrist ActiGraph accelerometer for 7 days and completed surveys assessing acculturation and PA-related psychological constructs, including parental and peer support, self-efficacy, attitudes, and perceived barriers. Multivariable linear regressions examined associations of acculturation categories (bicultural, Asian, Western, and separated) and parental and peer support scores with PA-related outcomes, adjusting for age, weight status, maternal education, and neighborhood resources.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eParticipants on average engaged in 20 minutes/day of moderate- and vigorous-intensity PA (MVPA; 95% CI\u0026thinsp;=\u0026thinsp;16\u0026ndash;24). Participants in Asian and bicultural acculturation categories reported higher parental PA support than those in the Western acculturation category (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). Compared to participants in the bicultural category, those in the Asian category reported greater perceived barriers to PA (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). Higher parental support was associated with greater PA self-efficacy (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and lower perceived barriers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Higher peer support was associated with more positive PA attitudes (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, acculturation, parental support, or peer support was not significantly associated with MVPA levels.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFindings suggest that promoting PA-supportive parenting practices may enhance PA self-efficacy and reduce barriers to PA, while peer support may foster positive PA attitudes among South Asian American female adolescents.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eClinicalTrials.gov identifier: NCT04400253. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/study/NCT04400253\u003c/span\u003e\u003cspan address=\"https://clinicaltrials.gov/study/NCT04400253\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e May 21, 2020.\u003c/p\u003e","manuscriptTitle":"Associations of Acculturation and Social Support with Physical Activity among South Asian Female Adolescents in the United States","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 16:33:52","doi":"10.21203/rs.3.rs-6967449/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-27T05:58:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-24T15:46:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143995892731042178963577297839185369839","date":"2025-10-17T06:41:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31533500119915846517450458019167446882","date":"2025-10-14T15:30:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288763288029562020176035124233186001967","date":"2025-10-14T09:41:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-01T22:59:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314028054286498007747717423389202177324","date":"2025-08-09T16:47:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-08T21:35:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280099253886108327290473932008166721993","date":"2025-07-23T02:19:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-21T01:33:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-30T19:40:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-30T19:35:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-06-30T19:31:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a112ee5c-8e2e-487d-b68c-58ae7a9d7d6d","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:05:27+00:00","versionOfRecord":{"articleIdentity":"rs-6967449","link":"https://doi.org/10.1186/s12887-025-06442-6","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-12-19 15:58:06","publishedOnDateReadable":"December 19th, 2025"},"versionCreatedAt":"2025-07-23 16:33:52","video":"","vorDoi":"10.1186/s12887-025-06442-6","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06442-6","workflowStages":[]},"version":"v1","identity":"rs-6967449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6967449","identity":"rs-6967449","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}