Voices through cameras: Learning about the experiences and challenges of minority government-insured overweight and obese New York City adolescents using photovoice

Abstract

Background

Over one-third of US adolescents are overweight, and about 18% are obese. Prevalence is similar in New York City adolescents, with disparities across socioeconomic status and race/ethnicity. Photovoice is a participatory approach that allows participants to communicate experiences through photographs and interviews. The purpose of this pilot study was to increase adolescent awareness of positive and negative influences on dietary and physical activity (PA) behaviors, and increase understanding of the perceived role of the physician in influencing these behaviors.

Methods

Seven adolescents aged 13–19 years diagnosed with overweight or obesity were recruited from a government insurance-based pediatric clinic at New York Presbyterian Hospital/Weill Cornell Medical Center. Participants completed photovoice assignments and individual interviews addressing perceived barriers, strategies, and influences related to healthy dietary and PA behaviors. Interviews were transcribed and reviewed to identify key themes across participants.

Results

Barriers to healthy eating included family and cost; strategies included controlling portion sizes and eating in moderation. Barriers to PA included academic pressures/homework and the neighborhood environment; strategies included making PA fun and social support. Participants identified the major role of the physician and physical education teachers in influencing health behaviors, and the desire for increased or different communication with the physician to facilitate healthy eating and PA. Participant awareness of health behaviors was increased as a result of study participation.

Conclusions

Photovoice is a unique method to engage adolescents around personal dietary and PA influences and behaviors. Increased awareness of personal health behaviors may help promote positive behavioral change.

Keywords:

• Adolescents
• Diet
• Minority groups
• New York City
• Obesity
• Overweight
• Photography
• Physical activity

Acknowledgements

The authors gratefully acknowledge the students at Weill Cornell Medical College (WCMC) and the City University of New York School of Public Health for their assistance, the resident and attending pediatricians at New York Presbyterian Hospital/WCMC, and the study participants.

Additional information

Notes on contributors

Katherine Van Oss

Katherine Van Oss, MD is a preventive medicine physician studying pediatric obesity prevention in the Department of Healthcare Policy and Research at New York Presbyterian Hospital/Weill Cornell Medical College (NYPH/WCMC). Her current work includes clinic-, school-, and community-based interventions and parent education about nutrition and physical activity.

May May Leung

May May Leung, PhD, RD is an assistant professor of Nutrition at the City University of New York (CUNY) School of Public Health. Her research expertise includes developing innovative interventions in community-based settings focused on engaging and empowering youth to adopt healthy diet and physical activity behaviors to prevent obesity.

Julia Sharkey Buckley

Julia Sharkey Buckley, MS is a recent graduate of the Master of Science in Nutrition program at the CUNY School of Public Health. During her studies, she was involved in a number of community-based research projects and interventions related to youth nutrition and PA knowledge and practice.

Melanie Wilson-Taylor

Melanie Wilson-Taylor, MD is an assistant attending pediatrician and an assistant professor of pediatrics at NYPH/WCMC with research experience in patient/family-oriented anticipatory guidance and resident knowledge, attitudes, and behaviors related to community pediatrics. She serves as a faculty mentor to a medical student organization that focuses on obesity prevention in an underserved population in East Harlem.