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Early life exposures have been associated with obesity later in life. We aim to assess the association between early life exposure to food insecurity and change in BMI throughout childhood and adolescents. Food security status and growth variables from 243 Mother–child dyads from the Center for the Health Assessment of Mothers and Children of Salinas study were assessed 7 times over a 12-year period. Generalized log linear models with Poisson distributions and linear regression models were implemented to assess the associations between early life food insecurity and obesity and growth. Early life food insecurity was associated with a 0.43 (0.01, 0.82) kg/m2 decrease in BMI from age 2 to 3.5, and a 0.92 kg/m2 (0.38, 1.46) increase in BMI among boys from ages 3.5 to 5, after adjusting for covariates. Sex and age modify the association between early life exposure to food insecurity and BMI.

Highlights • 7 U.S. cities have a sugar-sweetened-beverage tax, raising $134 million annually. • Early childhood programs received the largest investment of tax revenues ($58M). • Community improvements (e.g., rec centers & libraries) were second largest ($21M). • Increasing healthy food and beverage access (e.g., produce subsidies) received $17M. • 85% of revenues supported projects and programs in impacted communities., We sought to describe how revenues from sugar-sweetened beverage (SSB) excise taxes in 7 U.S. cities are being allocated, who is benefiting from these investments, and whether allocations are consistent with the original intent of tax legislation. We collected information from public documents and key informants about allocations in the most recent fiscal year available (ranging from 2018 to 2021). Across the 7 U.S. cities with taxes, the average annual revenue from SSB taxes totaled $133.9 M. In the fiscal year studied, cities allocated a total of $133.2 M in SSB tax revenues. Human and community capital investments totaled $89.6 M (67% of all allocations) funding early childhood development, community infrastructure improvements, and youth and workforce development. Health-related investments totaled $36.9 M (28% of total allocations), funding access to healthy foods and beverages; support for physical activity opportunities; promotion of overall physical, mental or social health and wellbeing; health and nutrition education; chronic-disease prevention and management; and reducing SSB consumption. In the 3 cities that specified how tax revenues would be spent, allocations were consistent with promised uses of revenues. In addition, 85% of aggregated revenues ($112.9 M) were targeted to support work and programs in impacted communities (communities that experience health inequities, discrimination and exclusion). SSB tax revenues are supporting initiatives to improve community health, develop human and community capital, and advance equity. These investments may yield additional health benefits beyond those resulting from lower SSB consumption. Consistent tracking and public reporting on revenue allocations would increase transparency and accountability.

Sugar-sweetened beverages (SSBs) increase risk of cardiometabolic disease. Young people consume the largest amounts of SSBs and have experienced the greatest relative gains in obesity in the past several decades. There is evidence of addictive properties of both caffeine and sugar, the primary ingredients in SSBs, but little research into such properties of SSBs in naturally occurring consumption patterns. Thus, in this exploratory study, we sought to examine potentially addictive properties of SSBs during a 3-day SSB cessation intervention in overweight and obese adolescents who typically consume ≥3 SSBs daily. Participants (n = 25) were aged 13-18 years, mostly female (72%), and African American (56%) or Hispanic (16%) with a BMI≥95th percenttile (76%). Withdrawal symptoms and SSB craving were assessed approximately 1-week apart, during both regular SSB consumption and a 3-day period of SSB cessation in which participants were instructed to drink only plain milk and water. During SSB cessation, adolescents reported increased SSB cravings and headache and decreased motivation, contentment, ability to concentrate, and overall well-being (uncorrected Ps

Despite a growing body of evidence showing that sugar-sweetened beverage (SSB) taxes nudge consumers away from SSBs, we lack an understanding of people’s awareness and perceptions of SSB taxes and whether tax awareness and perceptions differ based on sociodemographic characteristics. We used serial cross-sectional study intercept surveys (n = 2715) in demographically diverse neighborhoods of Berkeley and Oakland in 2015 and 2017, and San Francisco and Richmond in 2017. In the year following successful SSB tax ballot measures, 45% of respondents correctly recalled that an SSB tax had passed in their city. In untaxed cities, 14% of respondents incorrectly thought that a tax had passed. Perceived benefits of SSB taxes to the community and to children’s health were moderate and, like correct recall of an SSB tax, were higher among respondents with higher education levels. Awareness of SSB taxes was low overall, and perceptions about taxes’ benefits varied by educational attainment, reflecting a missed opportunity to educate citizens about how SSB taxes work and their importance. Public health efforts should invest in campaigns that explain the benefits of SSB taxes and provide information about how tax revenues will be invested, both before and after a tax proposal has passed.

Background Prior research suggests a relationship between overall diet quality and breast cancer survival, although few studies have reported on this topic. We evaluated whether 4 dietary quality indices consistent with healthy eating recommendations around the time of breast cancer diagnosis were associated with risk of recurrence, cause-specific, and all-cause mortality. Methods A total of 3660 women diagnosed with invasive breast cancer were included. Diet was assessed an average of 2.3 (range = 0.7-18.7) months after diagnosis, from which 4 dietary quality indices were derived: the American Cancer Society guidelines (ACS), the alternate Mediterranean Diet Index (aMED), the Dietary Approaches to Stop Hypertension (DASH), and the 2015 Healthy Eating Index (HEI). Over 40 888 person-years of follow-up, 461 breast cancer recurrences, and 655 deaths were ascertained. Cox models were used to estimate hazards ratios (HRs) and 95% confidence intervals (CIs). Results Adjusted comparisons between extreme quintiles showed all 4 dietary quality indices to be inversely associated with all-cause mortality, suggesting a 21%-27% lower risk (ACS HR = 0.73, 95% CI = 0.56 to 0.95; aMED HR = 0.79, 95% CI = 0.61 to 1.03; DASH HR = 0.76, 95% CI = 0.58 to 1.00; HEI HR = 0.77, 95% CI = 0.60 to 1.01). Similar patterns were noted for non-breast cancer mortality (ACS HR = 0.69, 95% CI = 0.48 to 0.98; aMED HR = 0.73, 95% CI = 0.50 to 1.05; DASH HR = 0.55, 95% CI = 0.38 to 0.79; HEI HR = 0.67, 95% CI = 0.48 to 0.94). None of the dietary quality indices were associated with recurrence or breast cancer–specific mortality. Conclusion Food intake patterns concordant with dietary quality indices consistent with recommendations for healthy eating may be beneficial for women with breast cancer.

Importance Annually, US schools screen millions of students’ body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms. Objective To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population. Design, Setting, and Participants Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020. Interventions School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years. Main Outcomes and Measures Changes in BMIzscore and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up. Results A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMIzscore change (−0.003; 95% CI, −0.02 to 0.01 at 1 year and 0.01; 95% CI, −0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (−0.11; 95% CI, −0.18 to −0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (−0.06; 95% CI, −0.10 to −0.02). Conclusions and Relevance Body mass index reports alone do not improve children’s weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions. Trial Registration ClinicalTrials.gov Identifier:NCT02088086

Consumption of sugar-sweetened beverages (SSBs) contributes to adverse health outcomes and excess health care spending. To provide context for ongoing work assessing the impact of public health strategies, including SSB excise taxes, we used data from the California Health Interview Survey from 2011-2018 to estimate trends in beverage consumption among adults, teens, and children overall and by education, race/ethnicity, and family income. We found reductions in the annual prevalence and frequency of soda consumption across all age groups and heterogeneous increases in the consumption of fruit drinks among adults and children. Surveillance of beverage consumption trends will continue to strengthen and improve the ability of researchers and policy makers to effectively improve population health.

Background Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration. Objectives Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12. Methods We analyzed 204 mother-child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood. Results Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z-score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z-score compared to those who persistently lived in highly food secure households. Conclusions Changes in food security status and duration of food insecurity were associated with changes in children's growth.

The sugar-sweetened beverage (SSB) industry has claimed that food and beverage retailers are opposed to SSB taxes. In 2018 and 2019, we formally evaluated retailers' perceptions of SSB taxes using semi-structured interviews (including open- and closed-ended questions) with 103 randomly selected retailers (50 corner and liquor stores; 28 chain convenience, drug, and mass-merchandise stores; 18 chain supermarkets and discount supermarkets; and 7 independent supermarkets) across 3 cities with SSB taxes (Berkeley, Oakland, and San Francisco); interviews occurred in 2018 and 2019 (approximately 3years, 1year and 6months post tax-implementation, respectively). A majority of both small and large retailers reported the tax had only a minimal effect on their business (70%). About half of retailers believed that other cities should adopt SSB taxes (53%), and were supportive of a statewide SSB tax (53%), noting it would level the playing field and better support health in their communities. Retailers' responses did not differ based on neighborhood income, and only 2 responses differed significantly between large and small retailers. Only 2 of 103 retailers reported raising the price of a non-beverage product in response to the tax, specifically raising the price of snack foods of low nutritional quality and alcoholic beverages. A majority of retailers in 3 California cities with SSB taxes have no concerns regarding the tax, endorse the health goals of SSB taxes and support statewide expansion of SSB tax policies.

Author(s): Thompson, Hannah R; Ritchie, Lorrene; Park, Esther; Madsen, Kristine A; Gosliner, Wendi | Abstract: IntroductionSchools across the United States have removed sweetened, flavored milk from cafeterias to reduce students' sugar consumption and improve their health. However, evidence on the impact of the removal is limited. We examined the effect of a policy that removed chocolate milk from secondary schools on students' milk consumption and estimated milk-related nutrient intake.MethodsWe collected data on milk selection and consumption during 1 lunch period in 24 California public secondary schools pre-policy (N = 3,158 students in 2016) and post-policy (N = 2,966 students in 2018). Schools had a student population that was 38% Asian and 29% Latino, with 63% qualifying for free or reduced-price meals. We used linear mixed effects models to assess changes in milk selection and waste, and we estimated related changes in added sugars, calcium, protein, and vitamin D consumed from milk.ResultsThe proportion of students selecting milk declined 13.6%, from 89.5% pre-policy to 75.9% post-policy (95% CI for difference, 10.8% tο 16.4%), but the proportion of milk wasted remained stable (37.1% vs 39.3%; 95% CI for difference, -0.2% to 4.6%). Although average per-student milk consumption declined by less than 1 ounce per student (from 4.8 oz to 3.8 oz; 95% CI for difference, -1.1 oz to -0.7 oz), we observed no significant reductions in average per-student intake of calcium, protein, or vitamin D from milk. Estimated added sugars from milk declined significantly, by 3.1 grams per student (95% CI, -3.2 g to -2.9 g).ConclusionRemoving chocolate milk modestly reduced student milk consumption without compromising average intake of key milk-related nutrients, and consumption of added sugars from milk declined significantly. Secondary schools should consider removing chocolate milk to support healthy beverage consumption.

OBJECTIVES: Removing chocolate milk from school cafeterias is an increasingly popular policy approach for reducing youth sugar-sweetened beverage consumption and improving health. Evidence on the impact of such policies in urban secondary schools, which is needed to inform future school-based health improvement efforts targeting our highest-need youth, is lacking. The objective of this study is to determine the impact of a school district's chocolate milk removal policy on racially/ethnically and socioeconomically diverse middle and high school students’ milk, calcium, and added sugar consumption. METHODS: Student-level lunch data were collected in the springs of 2016 (pre-chocolate milk removal policy) and 2018 (post-policy) during one lunch period each in 24 middle and high schools in a diverse urban school district. Linear mixed effects models adjusted for school-level demographic characteristics were used to assess changes in the proportion of students who purchased milk; the proportion of milk consumed; and the average grams of added sugar, ounces of milk, and grams of calcium consumed per student. RESULTS: Pre-policy, 3,158 students (mean 132 per school) participated in lunch data collection across all 24 schools; post-policy, 2,966 students (mean 124 per school) participated. There was a 13.6% (95% CI −16.4, −10.8) decrease in the proportion of students who purchased milk pre-policy (89.5%) to post-policy (75.9%). The proportion of milk consumed remained stable pre- (68.3%) and post-policy (66.3%; 95% CI for difference −4.1, 0.01). There was a statistically significant 3.8g decline in added sugar consumed post- policy (95% CI for change −3.9g, −3.6g) and no significant changes in ounces of milk or grams of calcium consumed. CONCLUSIONS: Immediately post-chocolate milk removal from school cafeterias, fewer secondary students purchased milk. However, among students who purchased milk, consumption remained stable pre- and post-policy, and added sugar consumption significantly declined. Evidence on the longer-term impact of chocolate milk removal policies is necessary. FUNDING SOURCES: This work was funded by the United States Department of Agriculture, National Institute of Food and Agriculture, (Grant ID: 2015-68001-23236); Technology and Design Innovation to Support 21st Century School Nutrition.

Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California. Methods. We collected pretax (April–May 2017) and posttax (April–May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales. Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities. Conclusions. Within 4 to 10 months of implementation, Oakland’s and San Francisco’s SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.

Child obesity is understudied in Asian Americans, which include a growing population of recent immigrants. We examined the relationship between maternal nativity and time in the US, and obesity and obesogenic behaviors among Asian American children. We analyzed public-use data from the 2013&ndash, 2016 California Health Interview Survey for Asian American children ages 2 to 11 years. We used logistic regression to determine the odds of obesity and obesogenic behaviors associated with maternal nativity and time in the US. This study included n = 609 children. Children of US-born mothers had lower odds of obesity (adjusted odds ratio, AOR, 0.12, 95% CI 0.02 to 0.91) and lower fruit intake (AOR 0.15, 95% CI 0.03 to 0.81) than children of recent immigrants (&lt, 5 years in the US). Asian American children with recent immigrant mothers are more likely to be obese and eat less fruit than children with US-born mothers. Efforts to prevent obesity and increase fruit consumption are particularly important for this vulnerable population of children of recent immigrants.

Background Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited. Objectives The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities. Methods Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self-report and parental report in samples of children in each community (total n = 5138). Associations between composite indices of community programmes and policies and indicators of total and moderate-to-vigorous physical activity were examined without and with adjustment for demographic factors. Results An index reflecting the 6-year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate-to-vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non-Hispanic children but was negative for Hispanic children. Conclusions Community initiatives to promote physical activity in children were positively associated with children's physical activity in non-Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub-group.

Objectives. To evaluate a mass media campaign to reduce the consumption of sugar-sweetened beverages (SSBs). Methods. We disseminated messages emphasizing the health risks of SSBs through television, digital channels, and local organizations over 15 weeks in 2015–2016 in the Tri-Cities region of northeast Tennessee, southwest Virginia, and southeast Kentucky. We evaluated the campaign with pre- and post-telephone surveys of adults aged 18 to 45 years in the intervention area and by examining changes in beverage sales in the intervention and a matched comparison area in western Virginia. Results. Fifty-four percent of postcampaign respondents recalled seeing a campaign advertisement. After the campaign, 53% of respondents believed SSBs were a cause of heart disease, and respondents were more likely postcampaign to consider SSBs a “big cause of diabetes” (75% vs 60%; P

[ ]public health may be able to engage a broader coalition in fighting other preventable but deadly diseases, perhaps even obesity and diabetes [ ]sales taxes on soft drinks in Maine and Ohio, where 5 5% and 5 0% taxes, respectively, were added at the register, had no effect on sales 4 By contrast, a similarly sized excise tax in Washington State, which led to a 6% increase in shelf prices, was associated with a 5% decline in soft drink sales 5 Although Chriqui et al explain that Cook County used a sales tax because of existing restrictions, the tax size (equivalent to a 26% price increase) was five times larger than those in Maine and Ohio and led to a 21% net decline in sales while it was in place 2 FOCUS ON HEALTH Although excise taxes increase the cost of doing business for SSB manufacturers, and thereby lead to higher SSB prices and reduced consumption,1 it remains important to frame SSB taxes as a remedy to SSB-related disease and the tax revenues as a source of funding for health promotion By contrast, highlighting taxes as a means of reducing SSB consumption plays into the beverage industry's faulty but repeated claims that excise taxes restrict personal choice 3 Further, focusing on individual behaviors aligns with industry's talking points about personal responsibility;such talking points minimize the role inequitable environments across economic strata, including SSB advertising, play in shaping individual behaviors 1 NEXT STEPS Although Cook County's tax failed, it does pose an elegant natural experiment that could augment the science on SSB taxes, if the repeal's effect is consistent with evidence from Washington State and Denmark

Objectives. To examine the impact of physical education (PE) litigation on changes in cardio–respiratory fitness among racially/ethnically and socioeconomically diverse students. Methods. We used annual school-level data for all California schools with measures of fifth graders’ cardio–respiratory fitness spanning 2007–2008 through 2017–2018. A difference-in-difference design assessed changes before and after lawsuits in the proportion of students meeting fitness standards in schools in districts that were parties to PE lawsuits (n = 2715) versus in schools in districts not involved (n = 3152). We ran separate models with the proportion of students meeting fitness standards by sex, race/ethnicity, and low-income status as outcomes. Results. PE litigation led to a 1-percentage-point increase in the proportion of fifth-grade students meeting cardio–respiratory fitness standards (95% confidence interval [CI] = 0.03%, 2.0%). Effects were especially pronounced for female (1.3-percentage-point increase; 95% CI = 0.1%, 2.5%), African American (3.4-percentage-point increase; 95% CI = 0.5%, 6.2%), and low-income (2.8-percentage-point increase; 95% CI = 0.5%, 6.0%) students. Conclusions. Schools in districts subject to PE litigation showed greater improvements in student fitness, particularly among students typically at higher risk for inactivity and low fitness. Litigation may be an impactful tool for enforcing PE provision in accordance with the law.

Background: Current evidence demonstrates that, while a widely used tool for childhood obesity prevention, school-based BMI reports do not effectively reduce pediatric obesity. The purpose of this study was to examine the presumed mechanisms by which BMI reporting might impact child weight by assessing parents': (1) recall of BMI reports, (2) accuracy in recalling child overweight status, and (3) reactions to BMI reports. Methods: Mailed surveys were completed by 2205 racially/ethnically diverse parents of third- to seventh-grade students participating in the Fit Study who had either been exposed to 1 year of child BMI reporting (one report) or 2 years (two reports). Results: After 1 year of BMI reporting, parents of children with overweight were less likely [odds ratio (OR) = 0.7, 95% confidence interval (CI): 0.5-0.9] to recall receiving a BMI report and less likely (OR = 0.2, 95% CI: 0.1-0.3) to accurately recall their child's weight status from the BMI report, compared with parents of children with healthy weight. Differences in accuracy of child weight status recall persisted after 2 years of BMI reporting exposure. Only 22% of parents of children at risk for overweight and with overweight reported being surprised by the results. Conclusions: Parents' recall of receiving a school-based BMI report is low, as is the accuracy of recall of child's overweight status. Additionally, parents' surprise at, and concern for, BMI results is limited. Current BMI reports may be ineffective at reducing pediatric obesity due to their lack of salience and ability to compel meaningful behavior change among parents.

ObjectiveThe present study aimed to determine the store types from which people in low-income neighbourhoods purchase most sugar-sweetened beverages (SSB) and to identify associations between purchasing location and demographic characteristics.DesignStreet-intercept surveys of passers-by near high foot-traffic intersections in 2016. Participants completed a beverage frequency questionnaire and identified the type of store (e.g. corner store, chain grocery) from which they purchased most SSB.SettingEight low-income neighbourhoods in four Bay Area cities, California, USA.ParticipantsSample of 1132 individuals who reported consuming SSB, aged 18–88 years, who identified as African-American (41 %), Latino (29 %), White (17 %) and Asian (6 %).ResultsBased on surveys in low-income neighbourhoods, corner stores were the primary source from which most SSB were purchased (28 %), followed by discount stores (18 %) and chain groceries (16 %). In fully adjusted models, those with lower education were more likely to purchase from corner stores or discount groceries than all other store types. Compared with White participants, African-Americans purchased more frequently from corner stores, discount groceries and chain groceries while Latinos purchased more frequently from discount groceries.ConclusionsThe wide range of store types from which SSB were purchased and demographic differences in purchasing patterns suggest that broader methodological approaches are needed to adequately capture the impact of SSB taxes and other interventions aimed at reducing SSB consumption, particularly in low-income neighbourhoods.

Consumption of sugar-sweetened carbonated beverages (including soda) has declined nationally, but trends by state are unknown. We used data from the California Health Interview Survey to assess overall changes in soda consumption among adults aged 18 or older from 2011 through 2016 and identified differences by education and income level. Frequency of soda consumption (times per week) declined from 2011 through 2014 by 16.5% but returned to 2011 levels in 2015 and 2016; trends did not differ by education or income. The proportion of the population that consumed soda did not change among adults with less than a high school diploma or equivalent, but declined significantly among those with at least a high school diploma. Our findings suggest that soda consumption remains a pressing public health problem in California.

Climate change will affect the coastline of the Baltic Sea through changes in sea level, storm surges and waves. In Denmark, a large part of the responsibility for climate adaptation lies with the local municipalities. The purpose of this study was to map the user needs for coastal climate change information of five municipalities in the Danish south western Baltic Sea and the Danish Coastal Authority in a cost-efficient way and to transform the mapping into local climate indicators. An interview template was customized to form the basis for telephone interviews of key stakeholders and systematic gathering of the results. The interest for the interviews was high, and response from the interviewed persons on the use of the template was very positive. During the interviews, it was clear that the municipalities have access to extensive information on the population and infrastructure, as well as detailed geographical information. The main interests were in very high quality storm surge warnings and present day and future extreme sea level and wave heights. This should be based on modeling of past storm surges and future changes, taking observations, and historical records into account. There was a big need for more detailed information than presently available, and for common scenarios, which will help the collaboration between municipalities. Within this study, the user requirements were used to define targeted climate indicators. Within the C3S CODEC project, the indicators will be provided for the municipalities, based on a downscaling of European scale storm surge, and wave simulations to local scale.

OBJECTIVES:To estimate changes in sugar-sweetened beverage (SSB) and water consumption 3 years after an SSB tax in Berkeley, California, relative to unexposed comparison neighborhoods. METHODS:Data came from repeated annual cross-sectional beverage frequency questionnaires from 2014 to 2017 in demographically diverse Berkeley (n = 1513) and comparison (San Francisco and Oakland; n = 3712) neighborhoods. Pretax consumption (2014) was compared with a weighted average of 3 years of posttax consumption. RESULTS:At baseline, SSBs were consumed 1.25 times per day (95% confidence interval [CI] = 1.00, 1.50) in Berkeley and 1.27 times per day (95% CI = 1.13, 1.42) in comparison city neighborhoods. When we adjusted for covariates, consumption in Berkeley declined by 0.55 times per day (95% CI = -0.75, -0.35) for SSBs and increased by 1.02 times per day (95% CI = 0.54, 1.50) for water. Changes in consumption in Berkeley were significantly different from those in the comparison group, which saw no significant changes. CONCLUSIONS:Reductions in SSB consumption were sustained in demographically diverse Berkeley neighborhoods over the first 3 years of an SSB tax, relative to comparison cities. These persistent, longer-term reductions in SSB consumption suggest that SSB taxes are an effective policy option for jurisdictions focused on improving public health. (Am J Public Health. Published online ahead of print February 21, 2019: e1-e3. doi:10.2105/AJPH.2019.304971).

Author(s): Jeon, Diane; Chang, Emily G; McGing, Maggie; Hartman-Filson, Marlena; Sommers, Mathew; Lewis, Eula; Balmes, John R; Moisi, Daniela; Lederman, Michael M; Madsen, Kristine A; Woodruff, Prescott G; Hunt, Peter W; Huang, Laurence; Inflammation, Aging, Microbes and Obstructive Lung Disease (I AM OLD) Study | Abstract: BackgroundCOPD is a common HIV comorbidity, and HIV-infected individuals have a higher incidence and earlier onset of COPD compared to HIV-uninfected individuals. While the pathogenesis of HIV-associated COPD is largely unknown, chronic inflammation may contribute. Four pneumoproteins known to be markers of lung injury and inflammation have been associated with COPD in HIV-uninfected individuals: PARC/CCL-18, SP-D, CC-16, and sRAGE.ObjectiveTo determine whether these pneumoproteins are also associated with pulmonary function and COPD Assessment Test (CAT) scores in HIV-infected individuals.MethodsAssociations between plasma pneumoprotein levels and pulmonary function were determined in a cross-sectional study of otherwise healthy HIV-infected individuals enrolled between September 2016 and June 2017. Covariates included HIV-associated (antiretroviral therapy, CD4 count, and viral load) and COPD-associated (smoking and BMI) covariates.ResultsAmong 65 participants, 78.5% were male, 50.8% had undetectable viral load, and 76.9% were ever-smokers. Mean post-bronchodilator FEV1/FVC was 0.71, and mean DLco%predicted was 61%. Higher PARC/CCL-18 was associated with lower DLco%predicted and higher CAT score. Higher CC-16 was associated with lower DLco%predicted and lower FVC%predicted.ConclusionsThis exploratory analysis is the first to characterize associations between these four pneumoproteins and pulmonary function in an HIV-infected cohort. Our findings suggest the pathogenesis of HIV-associated COPD may differ from that of non-HIV-associated COPD due to HIV-specific inflammatory changes affecting DLco. PARC/CCL-18 is associated with structural and functional pulmonary abnormalities and may be an important COPD biomarker candidate in HIV infection. Our study is a preliminary step toward finding clinically relevant COPD biomarkers in high-risk populations.

Denmark has decided to reduce its GHG emissions by 70% compared to 1990 levels by 2030, which will imply changes to technologies, economic activities and behaviour. Here alongside, climate change remains a pressing issue, requiring climate information to be integrated into current and future planned activities in order to promote effective risk-coping strategies. This study maps the current use and future demands of data and services within climate and weather across spatiotemporal scales to understand how more targeted and thus more efficient data and climate services can be developed and employed, including upscaling and wider sectoral dissemination. A key to this process is a better understanding of the needs of current and new data and climate service-users. Based on a survey, we investigate how existing and potential data and climate service-users express their need for new data, products, services and tools within the Danish Realm, including Greenland, the Faroe Islands and the Danish Oceans. The survey was distributed to existing customers of the Danish Meteorological Institute (DMI) through personal networks and to 31,181 entry points in the Danish Business Register forming an extensive representation within Denmark. The focal sectors include agriculture, energy (including supply), and research and consultancy regarding climate issues. Key results indicate moderate differences in data characteristics between current users of data and climate services depending on their type of organization and sector, the low demand for future data and climate services compared to their current use by respondents and, finally and crucially, trust in suppliers’ reliability.

Regular physical activity improves academic performance in children, yet the short-term impact of activity on test scores and related behaviors, such as testing anxiety, is less established. Laboratory research demonstrates a positive relationship, but the impact of activity before testing in the school setting remains unstudied. We assessed the impact of a moderate-vigorous intensity physical education (PE) lesson directly before reading/math standardized tests on 5th grade student test-taking outcomes. A cluster RCT design was employed within a highly diverse public school district. Fifth grade classes (n = 29) were randomized to a standardized 40-min PE lesson immediately prior to testing or control condition. After testing, teacher ratings of students’ classroom behavior during math testing were 12% higher in intervention vs. control classes (p = 0.047; Cohen’s d = 0.79). There were no overall differences in student reported test-taking anxiety between groups, though differences by race/ethnicity and sex were present; intervention African American students reported a more positive physical state on math tests (11% higher, p = 0.012; Cohen’s d = 0.51) and on reading (10% higher, p = 0.040; Cohen’s d = 0.40) tests, and lower overall test anxiety during the math test (13% lower, p = 0.018; Cohen’s d = 0.48) than controls. However, intervention boys reported more off-task behavior (4% higher, p = 0.040; Cohen’s d = 0.03) than controls. There was no difference in test scores between groups. Teachers felt the PE lesson may have been too vigorous, as it left some students perspiring and thirsty during testing. Further research is necessary to better understand the conditions under which physical activity prior to testing impacts student’s testing anxiety and behaviors.

Background In the United States, the National School Lunch Program (NSLP) is the healthiest lunch option for students, yet participation is suboptimal and fruit and vegetable waste remains high. Improving school meal convenience, engaging teachers in the school-lunch program, and enhancing the cafeteria environment are promising strategies to improve participation and dietary intake, yet little evidence is available on their impact. Methods/design The Multi-Pronged Intervention to Increase Secondary Student Participation in School Lunch (MPI) is a 3-year quasi-experimental study in a large urban school district in California. A total of 24 middle and high schools participated in the study: half received the intervention and half served as controls. The intervention consisted of additional school lunch points of sale (vending machines and mobile carts), a school meal outreach program for teachers, and cafeteria redesigns. School meal participation, student-reported fruit and vegetable consumption, and school lunch plate waste were assessed at baseline and in years 1 and 2 of the intervention. Change in meal participation and fruit and vegetable consumption were compared between intervention and control arms to determine the impact of the intervention on school meal participation and dietary intake. Discussion This study is positioned to provide evidence on the feasibility and efficacy of a multi-level intervention to increase school meal participation and consumption of fruits and vegetables.

Physical education (PE) can improve student health. Schools with credentialed PE teachers receive more PE. However, many schools have reduced PE funding, resulting in fewer teachers and potentially poorer student health. We examined if PE teachers are equally available across school districts, and if availability is associated with higher student cardiorespiratory fitness. We contacted California districts educating students in grades K-6 (n = 894) to determine the number of credentialed elementary PE teachers per district in 2016–17. Public datasets provided demographics and student fitness. Generalized linear models examined associations between district-level demographic characteristics and PE teacher-to-student ratio. Linear regression assessed the relationship between PE teacher-to-student ratio and student fitness. Seventy-five percent of districts (n = 669) responded. On average, there were 0.6 PE teachers for every 500 students, including the half (51%) of districts without elementary PE teachers. Each additional100 students of all racial/ethnic backgrounds in the district was associated with a 0.1% (95% CI −0.2%, −0.1%) decrease in the ratio. Each 10% increase in African American and Latino students was associated with 29% (95% CI −47%, −5%) and 18% (95% CI −31%, −3%) decreases in the ratio, respectively. Each additional PE teacher per 500 students was associated with a 3% increase in aerobically fit students (95% CI 1%, 4%). Elementary PE teachers are lacking in California, particularly in districts with a high proportion of African American and Latino students, which may be contributing to health disparities. Creative action to fund PE should be explored to ensure all students benefit from quality PE.

Objective. To examine food and beverage depictions in books for preschoolers. Methods. Books for preschoolers from Reach Out and Read (ROR; n = 42), public library (n = 27), and Publisher’s Weekly booklists (n = 31) were examined for nutritive and empty-calorie food and beverage depictions. Results. It was found that 66% of books depicted at least 1 food or beverage. More books depicted nutritive items than empty-calorie items (87.5% vs 54.7%, P < .001). There was a trend toward fewer empty-calorie depictions in ROR books than in other booklists. Yet nearly half of ROR books depicted at least 1 empty-calorie item. ROR books also accounted for 5 of 10 books with the most empty-calorie item depictions and 3 of 4 books with branding. With regard to messaging, approximately a third of books with the most empty-calorie depictions promoted unhealthy foods. Conclusions. When selecting books for ROR, it may be important to consider food and beverage depictions and messages.

Background: Physical education (PE) can help to achieve important public health goals, but is often under-prioritized and lacking in schools. Objectives: To detail the actions, impact, and successes of a strategic alliance formed by three collaborating organizations to improve PE in a large California school district. Methods: Semistructured interviews with alliance members, principals, and teachers in 20 elementary schools, 3 years after the alliance formation. Lessons Learned: Interviewees reported district-level increases in priority and funding for PE and attributed improvements to the alliance’s collection and dissemination of local data on the status of PE. Common goals, trust, and open communication within the alliance were seen as critical to the alliance’s success. However, changes in district- or school-level accountability measures for PE were not reported. Conclusions: This strategic alliance succeeded in promoting district-level priority and funding for PE. Ongoing alliance work will focus on increasing accountability measures for PE, which may take longer to implement.

Childhood obesity is a public health threat that disproportionally affects Latino youth in the United States. Active and Healthy Families (AHF) is a culturally tailored, family-based program for addressing obesity disparities in a predominantly immigrant Latino population. AHF was the first primary care, culturally tailored intervention for Latino children to significantly reduce BMI in a randomized controlled trial. The 10-week AHF intervention reduced BMI (kg/m2) among overweight or obese children by 0.5, compared with an increase of 0.3 in the control group, yielding a -0.8 difference ( p < .01). A unique aspect of the program is its provider team: a physician, dietitian, and promotora. Because early feedback from families highlighted the importance of promotoras specifically, we sought to understand the unique mechanisms of promotora effectiveness in AHF. We conducted in-depth, semistructured interviews with the AHF providers ( n = 5) and parent participants ( n = 23) by phone between November 2012 and May 2013. In a grounded theory analysis, three main categories encompassing five themes emerged: (a) bridging communication by promotoras; (b) promotoras' personal qualities, including themes of kindness and caring and shared experiences with patients; and (c) impactful task performance, including themes of motivation, positive environment, and self-efficacy. Together, the themes serve as the basis of a conceptual model illustrating the process through which promotoras may enhance the impact of team-based obesity programs for the Latino community. Because this study identifies the specific ways through which promotoras can bridge cultural, linguistic, and other divides, it may inform development and dissemination of evidence-based approaches for obesity prevention in the Latino community.

Background In the U.S., 25 states conduct body mass index (BMI) screening in schools, just under half of which report results to parents. While some experts recommend the practice, evidence demonstrating its efficacy to reduce obesity is lacking, and concerns about weight-related stigma have been raised. Methods/design The Fit Study is a 3-arm cluster-randomized trial assessing the effectiveness of school-based BMI screening and reporting in reducing pediatric obesity and identifying unintended consequences. Seventy-nine elementary and middle schools across California were randomized to 1 of 3 Arms: 1) BMI screening and reporting; 2) BMI screening only; or 3) no BMI screening or reporting. In Arm 1 schools, students were further randomized to receive reports with BMI results alone or both BMI and fitness test results. Over 3 consecutive years, staff in schools in Arms 1 and 2 will measure students' BMI (grades 3–8) and additional aspects of fitness (grades 5–8), and students in grades 4–8 in all Arms will complete surveys to assess weight-based stigmatization. Change in BMI z-score will be compared between Arm 1 and Arm 2 to determine the impact of BMI reporting on weight status, with sub-analyses stratified by report type (BMI results alone versus BMI plus fitness results) and by race/ethnicity. The potential for BMI reports to lead to weight-based stigma will be assessed by comparing student survey results among the 3 study Arms. Discussion This study will provide evidence on both the benefit and potential unintended harms of school-based BMI screening and reporting.

PURPOSE OF REVIEW: Half of states in the USA have legislation requiring that schools conduct body mass index (BMI) screening among students; just under half of these states report results to parents. The effectiveness of school-based BMI screening and reporting in reducing childhood obesity is not established and the practice has raised concerns about the potential for increased weight-based stigmatization.RECENT FINDINGS: Recent experimental studies of BMI screening and reporting have not demonstrated a positive impact on students' weight status. However, the language and formatting of BMI reports used in studies to date have been suboptimal and have likely limited the potential effectiveness of the practice. This article reviews the recent literature on school-based BMI screening and reporting and highlights important areas for future inquiry. The present review suggests that evidence to date is not sufficient to support definitive conclusions about the value of school-based BMI screening and reporting as a childhood obesity prevention tool.

To determine trends in the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice by California children ages 2 to 11 years from 2003 to 2009.This analysis used serial cross-sectional data from the California Health Interview Survey, a telephone survey of households in California. Parents were asked how many servings of SSBs and 100% fruit juice the child consumed the day before. A test of trend was used to evaluate changes in consumption over time. Multivariate logistic regression was used to determine the independent effects of race/ethnicity, parental education, and household income on beverage consumption.The percentage of children consuming an SSB on the prior day declined from 40% in 2003 to 16% in 2009 (P.001) among children ages 2 to 5 and from 54% in 2003 to 33% in 2009 (P.001) among children ages 6 to 11. The percentage of children consuming any SSB decreased for all racial/ethnic groups, although there were disparities with higher consumption among Latinos. Among children ages 2 to 5, consumption of 2 or more servings of 100% fruit juice per day decreased among white children and increased among Latinos. For children ages 6 to 11, consumption of 2 or more servings of 100% fruit juice per day remained stable for white children and increased among Latinos and African Americans.The decrease in SSB consumption by California children from 2003 to 2009 is a promising trend. The increase in 100% fruit juice consumption among minority children during this period may be an unintended consequence of efforts to reduce SSB consumption.

ObjectiveTo examine the association between added sugar intake and metabolic syndrome among adolescents.DesignDietary, serum biomarker, anthropometric and physical activity data from the US National Health and Nutrition Examination Survey cycles between 2005 and 2012 were analysed using multivariate logistic regression models. Added sugar intake in grams per day was estimated from two 24 h standardized dietary recalls and then separated into quintiles from lowest to highest consumption. Multivariate logistic regression analyses were adjusted for physical activity, age, BMI Z-score and energy intake, and their interactions with race were included.SettingNationally representative sample, USA.SubjectsUS adolescents aged 12–19 years (n 1623).ResultsAdded sugar was significantly associated with metabolic syndrome. The adjusted prevalence odds ratios for having metabolic syndrome comparing adolescents in the third, fourth and fifth quintiles v. those in the lowest quintile of added sugar were 5·3 (95 % CI 1·4, 20·6), 9·9 (95 % CI 1·9, 50·9) and 8·7 (95 % CI 1·4, 54·9), respectively.ConclusionsOur findings suggest that higher added sugar intake, independent of total energy intake, physical activity or BMI Z-score, is associated with increased prevalence of metabolic syndrome in US adolescents. Further studies are needed to determine if reducing intake of added sugar may help US adolescents prevent or reverse metabolic syndrome.

IntroductionBecause California is home to one in eight U.S. children and accounts for the highest Medicaid and Children's Health Insurance Program spending, childhood obesity trends in California have important implications for the entire nation. California's racial/ethnic diversity and large school-based data set provide a unique opportunity to examine trends by race/ethnicity, including understudied Asian and American Indian youth, which has not been possible using national data sets. This study examined racial/ethnic disparities in prevalence of high BMI from 2003 to 2012.MethodsThis observational study included 11,624,865 BMI records from repeated cross-sections of fifth-, seventh-, and ninth-graders who underwent California's school-based fitness testing. Analyses conducted in 2015 used logistic regression to identify trends in prevalence of high BMI (BMI ≥85th, 95th, and 97th percentiles) and differences in trends by race/ethnicity from 2003 to 2012.ResultsAfrican American and Hispanic girls and American Indian boys increased in prevalence of high BMI, whereas non-Hispanic white and Asian youth and Hispanic boys decreased in prevalence of high BMI (p-values

Increasing physical activity is one of the cornerstones for combating obesity and reducing the risk of weight-related morbidity among America’s youth.1, 2 Despite the known importance of physical activity, only 18% of adolescents report achieving the recommended 60 minutes of daily physical activity.3 This is particularly concerning as disparities in physical activity3 parallel increasing disparities in pediatric obesity.4 Schools are a natural venue in which to increase physical activity among diverse youth and the after-school period poses fewer time constraints than the school day.5 Results of intervention studies to increase after-school physical activity have been mixed,6 making it difficult to identify best practices for promoting physical activity after school. Strategies that have been proven effective during the school day may be equally effective after school. Sports Play and Active Recreation for Kids (SPARK) is one program that was demonstrated to increase students’ moderate to vigorous physical activity (MVPA) during the school day.7 The SPARK program consists of 3 primary features: an active curriculum, staff-development, and follow-up support.7 However, no studies to date have examined the use of SPARK after school as a tool to help staff increase children’s physical activity. During the 2008–2009 school year, a large urban school district set a new policy of achieving 30 minutes of MVPA in the after-school setting per day. To assist schools in reaching this goal, the district purchased the SPARK program. The school district planned to introduce SPARK to 13 schools over a one-year period, and was willing to stagger implementation in order to evaluate SPARK’s impact on physical activity. We took advantage of this opportunity to examine the potential of SPARK to increase MVPA in the after-school setting and improve cardiorespiratory fitness and weight status.

Pediatric obesity in the United States remains a major public health concern.1, 2 An Institute of Medicine (IOM) report recommended school-based body mass index (BMI) screening to address childhood obesity, asserting that “schools should measure yearly each student’s [BMI] and make this information available to parents and to the student (when age appropriate).”3 As of 2010, 20 states require BMI or body composition screening and 6 states recommend screening, either alone or as part of a comprehensive fitness assessment.4 Among states requiring BMI or body composition screening, fewer than half require parent notification of test results,4 and prevalence of notification is unknown in these states. Yet, notification serves as the major mechanism by which BMI screening is expected to impact obesity: it is theorized that increasing parents’ awareness of their child’s risk will compel them to take steps towards improving their child’s health.5, 6 In addition to uncertainty about notification rates, little is known about methods used when school districts elect to notify parents. The FITNESSGRAM®,7 a battery of 6 fitness assessments that evaluate body composition (BMI, skinfolds, or bioelectrical impedance), aerobic capacity, flexibility, and strength and endurance, is required or recommended in at least 16 states4 and may be the vehicle for BMI or body composition screening and notification in many school districts (in California, 95% of schools use BMI to assess body composition for the FITNESSGRAM, personal communication from the California Department of Education [CDE]). A recent study of BMI screening and notification via FITNESSGRAM assessments did not demonstrate improvements in pediatric obesity at the population level;8 therefore, a better understanding of current notification methods will be critical in informing school-based efforts to reduce obesity. In California, annual FITNESSGRAM assessments have been required for 5th, 7th, and 9th grade students since 2001;9 however, parent notification has been optional. California’s policy affords the opportunity to collect meaningful data on the practice of BMI and body composition notification in the most populous state. Therefore, this study sought to examine the prevalence of and reasons for notification among school districts when notification is optional, the methods by which notification occurs, and the content and quality of notification messages.

BACKGROUND: Protective factors associated with positive youth development predict health and education outcomes. This study explored trends in these protective factors and in physical activity among low-income students, and determined the impact of a school-based youth development program on these trends. METHODS: This study used a quasi-experimental time series design including data from 158 low-income schools from 2001 to 2007. Ninety-four schools had exposure to a school-based program promoting physical activity and youth development through structured play; 64 schools served as controls. Primary outcomes were 5th-grade student scores (n = 13,109) on a California statewide survey for physical activity (1–6 scale) and measures of protective factors including problem solving skills, meaningful participation in school, and caring adults (1–4 scales). Predictors were time (year) and school's number of years of exposure to the program. RESULTS: Overall, significant annual declines were seen in protective factors, including students' report of feeling safe (−0.03, 95% CI [−0.03, −0.01]), caring adults at school (−0.03 [−0.05, −0.02]), and problem solving skills (−0.03 [−0.04, −0.02]). Cumulative declines over 6 years were equivalent to a drop of 1 school-level SD. Each additional year of exposure to the program predicted greater meaningful participation (0.02 [0.001, 0.5]), problem-solving skills (0.03 [0.0001, 0.06]), and increased physical activity (0.06 [0.01, 0.10]); exposure throughout elementary school (6 years) increased scores by 1 school-level SD. CONCLUSIONS: Low-income students reported a significant decline in protective factors since 2001. School partnerships with youth development programs promoting physical activity may ameliorate declines in emotional well-being and increase physical activity.

OBJECTIVES: The objective of this study was to investigate trends in prevalence of high BMI from 2001 to 2008 and examine racial/ethnic disparities. METHODS: Records for a total of 8 283 718 fifth-, seventh-, and ninth-grade students who underwent California's school-based BMI screening between 2001 and 2008 were included. Logistic regression identified trends in prevalence of high BMI (≥85th, ≥95th, ≥97th, and ≥99th percentiles). RESULTS: For 3 of 4 BMI cut points, prevalence continued to increase for black and American Indian girls through 2008, Hispanic girls plateaued after 2005, non-Hispanic white girls declined to 2001 prevalence levels after peaking in 2005, and Asian girls showed no increases. Non-Hispanic white boys peaked in 2005, then declined to 2001 prevalence levels for all BMI cut points; Hispanic and Asian boys declined after 2005 (for 3 lowest BMI cut points only) but remained above 2001 levels; and American Indian boys peaked later (2007) and declined only for BMI ≥95th. No girls and few boys showed a decline after peaking in prevalence of BMI ≥99th percentile. In 2008, disparities in prevalence were greatest for BMI ≥99th percentile, with prevalence of 4.9% for American Indian girls and 4.6% for black girls versus 1.3% for non-Hispanic white girls. CONCLUSIONS: On the basis of statewide California data, prevalence of high BMI is declining for some groups but has not declined for American Indian and black girls. These trends portend greater disparities over time, particularly in severe obesity. Interventions and policies that are tailored to the highest risk groups should be pursued.

This study explored a community-based after-school program’s effect on obesity in minority children. Study participants included 178 third through fifth graders (47% Latino, 25% Asian, and 18% African-American) enrolled in America SCORES Bay Area. Outcomes were attendance, change in fitness (20-meter shuttle test), and body mass index (BMI) z-score over eight months. At baseline, 52 percent of children were overweight or obese. Children attended SCORES > 4 days/week and fitness significantly improved (p < 0.01). BMI z-score decreased by 0.04 (p = 0.10) overall, and by 0.05 (p = 0.08) among obese children, but increased among African-American children. These results suggest that SCORES increases fitness and may improve BMI in some minority children. Effect modification by race may relate to differential growth patterns or engagement in SCORES. These findings suggest community-based programs could effectively address obesity. A randomized trial of the SCORES program is warranted to rigorously examine this type of after-school program’s impact on child health.

School-based body mass index (BMI) screening and reporting could have a positive impact on student health, but best practices for writing a report are unknown. Building on previous qualitative work, 8 focus groups were conducted with a diverse group of California parents (n = 79) to elicit feedback on report content and design. Results indicate that parents want a visually appealing, picture-heavy report that clearly defines BMI, avoids stigmatizing language, and includes recommendations for appropriate actions whole families can take. Next steps involve using the final report in a statewide, randomized trial to determine the effectiveness of school-based BMI screening and reporting in reducing childhood obesity.

Identifying sustainable approaches to improving the physical activity (PA) and nutrition environments in schools is an important public health goal. This study examined the impact of Energy Balance for Kids with Play (EB4K with Play), a school-based intervention developed by the Academy of Nutrition and Dietetics Foundation and Playworks, on students' PA, dietary habits and knowledge, and weight status over 2 years.This cluster-randomized, controlled trial took place in four intervention and two control schools over 2 years (n=879; third- to fifth-grade students). PA (fourth and fifth grades only), dietary knowledge and behaviors, school policies, and BMI z-score were assessed at baseline (fall 2011), midpoint (spring 2012), and endpoint (fall 2012 for accelerometers; spring 2013 for all other outcomes).At endpoint, there were no group differences in change in PA or dietary behaviors, although BMI z-score decreased overall by -0.07 (p=0.05). Students' dietary knowledge significantly increased, as did the amount of vegetables schools served. Post-hoc analyses stratified by grade revealed that, relative to control students, fourth-grade intervention students reduced school-day sedentary time by 15 minutes (p=0.023) and third-grade intervention students reduced BMI z-score by -0.2 (0.05; p0.05). There were no signicifant differences for older students.EB4K with Play, which leverages the existing infrastructure of two national programs, increases children's dietary knowledge and may improve weight status and decrease sedentary behaviors among younger children. Future iterations should examine programming specific for different age groups.

Introduction The Alliance for a Healthier Generation’s Healthy Schools Program (HSP) is a national evidence-based obesity-prevention initiative aimed at providing the schools in greatest need with onsite training and technical assistance (TTA) and consultation with national experts (HSP national advisors) to create sustainable healthy change in schools’ nutrition and physical activity environments. The objective of this study was to evaluate the impact of HSP on the prevalence of overweight and obesity in California schools, from HSP’s inception in 2006 through 2012. Methods We used statewide body mass index (BMI) data collected annually from 5th-, 7th-, and 9th-grade students to determine whether enrolling in the HSP’s onsite intervention reduced the prevalence of overweight and obesity in intervention schools (n = 281) versus propensity-score matched control schools (n = 709) and whether increasing exposure to the program (TTA and contact with HSP national advisors) was associated with reductions in the prevalence of overweight and obesity. Results Analyses showed no difference between HSP schools and control schools in overweight or obesity prevalence. However, program exposure varied widely among participating schools, and each additional contact with TTA or HSP national advisors was associated with a 0.3% decline in overweight and obesity prevalence (P < .05). Conclusion HSP appears to be an important means of supporting schools in reducing obesity. Although participation in HSP alone was not sufficient to improve weight status in California schools, there was a clear dose–response relationship to the program. HSP serves as an effective model for addressing childhood obesity among engaged schools.

Background— The 6-minute walk test (6MWT) independently predicts congestive heart failure severity, death, and heart failure hospitalizations, but must be administered in clinic by qualified staff on a premeasured course. As part of the Health eHeart Study, we sought to develop and validate a self-administered 6MWT mobile application (SA-6MWTapp) for independent use at home by patients. Methods and Results— We performed a validation study of an SA-6MWTapp in 103 participants. In phase 1 (n=52), we developed a distance-estimation algorithm for the SA-6MWTapp by comparing step counts from an Actigraph and measured distance on a premeasured 6MWT course with step counts and estimated distance obtained simultaneously from our SA-6MWTapp (best estimation algorithm, r=0.89 [95% confidence interval 0.78–0.99]). In phase 2, 32 participants (including those with congestive heart failure and pulmonary hypertension) used the SA-6MWTapp independently in clinic, and the distance estimated by the SA-6MWTapp was compared with the measured distance (r=0.83 [95% confidence interval 0.79–0.92]). In phase 3, 19 patients with congestive heart failure and pulmonary hypertension consecutively enrolled from clinic performed 3.2±1 SA-6MWTapp tests per week at home over 2 weeks. Distances estimated from the SA-6MWTapp during home 6MWTs were highly repeatable (coefficient of variation =4.6%) and correlated with in-clinic–measured distance (r=0.88 [95% confidence interval 0.87–0.89]). Usability surveys performed during the second (in-clinic) and third (at-home) phases demonstrated that the SA-6MWTapp was simple and easy to use independently. Conclusions— An SA-6MWTapp is easy to use and yields accurate repeatable measurements in the clinic and at home.

Background We examined the efficacy of a culturally relevant exercise program in improving glycated hemoglobin (HbA1c) among South Asian women with type 2 diabetes, compared with usual care. Methods This was a randomized controlled 8-week pilot study of Bollywood dance among South Asian women with type 2 diabetes. The intervention consisted of 1 h Bollywood dance classes offered twice per week. The primary outcome was change in HbA1c. The effect of attendance on this outcome was also examined. Results The intervention group demonstrated a decrease in HbA1c from baseline (−0.18% (0.2%); p=0.018) compared with a non-significant increase in the usual care group (+0.03% (0.2%)); p value for difference between groups was 0.032. Participants attending at least 10 of 16 sessions had a statistically significant reduction in weight (−0.69 kg (0.76 kg)) compared with those attending fewer sessions (+0.86 kg (0.71 kg)). Conclusions These results support culturally relevant dance as a successful exercise intervention to promote HbA1c control, compared with usual care. Trial registration number NCT02061618.

Validating published risk models in a different time and setting can be a labor-intensive process. Data in electronic format provide the potential to test the validity of risk models without labor-intensive chart reviews and data capture. The authors attempted to use readily available electronic data to find appropriate cases and to validate and refine a previously developed risk model for predicting bacteremia in children with cancer who had fever and neutropenia.By applying a largely automated case-finding algorithm to linked, electronic clinical and administrative data systems, the authors identified and acquired data regarding 157 episodes of fever and neutropenia in children with cancer admitted to a children's hospital during an 11-month period in 1997. The authors applied a previously developed and validated risk model for bacteremia to this 1997 cohort by assessing the odds ratios among risk groups. The model assigns encounters with absolute monocyte count of 100 cells or more/mm3 to a low-risk group and encounters with an absolute monocyte count of less than 100 cells/mm3 to intermediate-risk (temperature39.0 degrees C) or high-risk (or = 39.0 degrees C) groups. In addition, the authors explored whether the new data would have generated the same model. Univariate and multivariable analyses were performed to determine whether there were additional independent predictors of bacteremia. Recursive partitioning of admission absolute monocyte count and temperature was used to assess whether similar cutpoints would be found.There were 12 episodes of bacteremia (7.6%) among the 157 encounters. The previously developed model correctly predicted increasing rates of bacteremia in this 1997 cohort, ranging from 2.5% in the low-risk group (one episode in a child with an infected central line) to 24% in the high-risk group. The odds ratio for the high-risk versus intermediate-risk group was 4.09 (95% confidence interval 1.05-15.91), comparable to the odds ratio of 3.96 in the previously published derivation cohort (95% confidence interval 1.4-11.1). Multivariate analysis of the new data revealed no independent risk factors for bacteremia other than admission absolute monocyte count and temperature. Recursive partitioning of absolute monocyte count and temperature generated risk categories that were somewhat different from those of the original model. The new data yielded three categories: low risk (temperatureor = 39.5 degrees C and absolute monocyte count10/mm3), intermediate risk (temperatureor = 39.5 degrees C and absolute monocyte countor = 10/mm3), and high risk (temperature39.5 degrees C).Existing electronic data provide an efficient means for case-finding and model validation and refinement. The previously developed bacteremia model had good but not optimal predictive performance in the new data set. Admission absolute monocyte count and temperature remain significant risk factors for bacteremia. Redefining the risk categories, including a much lower cutpoint for admission absolute monocyte count, improved the model's discrimination, which suggests that predictive models need periodic updating.

Objective There is a critical need for culturally relevant interventions to address obesity among Latino children, who have a greater risk of obesity and diabetes than non-Hispanic white children. To test the impact of a family-centered, culturally tailored obesity intervention delivered through group medical appointments on body mass index (BMI) and other measures of cardiovascular risk among Latino children. Methods In a randomized controlled trial, 55 parent-child dyads were assigned to Active and Healthy Families (AHF) or a usual care wait-list control condition. Dyads were eligible if they spoke Spanish and if the child received care in a federally qualified health center, was aged 5 to 12 years, had a BMI in the 85th percentile or higher, and had not participated in AHF. The 10-week AHF intervention included biweekly group sessions delivered by a registered dietitian, physician, and promotora triad. Sessions covered topics such as parenting, screen time, healthy beverages, physical activity, and stress due to immigration. Results Child BMI (kg/m 2 ) decreased (−0.50) in the AHF group and increased (+0.32) in the control group, yielding an adjusted difference in change of −0.78 (95% confidence interval [CI] −1.28, −0.27). Children assigned to AHF also exhibited relative improvements over controls in BMI z score (−0.10; 95% CI −0.19, −0.02) and triglycerides (−26.8 mg/dL; 95% CI −50.1, −3.6), but no significant between-group differences were observed for blood pressure or other fasting blood measures. Conclusions AHF resulted in reductions in child BMI, BMI z score, and triglycerides. AHF, which was designed for low-income Latino families, has potential to reduce health disparities, but future studies are needed to determine long-term impact.

Improving nutrition and physical activity behaviors associated with childhood obesity are significant national public health goals. Energy Balance for Kids with Play (EB4K with Play), developed through a partnership between the Academy of Nutrition and Dietetics Foundation and Playworks, is a multi-component school-based intervention designed to address youth's nutrition and physical activity behaviors. This article describes the EB4K with Play intervention and evaluation study and presents the baseline data.The evaluation is a 2-year cluster-randomized design targeting third- to fifth-grade students enrolled in a low-income, urban school district in northern California. Six schools were recruited to participate. Four were randomized to the intervention group and two into a control group. Baseline student-level data pertaining to nutrition, physical activity, fitness, and BMI were collected in the fall of 2011. The EB4K with Play program, which includes direct-to-student nutrition and physical activity interventions, a school wellness component, and parent/community partner outreach components, began immediately after baseline data collection.An ethnically diverse sample of students (n=844) was recruited to participate in the study. Baseline data showed a higher percent of eligibility for free and reduced-price school lunch and higher rates of obesity/overweight than the California state averages. Fitness levels and levels of moderate-to-vigorous physical activity were comparable to state averages.End-point data will be collected after 2 years of the intervention. The findings from this study should help guide future efforts to design effective intervention programs to support the prevention of pediatric obesity.