Background on the Development of the FNPA Tool
The FNPA tool was developed by researchers with the Physical Activity and Health Promotion Lab at Iowa State University based on in collaboration with the Academy of Nutrition and Dietetics following a comprehensive evidence analysis examining the influence of physical activity, sport participation, television viewing and video games for their influence on child adiposity. From this analysis, ten constructs were formulated which are now included in the FNPA.
These constructs include
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Foundation of the FNPA
Foundational Concepts
The need for a behaviorally based screening tool was identified by researchers affiliated with the Academy of Nutrition and Dietetics. Click here to access the original manuscripts describing the vision for the tool |
Original Validation of the FNPA
The original FNPA was a 21-item questionnaire evaluating ten established constructs, or topic areas, identified by the evidence analysis. Initial validation was performed in a sample of 854 first grade children and their parents from 37 of 39 elementary schools in a large Midwestern urban school district (Des Moines, IA). Anthropometric data were obtained by trained school nurses and parents completed the FNPA survey. Correlational analysis and logistic regression were used to examine associations among FNPA factors and the relationship between these factors and child weight status. Significant correlations were found between BMI and seven of the ten constructs (breakfast/family meals, modeling nutrition, high calorie beverage intake, television in the bedroom, parent physical activity, child physical activity and sleep schedule) as well as between BMI and the overall FNPA score.
The predictive validity of the FNPA tool was examined using a longitudinal design in a large sample of youth. A one-year follow-up was conducted with the original validation sample of urban elementary school children. Anthropometric measurements were repeated by school nurses one year later and change in BMI percentile was calculated. Over half of the participants exhibited increases in BMI percentile for age and gender with the FNPA score explaining unique variance in BMI at follow-up (β = -0.017), suggesting that an increase of 10 points on the FNPA corresponds to a decrease of 0.17 BMI units. While the independent effect of the FNPA score is small, it does suggest an impact of modifiable home environment factors.
The predictive validity of the FNPA tool was examined using a longitudinal design in a large sample of youth. A one-year follow-up was conducted with the original validation sample of urban elementary school children. Anthropometric measurements were repeated by school nurses one year later and change in BMI percentile was calculated. Over half of the participants exhibited increases in BMI percentile for age and gender with the FNPA score explaining unique variance in BMI at follow-up (β = -0.017), suggesting that an increase of 10 points on the FNPA corresponds to a decrease of 0.17 BMI units. While the independent effect of the FNPA score is small, it does suggest an impact of modifiable home environment factors.
Updates to the FNPA: Cognitive Testing and Reliability
We have recently refined the wording and formats in the FNPA tool to best capture the ever-changing landscape of factors that may impact child weight status. We have retained the same 10 evidence-based constructs but cognitive testing revealed the need to make some adjustments in the wording. For example, the original FNPA only asks about television in the screen time questions. New forms of media such as video games and cell phones had to be added to these items. We also systematically evaluated two different response scales - one based on subjective reports of frequency (e.g. "typically") and another based on more objective reports in a typical week (e.g. "3 days" / "4 days"). This study showed support for the existing subjective response scale. Click here to download the current (Subjective Format) version of the FNPA.
