The influence of friends and psychosocial factors on physical activity and screen time behavior in adolescents: a mixed-methods analysis.

(1) Determine the association between adolescent moderate-to-vigorous physical activity (MVPA) and screen time with their nominated friends' behaviors and (2) explore potential mechanisms of friends' social influences on MVPA and screen time. Participants consisted of 152 adolescents (mean age: 14.5 years, 53 % female, 50 % high school, 80 % Caucasian). MVPA was measured with an Actigraph GT3X+ accelerometer. Demographic and psychosocial variables were assessed via questionnaires. Participants nominated up to 5 friends who completed MVPA and screen time questionnaires. A subset of adolescents (n = 108) participated in focus groups that examined potential mechanism of friends' influence on MVPA and screen time. Multiple regression analysis examined the association of demographic, psychological, and nominated friend variables with participants' MVPA and screen time. NVivo 10.0 was used to analyze qualitative data. Greater levels of friends' MVPA was associated with greater levels of MVPA in both males (p < .0001) and females (p < .0001). Greater levels of friends' screen time was associated with greater levels of screen time in males (p = .04) while psychosocial variables, such as increased screen time enjoyment, were associated with increased screen time in females (p = .01). School level was not associated with either MVPA or screen time. Focus group data indicated that friends positively influenced participants' MVPA through engaging in activity with participants, verbal encouragement, and modeling of MVPA. All participants preferred to be active with friends rather than alone, however, females preferred activity with a close friend while males preferred to be active with a group. Enjoyment of MVPA was the most cited reason for engaging in MVPA with friends. The majority of participants reported friends not having an influence on screen time. Adolescents with active friends are more likely to be physically active and spend less time engaging in screen-based behaviors. Interventions to increase MVPA in youth could be designed to include the recruitment of friends to increase enjoyment of MVPA.