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School-based physical activity (PA) opportunities can help students engage in greater amounts of daily PA, meet PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This exploratory study examined associations between school-level determinants and the implementation of school-based PA opportunities. We analyzed cross-sectional survey data from schools (n= 46) participating in the Healthy Zone School Program (HZSP) (Dallas, Texas, USA) during 2019–2020. Respondents completed an electronic survey that included measures of school-level determinants (e.g. culture, leadership, priority) and the implementation of school-based PA opportunities. We used linear regression models to examine associations between determinants and implementation outcomes (number of PA opportunities delivered, perceived overall success of each PA program/activity used). After adjusting for campus type (i.e. elementary, middle, high, K-12), student race/ethnicity, and percentage of economically disadvantaged students, no constructs were associated with the number of PA opportunities implemented. Linear regression models suggest access to knowledge and information (β = 0.39, P= .012, 95% CI = 0.24–1.44) and implementation climate (β = 0.34, P= .045, 95% CI = 0.02–1.59) were positively associated with the success of school-based PA opportunities. Our findings provide suggestive evidence that access to knowledge and information and a supportive school climate may improve the overall success of PA opportunities provided to students. Future research should examine additional school-level determinants to understand their importance to implementation and inform the development of strategies to improve schools’ capacity for implementing PA opportunities successfully.A school climate that supports implementation and access to knowledge and information related to physical activity (PA) programs and activities may improve implementation success.School-based physical activity (PA) opportunities (e.g. programs, activities, policies) help students engage in greater amounts of daily PA, meet national PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This study explored what factors contribute to schools’ ability to provide PA opportunities throughout the school year. We administered a survey to schools participating in the Healthy Zone Schools program during the 2019–20 academic year to assess the relationship between school-level determinants (e.g. culture, leadership, priority) and implementation outcomes related to school-based PA opportunities (e.g. number of programs and activities implemented, overall success of programs/activities implemented). We found no evidence of an association between determinants and the number of PA programs and activities implemented. However, we identified implementation climate and access to knowledge and information as key drivers of implementation success. This information can be used to develop implementation strategies that improve PA opportunities offered by schools.

•The COVID-19 pandemic negatively impacted physical activity among U.S. adolescents.•During COVID-19 summer, adolescents' steps dropped compared with those during pre–COVID-19 school.•Both boys and girls had less moderate-to-vigorous physical activity during COVID-19 school than during pre–COVID-19 school.

Background: Studies across racial/ethnic groups indicate that physical activity (PA) and alcohol consumption are positively associated, and that alcohol consumption is negatively associated with body mass index (BMI), but this relationship is less often evaluated in Hispanics. The purpose of this study was to assess the relationships between alcohol consumption, PA, and BMI in Hispanic adults. Methods: In this secondary data analysis of a Mexican-American cohort, we collected self-reported PA, alcohol consumption, and demographics, and measured height and weight. Linear regression assessed the association between PA and alcohol consumption with BMI, controlling for covariates. Total sample for analyses was n= 3897. Results: We found an inverse relationship between high PA and BMI in the full sample (adjusted estimate = − 0.03, 95% CI − 0.07, − 0.01) and in females, but not males. We also found an inverse relationship between current alcohol use and BMI in the full sample (adjusted estimate = − 0.05, 95% CI − 0.09, − 0.01) and both sexes. There was no significant interaction between PA and alcohol use on BMI. Conclusions: In this study of Mexican-origin adults, current alcohol use and high PA were associated with lower BMIs, but there was no interaction between PA and alcohol use. These results can be used to inform multiple behavior change interventions in Mexican-origin adults.

Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, and identified patterns and themes. The interviewed PCPs (n = 16) were from internal or family medicine, with a range of experience (1.5-30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. Patients with abnormal liver imaging who had insurance or were within a safety-net healthcare system were referred by PCPs to specialists. Uninsured patients with persistently elevated liver enzymes received lifestyle recommendations from PCPs without confirmatory imaging or specialist referral. The role of PCPs in NAFLD management varied, with some helping patients set dietary and physical activity goals while others provided only general recommendations and/or referred patients to a dietitian. The diagnosis and management of NAFLD vary widely among PCPs and may be impacted by patients’ insurance status and clinic-specific practices. The increasing burden of NAFLD in the U.S. medical system highlights the need for more PCPs involvement in managing NAFLD.

Purpose: There is minimal understanding of the potential for coaction, defined as action on one behavior increasing the likelihood of taking action on another behavior, between physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study was to assess the bidirectional coaction between FV intake and PA, as well as self-efficacy for these behaviors, in a racially diverse sample of obese adults.Design: This is a secondary analysis using data collected from the Path to Health study, a randomized controlled trial. ClinicalTrials.govIdentifier: NCT03674229.Sample: Obese adults who completed baseline and 6-month follow-up assessments.Measures: For this study, data on FV intake, leisure time PA, and 7-day accelerometer data were analyzed at baseline and 6-month follow-up.Analysis: We interchanged modeling the FV intake and PA change variables as the independent and dependent variables. We conducted multiple imputation and both linear and multinomial regression.Results: The sample (n = 168) was 59% female and mainly split between white (42%) and African American (42%). Change in self-efficacy for PA was predictive of change in self-efficacy for FV intake and vice versa. When compared with participants with no change in FV intake, someone with a positive change in FV intake was more likely to have a positive change in self-reported PA (adjusted risk ratio [RR] = 6.72, 95% confidence interval [CI] = 1.69-26.68). Likewise, when compared with no change, participants with a positive change in self-reported PA were more likely to report a positive change in FV intake (adjusted RR = 6.79, 95% CI = 1.70-27.17).Conclusion: Findings suggest coaction between self-efficacy for FV intake and PA as well as between FV intake and PA. Coaction could be capitalized on to more effectively promote both energy-balance behaviors.

Purpose The Sustainable Culturally Adapted Nutrition Program (SCAN) is a novel adaptation to the National Diabetes Prevention Program (NDPP) that aims to improve attendance and effectiveness. This paper presents its feasibility and impact through the initial 6-month outcomes.Design A pragmatic quasi-experimental pilot study with intervention (DPP plus SCAN) and control (DPP only) groups.Samples and Inclusion Criteria Sustainable Culturally Adapted Nutrition Program participants were recruited from federally qualified health center (FQHC) clinic patients enrolled in a NDPP in Houston, Texas. Participants needed to be (1) ≥18 years old, (2) body mass index >25, (3) no prior diagnosis of diabetes, and (4) not pregnant.Intervention Sustainable Culturally Adapted Nutrition Program cooking classes were designed to teach skills to prepare fresh produce, and utilized Motivational Interviewing (MI) techniques to encourage participants to adapt these skills for foods that were culturally important to them.Outcome Measures (1) National Diabetes Prevention Program attendance, (2) BMI and (3) percent weight loss.Analysis We used linear mixed models to test the association between weights and NDPP attendance.Results 22 intervention and 15 control participants completed the program to the 6-month point. Intervention participants had increased DPP attendance over controls (7.14 vs 6.87 session). Intervention participants also demonstrated on average, 1.5% weight loss for each additional SCAN class attended (P= .144).Conclusions The SCAN adaptation shows promising results for effectively increasing both NDPP attendance and weight loss.

Purpose: Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border.Design and sample: We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588).Measures: We collected social support for PA and self-reported leisure-time PA.Analysis: We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time.Results: Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment.Conclusion: As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because familismo(commitment and mutual obligation to family) is considered to be a strong value in these communities.

Clinical trials are essential to advancing knowledge to reduce disease morbidity and mortality; however, ethnic and racial minorities remain under-represented in those studies. We explored knowledge and perceptions of clinical trials among Mexican-Americans in Texas. We conducted focus groups (N = 128) stratified by gender, language preference, and geographical location. This paper presents four emergent, primary themes: 1) knowledge and understanding of clinical trials, 2) fears and concerns about participating, 3) perceived benefits of participating, and 4) incentives to participate. Results suggest that lack of knowledge and understanding of clinical trials leads to misunderstanding about research, including fears and lack of trust. Participants indicated that fears related to perceived experimentation, harm, immigration status, and lack of clinical trial opportunities within their communities were barriers to participation. On the other hand, free healthcare access, helping family members in the future, and monetary incentives could facilitate participation. We also found differences across themes by language, gender, and place of residence. Findings from our study could inform the development of interventions to enhance recruitment of Mexican-American participants into clinical trials.

Purpose: Hispanic/Latino adults on the Texas-Mexico border have high rates of chronic disease. Neighborhoods can influence health, though there is a limited research on neighborhood environment and health in Hispanics/Latinos. The purpose of this study was to assess the relation of neighborhood environment with health variables in Hispanic/Latino adults, including physical activity [PA], depression, anxiety, and lab-assessed conditions (type 2 diabetes, metabolic syndrome, and chronic inflammation).Methods: Participants were randomly-selected from a Hispanic/Latino cohort on the Texas-Mexico border. Neighborhood environment, self-reported PA, anxiety, and depression were assessed through questionnaires. Laboratory values determined Type 2 diabetes, metabolic syndrome, and C-reactive protein (CRP). We conducted multivariable linear and logistic regression analyses to assess the associations of neighborhood environment and health variables, controlling for covariates.Results: Participants (n = 495) were mostly females, without insurance. After controlling for covariates, crime (Adjusted Odds Ratio [AOR] = 1.59 (95%CI 1.06-2.38), no streetlights (AOR = 1.65, 95%CI 1.06-2.57), and traffic (AOR = 1.74, 95%CI 1.16-2.62) were all significantly associated with anxiety. Only traffic was significantly associated with depression (AOR = 1.61, 95%CI1.05-2.47). A lack of nearby shops (AOR = 0.57, 95%CI 0.38-0.84) and no one out doing PA (AOR = 0.53, 95% CI 0.34-0.83) were both significantly associated with lower odds of meeting PA guidelines. A lack of nearby shops was associated with a 26% increase in the CRP value (β = 0.26, 95%CI 0.04-0.47).Discussion: Several neighborhood environment variables were significantly associated with mental health, PA and CRP, though estimates were small. The neighborhood environment is a meaningful contextual variable to consider for health-related interventions in Hispanic/Latino adults, though more study is needed regarding the magnitude of the estimates.Trial registration: NCT01168765.