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It is unclear how changes in plant-based dietary quality are linked to the subsequent risk of cognitive impairment.

From 2019–2021, overdose deaths among youth and young adults ages 10–19 years of age residing in the United States increased by 109 %. We sought to examine the extent to which youth and young adults who have experience with substance use are aware of the harm reduction policies and interventions, including the statewide Good Samaritan Law (GSL), naloxone, and fentanyl test strips, and have access to naloxone and fentanyl test strips.

AbstractFood insecurity (FI) is a growing health problem, worsening during the COVID-19 pandemic. Fresh food prescription programs (FFRx) have been shown to increase healthy eating and decrease FI, but few FFRx are community-informed, or theory based. Our FFRx was a delivery program developed to alleviate FI for older adults. It was implemented in an academic medical center and guided by the Capabilities, Opportunities, Motivations, and Behaviors and Theoretical Domains Framework. We tested impacts of the program on FI, Fruit and Vegetable (FV) intake, depression, and loneliness at six-month intervals. During the FFRx, 31 people completed surveys every six months. FI decreased by an average of 2.03 points (p= <.001) while FV intake increased from a mean of 2.8 servings per day to 2.9 servings per day (p = .53). Depression and loneliness scores stayed stable. Preliminary data from this FFRx program, a partnership between an academic medical center and community partners, had positive impacts on FI.

Sedentary behavior is associated with poor physical and mental health. Targeting sedentary behavior is a simple strategy that may help counter physical and mental health concerns associated with COVID-19-related social restrictions. Of course, traditional strategies such as achieving optimal exercise and physical activity levels are also important and should be recommended. However, even under normal circumstances, the difficulty in promoting lasting exercise habits at multiple levels (e.g. individual, environment, policy) are well documented, and chances of maintaining or improving these factors is now even lower. Thus, relative to other lifestyle behaviors – sedentary behavior may be more amenable to change. Moreover, reducing sedentary behavior may be less susceptible to influence from factors associated with health disparities such as age, race, and socio-economic status compared to exercise or physical activity. Sedentary behavior is a feasible health strategy that should be targeted during COVID-19.Reducing sedentary behavior is a realistic strategy to help combat the negative physical and mental health consequences associated with the COVID-19 pandemic.

The worldwide expansion of users on the Internet has popularized the access of individuals to information that may not be obtained otherwise. Social media has fostered interactions between individuals and health organizations by changing the nature and speed of engagement. While it is known that many public health organizations use social media to engage their audiences, little is known about effective strategies and best practices for the dissemination of knowledge and audience engagement. Many barriers exist in the dissemination of public health messages, including limited funds to support information sharing. Blogs and social media networking sites can be dynamic, cost-effective communication tools with the potential to reach scientific, practitioner, and public audiences who may be missed through traditional outlets. This article describes rudimentary processes of developing a blog and using social media to disseminate public health information and potential applications in the day-to-day activities for other public health organizations. With the growing demand for instant communication and concise information, a strong Internet presence could help organizations maximize their reach and impact.

In 2015, YMCA-operated afterschool programs (ASPs) across South Carolina pledged to achieve the national standard that calls for every child to accumulate 30 min/day of moderate-to-vigorous physical activity (MVPA) during program time. This study shares the first-year findings related to the dissemination, implementation, and outcomes associated with the statewide intervention to achieve the MVPA Standard. Twenty ASPs were sampled from all YMCA-operated ASPs (N = 97) and visited at baseline (spring 2015) and first-year follow-up (spring 2016). Programs were provided standardized professional development training to increase the MVPA children accumulated while attending ASPs. The training focused on extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Implementation was evaluated via direct observation. Intent-to-treat (ITT) and as-treated comparisons were conducted in summer 2016. Reach/adoption was variable, with attendance at trainings ranging from 0 to 100% across ASPs. Effectiveness of the intervention using ITT models indicated no changes from baseline in the percentage of programs meeting the MVPA standard for boys or girls. Implementation levels also varied and were related to increases in both boys' and girls' MVPA for moderate and high implementers. Findings indicate improvements in MVPA can be made from attending the trainings and implementing some or all of the training components. Additional work is necessary to identify ways to ensure staff attend trainings to implement strategies and to identify which specific factors contributed to increases in MVPA.

Purpose. The aim of this study was to evaluate an intervention designed to assist after-school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable be served daily and sugar-sweetened beverages/foods and artificially flavored foods eliminated.Design. The study used a 1-year group-randomized controlled trial.Setting. The study took place in ASPs operating in South Carolina, United States.Subjects. Twenty ASPs serving over 1700 children were recruited, match-paired postbaseline on enrollment size and days fruits/vegetables were served per week, and randomized to either intervention (n = 10) or control (n = 10) groups.Intervention. The study used Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multistep adaptive intervention framework that assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost.Measures. Direct observation of snacks served and consumed and monthly snack expenditures as determined by receipts were used.Analysis. The study used nonparametric and mixed-model repeated measures.Results. By postassessment, intervention ASPs increased serving of fruits/vegetables to 3.9 ± 2.1 vs. 0.7 ± 1.7 d/wk and decreased serving sugar-sweetened beverages to 0.1 ± 0.7 vs. 1.8 ± 2.4 d/wk and sugar-sweetened foods to 0.3 ± 1.1 vs. 2.7 ± 2.5 d/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01 per snack decrease in the control group ($0.39 to $0.38). Across both assessments and groups, 80% to 100% of children consumed FVs.Conclusions. The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost.

Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI -114 to -19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (-5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits.

AbstractBackground:In 2011, the YMCA of the United States adopted physical activity standards for all their afterschool programs (ASPs), which call for children to accumulate 30 minutes of moderate-to-vigorous physical activity (MVPA) while attending YMCA ASPs. The extent to which youth attending YMCA ASPs achieve this standard is unknown.Methods:Using a cluster-stratified design, 20 ASPs were sampled from all YMCA-operated ASPs across South Carolina (N= 102). ASPs were visited on four unannounced, nonconsecutive weekdays. Accelerometer-derived minutes spent in MVPA were dichotomized to ≥30 min/d of MVPA and <30 min/d of MVPA. Program characteristics were measured through document review and direct observation and compared to MVPA levels using random-effects quantile regression.Results:Boys (n= 607) and girls (n= 475) accumulated a median of 25.3 and 17.1 min/d of MVPA, respectively, which translated into 33% (range 6.2%–67.3%) and 17% (0%–42.6%) achieving the 30 min/d of MVPA standard, respectively. Increase in time scheduled for activity (10.7–11.7 min/d of MVPA), limited sedentary choices during activity time (6.9–8.9 min/d of MVPA), and staff activity-promotion training (4.8–7.9 min/d of MVPA) were associated with higher accumulated minutes of MVPA for boys and girls. Program revenue, percent activity structure that was for free play, and indoor/outdoor space were inconsistently related to meeting the MVPA standard.Conclusions:Modifiable programmatic structures were associated with higher amounts of MVPA. These findings suggest that simple programmatic changes could help ASPs to achieve the MVPA standard, regardless of infrastructure or finances.

Many studies examining individual-level correlates in youth utilize self-report rather than objective measures of physical activity (PA). This utilization of self-report may result in associations that are not present when examining objectively measured PA. The present study investigates the relationship between hypothesized correlates of PA with objectively and subjectively measured PA.

Despite approximately equal numbers of male and female medical school graduates, women are entering academic medicine at a lower rate than their male colleagues. Of those who do assume a faculty position, female faculty members report higher levels of burnout, often attributable to gender-specific difficulties in clinical expectations and maintenance of work-life balance. Many of these struggles are attributable to issues that are amenable to supportive policies, but these policies are inconsistent in their availability and practice. This commentary presents evidence for inconsistencies in the day-to-day experience of female faculty members, and proposes solutions for the mitigation of the challenges experienced more often by female faculty members with the goal of diversifying and strengthening academic medicine.

Purpose. To determine if the sex of the child moderates the relationships between perceptions of the physical/social environments and moderate to vigorous physical activity (MVPA) in youth.Design. Cross-sectional.Setting. North Carolina.Subjects. A final sample of 711 children, 8 to 17 years of age, was available for analysis.Measures. Self-reported presence of environmental factors previously identified to be associated with physical activity in youth was collected via survey. Daily MVPA was assessed via accelerometry for a minimum of 4 days.Analysis. Multilevel linear regression models were employed, adjusted for clustering at the county and individual level. MVPA was first regressed onto sex and environmental perception items while controlling for grade and race. The interaction term between sex and environmental perception was then added to the model.Results. A significant positive association was observed in the first models between MVPA and two items related to parent permission to (1) walk and (2) ride a bike in the neighborhood. These effects were fully moderated by sex, with males indicating “yes” on these items exhibiting 6.87 and 5.21 more minutes of MVPA (respectively) than males indicating “no.”Conclusion. Environmental perceptions appear to be related to MVPA, but this relationship is present only in males. Future research should be conducted to identify modifiable social and physical characteristics that are associated with MVPA in females.

Purpose. To examine associations between the built/social environment (neighborhood amenity density, crime) and health indicators (body mass index [BMI] percentile, cardiovascular fitness, and time spent in moderate to vigorous physical activity [MVPA]) among rural and urban youth.Design. Cross-sectional.Setting. Eastern North Carolina.Subjects. Youth (n = 296) were recruited from three middle schools.Measures. Neighborhood density was estimated using Walk Score. Crime was assessed using Regional Analysis and Information Sharing online. BMI percentiles were calculated from measured height and weight. Cardiovascular fitness was estimated using heart rate measured at the conclusion of a 3-minute step test. Time spent in MVPA was measured objectively via accelerometer.Analysis. Bivariate and multivariate statistics were used to examine associations between Walk Score, crime, BMI percentile, cardiovascular fitness (as measured via heart rate), and MVPA.Results. Walk Score was positively correlated with crime. There were positive, statistically significant associations between Walk Score and (1) BMI percentile (p = .0223) and (2) heart rate (p = .0044), and (3) inverse associations between Walk Score and MVPA (p = .0042), indicating that high neighborhood density was associated with greater BMI percentiles, lower fitness, and less MVPA among urban youth.Conclusion. These counterintuitive findings may be due to the negative effect of crime on health indicators, which may outweigh potential positive health impacts of high neighborhood amenity density.

AbstractBackground:Children tend to be sedentary during the after-school hours, and this has deleterious effects on their health. The objective of the present study was to determine the effects of a 3-year after-school physical activity (PA) program, without restriction of dietary energy intake, on percent body fat (%BF), cardiorespiratory fitness (CRF), and cardiometabolic markers in children.Methods:A cluster randomization design was employed. A total of 574 3rdgrade children from 18 elementary schools in the southeastern United States participated. The intervention consisted of 80 minutes of age-appropriate moderate-to-vigorous PA each school day. The main outcomes of interest were %BF measured by dual-energy X-ray absorptiometry; CRF measured by heart rate in response to a submaximal step test; nonfasting total and high-density lipoprotein cholesterol (HDL-C); and resting blood pressure (BP).Results:Intent-to-treat analyses showed significant treatment by time interactions for %BF (p=0.009) and CRF (p=0.0003). The change pattern of the means suggested that %BF and CRF in intervention children improved relative to control children during the school months, rebounding to the levels of control children over the summers following years 1 and 2. Year-by-year analyses of what occurred during the months when the program was offered revealed dose–response relations for %BF and CRF, such that the clearest beneficial effects were seen for those youth who attended at least 60% of the after-school sessions. No significant intervention effects were seen for cholesterol or BP.Conclusions:An after-school PA program was effective in reducing adiposity and improving CRF, especially in the children who attended the sessions at least 3 days/week. However, the favorable effects on %BF and CRF were lost over the summer. Thus, it is critical to incorporate strategies that attract and retain the children to receive an adequate dose of PA year-round.Trial Registration:Clinicaltrials.gov number, NCT00061841.

Purpose. To examine associations between county-level natural amenities, physical activity (PA), and body mass index (BMI).Design and Setting. Cross-sectional study among 100 North Carolina counties.Measures. We obtained percentage of county residents meeting PA criteria and county-wide means for reported height and weight from the North Carolina Behavioral Risk Factor Surveillance System, combining years 2003, 2005, and 2007. The county natural amenities scale was the independent variable. Potential county-level covariates were percentage rural, percentage black, median age, and median household income (Census 2000).Analysis. We conducted weighted bivariate and linear regression analyses to examine relationships between natural amenities, aggregate PA, and aggregate BMI.Results. BMI and natural amenities were negatively associated (parameter estimate = –.13 (.06), p = .03). When percentage meeting PA criteria was included, the parameter estimate attenuated 15%.Conclusion. There was an inverse relationship between natural amenities and BMI, partially mediated by PA.

Objective: The percentage of obese children in the United States has increased dramatically over the past three decades, particularly among ethnic/ racial minorities. This study sought to examine the impact of a clinical case-management intervention based upon the Transtheoretical Model (TTM) to reduce obesity and increase physical activity in children.Methods: Nineteen obese African-American children ages 8-12 were recruited from two pediatric clinics and were randomized to either a 12-week intervention group or a control group. Dependent variables included body mass index (BMI) percentile, physical activity, and stage of change for the child and parent.Results: In comparison to the control group, the intervention group demonstrated significant decreases in BMI and improvements in daily vigorous physical activity. The children in the intervention group demonstrated movement toward action/maintenance stages of change.Conclusions: A 12-week TTM-based case management intervention can have a favorable impact on obesity and physical activity in African-American child.

The Physical Self-attribute Questionnaire was developed for use in conjunction with the Physical Self-perception Profile to model cognitive facets of perceived competence, certainty, importance, and discrepancy from ideal to each of the physical subdomains measured by the latter (Strength, Attractive Body, Condition, and Sport). To this end, two studies were conducted. Study 1 examined the factor structure, test-retest reliability, and validity of the questionnaire in a sample of 154 (28 men, 126 women) undergraduate health students. Reliability and validity were acceptable, and confirmatory factor analysis indicated good fit for a four-factor solution. In Study 2, the reliability, validity, and factor structure was again confirmed in a sample of 120 (83 men, 37 women) undergraduate students recruited from exercise classes. Results of these two studies suggest that the Physical Self-attribute Questionnaire is a viable tool to measure the underlying cognitive facets of subdomain-specific physical self-esteem.

Objective:To test the hypothesis that third grade children (mean age = 8.7, SD = 0.5) who attended an 8‐month after‐school program would exhibit favorable changes in body composition, cardiovascular fitness, blood pressure, total cholesterol, and high‐density lipoprotein‐cholesterol compared with children in control condition. Research Methods and Procedures:Subjects were 61% African‐American, 31% white, and 8% other racial background from 18 public schools. Sixty‐eight percent were eligible for free or reduced price lunch. Percentage body fat and bone mineral density were assessed by DXA, cardiovascular fitness by heart rate response to a step test, resting blood pressure with a Dinamap, and non‐fasting total cholesterol and high‐density lipoprotein‐cholesterol by finger stick. Data pre‐ and post‐intervention were available for 447 children. Children in the nine intervention schools who attended at least 40% of the after‐school sessions were compared with control subjects. Results:Compared with the control subjects and after controlling for race, sex, free/reduced price lunch status, and school‐level covariates, youths in the intervention group showed a relative reduction of percentage body fat [−0.76 (95% confidence interval (CI), −1.42, −0.09)], a greater relative gain in bone mineral density [0.008 (95% CI, 0.001, 0.005)], and a greater relative reduction in heart rate response to the step test [−4.4 (95% CI, −8.2, 0.6)]. The other outcome variables showed non‐significant trends in favor of the intervention subjects. Discussion:These results are promising in light of the potential impact on the emerging childhood obesity epidemic. The Medical College of Georgia FitKid Project has the potential to be institutionalized because it is built on the existing infrastructure in most public schools in the U.S.

Many elderly persons are engaging in resistance exercise to counter muscle atrophy due to aging. Here, the acute effects of resistance exercise on postural control mechanisms were examined. Postural control was quantified by mean square center-of-pressure displacements were calculated utilizing force vectors in accordance with previously developed equations. Stabilogram-diffusion plots utilized the displacements as data points after curve-fitting techniques were applied. Two regions, representing the open-loop and closed-loop postural control mechanisms, are shown by the plots and separated at the critical point, which represents the shift in control mechanisms. 21 older adults (age M= 71.2, SD= 3.84, range 66–81 years) performed three sets of 10–12 repetitions for six resistance exercises for the lower extremity until fatigue. Immediately after exercise, postural stability was reduced. This was represented by a shift of the critical point to the right, indicating an increase in open-loop control. Since resistance training has an acute negative effect on postural control, it is advised to assist elderly clients carefully and immediately after resistance training.

The purpose of the present study was to examine the relationships of interscholastic sports participation with locus of control, self-concept, cognitive test scores, and school dropout in adolescents via a secondary analysis of National Educational Longitudinal Study 1988 (NELS:88). Subjects were 1,883 students who completed all measurements in 8th grade (1988), at Follow-up 1 (10th, 1990), and Follow-up 2 (12th, 1992). Scales utilized to measure locus of control, self-concept, and cognitive ability were developed by the National Center for Educational Statistics. Dropout was assessed through school records and contact with participants. At baseline and Follow-up 1, students self-reporting sport participation displayed higher self-concept and locus of control; however, these differences were no longer observed at Follow-up 2. Drop-out rate for boys at Follow-up 2 was significantly lower for students reporting interscholastic sport participation at baseline or at Follow-up 1. Similarly, drop-out rate for girls at Follow-up 2 was significantly lower for students reporting interscholastic sport participation at baseline or at Follow-up 1. These findings support the presumed positive role of sport participation for adolescents in American schools.