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Objective: To evaluate implementation of nutrition/physical activity-related policies/practices at colleges participating in a healthy campus initiative and campus health leaders' perceptions of policies/practices' support for student health and ease of/barriers to implementation. Participants: Health leaders at colleges participating in the Healthier Campus Initiative (HCI), with completed or ongoing three-year HCI commitments. Methods: Surveys asked which of 41 guidelines were implemented and perceptions around support for student health and ease of/barriers to implementation. Qualitative interviews explored similar domains. Results: Campuses with completed HCI commitments (n = 17) averaged 27.6 guidelines implemented, versus 21.1 on campuses with commitments ongoing (n = 13; p = 0.003). Perceived support for student health and implementation ease varied by guideline. Common implementation barriers included financial costs and time. Interviews largely reinforced these findings. Conclusions: Completion of a campus environmental change initiative may be associated with more health-supporting practices. Campuses may benefit from implementing coordinated policy/practice changes supporting healthy eating and physical activity. [ABSTRACT FROM AUTHOR]

Purpose: Socioeconomic status (SES) may impact children's physical activity (PA) behaviors and confidence to participate in PA. We examined how SES modifies the relationship between children's perceived athletic competence (PAC) and moderate to vigorous PA (MVPA).Methods: Children (N = 1157; 45% male; grades 3--4) were recruited for the Fueling Learning through Exercise study. Free/reduced price lunch eligibility was used as an indicator of SES. Seven-day accelerometry (ActiGraph GT3X+) was used to measure daily MVPA, out-of-school MVPA (O-MVPA), and school-time MVPA. PAC was assessed using the Harter's Self-Perception Profile for Children (6 items, scored 1--4; median split: high and low PAC). Results: MVPA and PAC differed between low-SES [n = 556; 41.6 (17.1) min/d; high PAC = 45%] and middle-SES children [n = 412; 49.6 (22.7) min/d; high PAC = 62%]. There was an interaction between SES and PAC for MVPA (P < .001) and O-MVPA (P < .001), but not for school-time MVPA (P > .05). Middle- SES children with high PAC were more likely to engage in MVPA (β = 6.6 min/d; 95% confidence interval, 3.9 to 9.3; P < .001) and O-MVPA (β = 4.8min/d; 95% confidence interval, 2.8 to 6.8; P < .001), associations that did not exist for low-SES children (P > .05). Conclusions: PAC was positively associated with daily MVPA and O-MVPA, but not among low-SES children. Research is needed to elucidate the factors that shape the relationship between PAC and MVPA. [ABSTRACT FROM AUTHOR]

Background: Associations between physical activity (PA) intensity and volume and adolescents' cardiometabolic health have research, policy, and practice implications. This study compares associations between cardiometabolic risk factors and 1) moderate-to-vigorous PA (MVPA) minutes versus total PA volume (accelerometer-derived total activity counts, TAC) and 2) light PA volume (counts at light intensity, L-TAC) versus moderate-to-vigorous PA volume (counts at moderate-to-vigorous intensity, MV-TAC). Methods: 2105 adolescents from 2003- 2006 NHANES were included. Independent variables were MVPA minutes, TAC, L-TAC, and MV-TAC. Regression models tested associations between PA variables and continuous metabolic risk index (CMRI), waist circumference, systolic and diastolic blood pressure, HDL, insulin, and triglycerides. Results: TAC demonstrated a slightly stronger inverse association with CMRI (P = .004) than did MVPA (P = .013). TAC and MVPA were both associated with systolic and diastolic pressure, HDL, and insulin; associations were similar or slightly stronger for TAC. L-TAC and MV-TAC were both associated with CMRI and HDL. Only L-TAC was associated with diastolic pressure. Only MV-TAC was associated with waist circumference, systolic pressure, and insulin. Conclusions: Compared with MVPA minutes, TAC demonstrates similar or slightly stronger associations with cardiometabolic risk factors. L-TAC and MV-TAC appear similarly associated with adolescents' clustered risk but differently associated with individual risk factors. [ABSTRACT FROM AUTHOR]

Abstract Background There are disproportionately higher rates of overweight and obesity in poor rural communities but studies exploring children’s health-related behaviors that may assist in designing effective interventions are limited. We examined the association between overweight and obesity prevalence of 401 ethnically/racially diverse, rural school-aged children and healthy-lifestyle behaviors: improving diet quality, obtaining adequate sleep, limiting screen-time viewing, and consulting a physician about a child’s weight. Methods A cross-sectional analysis was conducted on a sample of school-aged children (6–11 years) in rural regions of California, Kentucky, Mississippi, and South Carolina participating in CHANGE (Creating Healthy, Active, and Nurturing Growing-up Environments) Program, created by Save the Children, an independent organization that works with communities to improve overall child health, with the objective to reduce unhealthy weight gain in these school-aged children (grades 1–6) in rural America. After measuring children’s height and weight, we17 assessed overweight and obesity (BMI ≥ 85th percentile) associations with these behaviors: improving diet quality18 (≥ 2 servings of fruits and vegetables/day), reducing whole milk, sweetened beverage consumption/day; obtaining19 adequate night-time sleep on weekdays (≥ 10 hours/night); limiting screen-time (i.e., television, video, computer,20 videogame) viewing on weekdays (≤ 2 hours/day); and consulting a physician about weight. Analyses were adjusted 21 for state of residence, children's race/ethnicity, gender, age, and government assistance. Results Overweight or obesity prevalence was 37 percent in Mississippi and nearly 60 percent in Kentucky. Adjusting for covariates, obese children were twice as likely to eat ≥ 2 servings of vegetables per day (OR=2.0,95% CI 1.1-3.4), less likely to consume whole milk (OR=0.4,95% CI 0.2-0.70), Their parents are more likely to be told by their doctor that their child was obese (OR=108.0,95% CI 21.9-541.6), and less likely to report talking to their child about fruits and vegetables a lot/sometimes vs. not very much/never (OR=0.4, 95%CI 0.2-0.98) compared to the parents of healthy-weight children. Conclusions Rural children are not meeting recommendations to improve diet, reduce screen time and obtain adequate sleep. Although we expected obese children to be more likely to engage in unhealthy behaviors, we found the opposite to be true. It is possible that these groups of respondent parents were highly aware of their weight status and have been advised to change their children’s health behaviors. Perhaps given the opportunity to participate in an intervention study in combination with a physician recommendation could have resulted in actual behavior change.

Summary: Research indicates that most college students are not meeting dietary and physical activity guidelines, and the average student gains an estimated 1.6–3.0 kg during 4 years of study. College administrations are well‐positioned to influence student weight‐related health behaviours by ensuring that campus environments/policies promote health. However, to date, campus health interventions have largely addressed individual and interpersonal factors rather than environmental/policy‐level changes. Using an ecological perspective, this narrative review synthesizes the literature on campus environmental/policy‐level factors (e.g., food availability, physical activity requirements) associated with student diet, physical activity and weight, as well as campus interventions to address these factors. Web of Science and PubMed databases were searched between December 2018 and November 2019. Results indicate that campus food environments may contribute to overconsumption and weight gain, and the number of campuses requiring students to participate in physical activity courses is in decline. Eight examples of environmental/policy‐level campus interventions are presented: nutrition labels in dining halls, campus‐wide healthy choice marketing campaigns, restricted payment methods for à la cart dining, trayless dining, health‐themed residence halls, peer health education programmes, active classroom spaces and physical activity course requirements. Implications for research and health promotion programmes/policies in the field of college health are discussed. [ABSTRACT FROM AUTHOR]

Background: Evidence supports the role of physical and social environments in active living, including perception of environment. However, measurement of perceived environments in rural settings is lacking. This study describes the development of the Rural Active Living Perceived Environmental Support Scale (RALPESS). Methods: Premised on social ecological and cognitive perspectives, 85 initial items were generated through a literature review and a mixed-methods investigation of "activity-friendly" environments. Items were organized by resource areas--town center, indoor and outdoor physical activity areas, schools, churches, and areas around the home/neighborhood--and submitted for expert panel review. In 2009, a revised questionnaire was disseminated to adolescents, parents, public school staff, and older adults in 2 rural southeastern United States counties. Principal component analysis with varimax rotation was used to explore factor structure (n = 542). Results: The final analysis yielded 33 items with 7 factors: 1) church facilities, 2) town center connectivity, 3) indoor areas, 4) around the home/neighborhood, 5) town center physical activity resources, 6) school grounds, and 7) outdoor areas. Conclusions: The RALPESS is a valid, internally consistent, and practically useful instrument to measure perceptions of rural environments in the context of physical activity across the lifespan. Confirmatory factor analysis is recommended to validate factor structure. [ABSTRACT FROM AUTHOR]

Background: Despite the recognized health benefits, few older women participate in strength-training exercises. Methods: The purpose of this study was to examine factors related to older women's adherence to strength training after participation in the StrongWomen Program, a nationally disseminated community program. Adherence was defined as ≥4 months of twice-weekly strength training. Surveys were sent to 970 program participants from 23 states and to participants' corresponding program leaders. Five-hundred fifty-seven participants responded (57%). Results: Of respondents who completed surveys (527), 79% (415) adhered to strength training; adherers reported a mean of 14.1 ± 9.1 months of strength training. Logistic-regression analysis revealed that exercise adherence was positively associated with age (p = .001), higher lifetime physical activity levels (p = .045), better perceived health (p = .003), leader's sports participation (p = .028), and leader's prior experience leading programs (p = .006). Conclusion: These data lend insight to factors that may be related to exercise adherence among midlife and older women. [ABSTRACT FROM AUTHOR]

Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012-2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale. [ABSTRACT FROM AUTHOR]

No one-size-fits-all strategy works to increase physical activity (PA) at schools. To realize success, practitioners need flexible PA programs to support the multi-component comprehensive school physical activity program (CSPAP) approach. Walk/run programs have the potential to provide this flexibility, and some have demonstrated increased physical activity at school. Walk/run clubs may be particularly amenable to widespread adoption given that they require limited equipment, facilities or training among adult leaders; their implementation can occur at diverse times before, during or after school; and they demonstrate high levels of acceptability among children, parents and administrators. This article shares both the challenges and best practices of 85 schools participating in a district-level walk/run club initiative. These actionable findings can inform practice at the thousands of schools nationwide already providing walking and running programs or other schools looking to implement such a program. Incorporating the suggested tactics, such as setting moderate goals, using incentives judiciously, emphasizing fun, and fostering a supportive PA environment, may help other practitioners lead effective walk/run programs. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND A supportive school-based physical activity environment (PAE) is integral to children's physical activity behaviors, but less understood is its association with academic achievement. We aimed to assess the association between PAE and academic performance and whether a stronger relationship exists in lower-income schools (LIS) compared to middle-income schools (MIS). METHODS Schoolchildren (grades 3rd to 5th) were recruited from 17 Massachusetts public schools. Schools were classified based on geographic characteristics and free/reduced-price lunch (FRPL) eligibility (LIS = 7, Median FRPL = 86%; MIS = 10, Median FRPL = 20%). PAE was measured using a 10-item survey. Mixed-effects logistic regression models were used to examine associations between PAE and scoring Advanced/Proficient on standardized Math and English Language Arts (ELA) tests. RESULTS Demographic characteristics differed between LIS (N = 278, 5% non-Hispanic white) and MIS (N = 297, 73% non-Hispanic white). In LIS, PAE was associated with Math (odds ratio = 5.40, 95% CI = 2.52-11.54 p < .001), but not ELA test scores (p > .05). There was no relationship between PAE and MIS test scores (p > .05). Schooltime moderate-to-vigorous physical activity was not associated with test scores (p > .05). CONCLUSIONS A beneficial relationship exists between a high-PAE and test scores among LIS children, suggesting that the PAE may be associated with a more supportive environment and may be more fundamentally important for lower-income students. [ABSTRACT FROM AUTHOR]

Objective: We examined the adoption of Fuel Up to Play 60 (FUTP 60) and factors related to implementation of "plays," or guided changes to healthy eating and physical activity practices. Methods: A cross-sectional study using a survey instrument to assess adoption and implementation as reported by school stakeholders. Results: Schools enrolled during 2010-11 (N = 10,245) and 2011-12 (N = 8,995) were surveyed. In 2010-11 and 2011-12 respectively, 47.6% and 44.1% of responding schools implemented a play. Schools with an adult program advisor, a student ambassador, a program kit, a grant, or that completed activities and/or competitions were more likely to implement a play. Conclusion: FUTP 60 program characteristics are associated with implementation of healthy eating and physical activity plays, and the resources provided to schools may help with implementation. [ABSTRACT FROM AUTHOR]

Background: Tens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states.Methods: An online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5-12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively).Results: About half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three.Conclusions: Most programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted. [ABSTRACT FROM AUTHOR]

This study tested whether overweight/obese children’s attendance in a community-based physical activity (PA) program was associated with changes in cardiorespiratory fitness (CRF) and adiposity and whether in-program activity levels influenced those associations. Program sessions (offered twice/week, 2 hours/session, over 9 months) included structured exercise/sports. At baseline and follow-up, CRF was measured as Progressive Aerobic Cardiorespiratory Endurance Run (PACER) laps, height/weight were measured, and body mass index (BMI) was calculated. Attendance was recorded as sessions attended. Children wore pedometers in 10 representative sessions; in-program activity was calculated as mean steps/minute across sessions. Linear mixed models tested associations between attendance and changes in PACER score and BMI and the influence of in-program activity on those associations. A total of 101 participants (56% male, 93% Hispanic) completed baseline and one or two follow-up fitness/adiposity measurements. Attendance was associated with PACER change (β = .093, p = .01) but not BMI change (β = .00026, p = .97). There were significant interactions between attendance and in-program activity: Attendance more favorably affected PACER (p < .0001) and BMI (p = .03) as in-program activity levels increased. Attending community-based PA programs may improve CRF among overweight/obese children, particularly when participants are highly active during program time. Community practitioners should not only enroll overweight/obese children in PA programs but also promote adequate attendance/in-program activity levels. [ABSTRACT FROM AUTHOR]

Background: Increasing physical activity (PA) during the school day and out-of-school time are critical strategies for preventing childhood obesity and improving overall health. The purpose of the present investigation was to examine schoolchildren's volume and type of PA during school-time and out-of-school, compared to national recommendations and differences by sex and weight status. Methods: This cross-sectional analysis included 517 3rd-5th grade schoolchildren from 13 New England elementary schools (October 2013-January 2014). Demographics were collected by parent questionnaire. Measured height and weight were used to categorize child weight status. Accelerometer data were collected over 7 days. PA was coded as total activity counts and minutes of sedentary, light, and moderate-to-vigorous physical activity (SED, LPA, MVPA) during 1) school, 2) weekday out-of-school, 3) weekend, and 4) total daily time. Multivariable mixed models were used to examine associations between sex and weight status and total counts, SED, LPA, and MVPA, controlling for demographics, wear-time, and clustering within schools. Results: 453 participants (60.5 % girls; mean age 9.1 years; 30.5 % overweight/obese) had valid accelerometer wear time (≥3 days, ≥ 10 h/day). Few children achieved 60 min total daily (15.0 %) or school-time (8.0 %) MVPA recommendations. For all time-of-day categories, girls achieved fewer MVPA minutes than boys (p < .0001), and overweight/obese participants achieved fewer MVPA minutes than normal/underweight participants (p = 0.05). Minutes of LPA declined by grade-level (p < .05) and were lower in girls than boys during school-time only (p < .05). Conclusion: Disparities in MVPA by sex and weight status across school and out-of-school time highlight the need for programs with equitable reach. [ABSTRACT FROM AUTHOR]

Increases in the prevalence of overweight and obesity are a function of chronic, population-level energy imbalance, whereby energy intakes exceed energy expenditures. Although sometimes viewed in isolation, energy intakes and expenditures in fact exist in a dynamic interplay: energy intakes may influence energy expenditures and vice versa. Obesogenic environments that promote positive energy balance play a central role in the obesity epidemic, and reducing obesity prevalence will require re-engineering environments to promote both healthy eating and physical activity. There may be untapped synergies in addressing both sides of the energy balance equation in environmentally focused obesity interventions, yet food/beverage and physical activity environments are often addressed separately. The field needs design, evaluation, and analytic methods that support this approach. This paper provides a rationale for an energy balance approach and reviews and describes research and practitioner work that has taken this approach to obesity prevention at the environmental and policy levels. Future directions in research, practice, and policy include moving obesity prevention toward a systems approach that brings both nutrition and physical activity into interdisciplinary training, funding mechanisms, and clinical and policy recommendations/guidelines. [ABSTRACT FROM AUTHOR]

Objectives. We investigated the body mass index (BMI; weight in pounds/[height in inches]2 × 703) of parents whose children participated in Shape Up Somerville (SUS), a community-based participatory research study that altered household, school, and community environments to prevent and reduce childhood obesity. Methods. SUS was a nonrandomized controlled trial with 30 participating elementary schools in 3 Massachusetts communities that occurred from 2002 to 2005. It included first-, second-, and third-grade children. We used an inverse probability weighting estimator adjusted for clustering effects to isolate the influence of SUS on parent (n = 478) BMI. The model's dependent variable was the change in pre- and postintervention parent BMI. Results. SUS was significantly associated with decreases in parent BMIs. SUS decreased treatment parents' BMIs by 0.411 points (95% confidence interval = -0.725, -0.097) relative to control parents. Conclusions. The benefits of a community-based environmental change childhood obesity intervention can spill over to parents, resulting in decreased parental BMI. Further research is warranted to examine the effects of this type of intervention on parental health behaviors and health outcomes. [ABSTRACT FROM AUTHOR]

The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes. [ABSTRACT FROM AUTHOR]

ObjectiveApproximately one-third of children in the USA are either overweight or obese. Understanding the perceptions of children is an important factor in reversing this trend.DesignAn online survey was conducted with children to capture their perceptions of weight, overweight, nutrition, physical activity and related socio-behavioural factors.SettingWithin the USA.SubjectsUS children (n 1224) aged 8–18 years.ResultsTwenty-seven per cent of children reported being overweight; 47·1 % of children overestimated the rate of overweight/obesity among US children. A higher percentage of self-classified overweight children (81·9 %) worried about weight than did self-classified under/normal weight children (31·1 %). Most children (91·1 %) felt that it was important to not be overweight, for both health-related and social-related reasons. The majority of children believed that if someone their age is overweight they will likely be overweight in adulthood (93·1 %); get an illness such as diabetes or heart disease in adulthood (90·2 %); not be able to play sports well (84·5 %); and be teased or made fun of in school (87·8 %). Children focused more on food/drink than physical activity as reasons for overweight at their age. Self-classified overweight children were more likely to have spoken with someone about their weight over the last year than self-classified under/normal weight children.ConclusionsChildren demonstrated good understanding of issues regarding weight, overweight, nutrition, physical activity and related socio-behavioural factors. Their perceptions are important and can be helpful in crafting solutions that will resonate with children. [ABSTRACT FROM AUTHOR]

The authors describe the Active Living Research 2013 Conference: Achieving Change Across Sectors: Integrating Research, Policy, and Practice event that was held in San Diego, California from February 26 to 28, 2013. Topics include the Instant Recess routine of Dr. Toni Yancey, the collection of evidence to inform practice, initiatives to prevent childhood obesity, and musical chairs.

Abstract: Objective: The objective of this study was to test the hypothesis that community-based environmental change intervention prevents undesirable weight gain in children. Method: The method used in this study was a two-year, non-randomized, controlled trial (2003–2005) using community-based participatory methodology in three diverse cities in Massachusetts: one intervention and two socio-demographically-matched control communities (pooled for analysis). Children (n=1028), with a mean age=7.61+1.04years participated. Interventions were made to improve energy balance by increasing physical activity options and availability of healthful foods (Year 1). To firmly secure sustainability, the study team supported policies and shifted intervention work to community members (Year 2). Results: Change in body mass index z-score (BMIz) was assessed by multiple regression, accounting for clustering within communities and adjusting for baseline covariates. Sex-specific overweight/obesity prevalence, incidence and remission were assessed. Over the two-year period, BMIz of children in the intervention community decreased by −0.06 [p=0.005, 95% confidence interval: −0.08 to −0.04] compared to controls. Prevalence of overweight/obesity decreased in males (OR=0.61, p=0.01) and females (OR=0.78, p=0.01) and remission increased in males (OR 3.18, p=0.03) and females (OR 1.93, p=0.03) in intervention compared to controls. Conclusion: Results demonstrate promise for preventing childhood obesity using a sustainable multi-level community-based model and reinforce the need for wide-reaching environmental and policy interventions. [Copyright &y& Elsevier]

Background: The purpose of this study is to describe the behavioral changes in children resulting from Shape Up Somerville (SUS), a community-based, participatory obesity prevention intervention that used a multi-level, systems-based approach. It was set in Somerville, an urban, culturally diverse community in Massachusetts, USA. Methods: This was a non-randomized, controlled 2-year community-based intervention trial with children enrolled in grades 1 to 3 (ages 6-8 years). Overall, the SUS intervention was designed to create environmental and policy change to impact all aspects of a child’s day. Pre-post outcomes were compared between Somerville and two control communities that were chosen based on socio-demographic similarities. Behavioral outcomes were fruit and vegetable and sugar-sweetened beverage consumption; number of organized sports and physical activities per year; walking to and from school; screen and television time; television in bedroom; and dinner in room with television on. These measures were assessed by parent/caregiver report using a 68-item Family Survey Form. Data were analyzed using multiple linear regression, accounting for covariates and clustering by community. Results: Intervention group children, compared to the control group, significantly reduced sugar-sweetened beverage consumption (-2.0 ounces per day; 95% CI -3.8 to -0.2), increased participation in organized sports and physical activities (0.20 sports or activities per year; 95% CI 0.06 to 0.33), and reduced their screen time (-0.24 hours per day; 95% CI -0.42 to -0.06). Conclusions: Results of this study, particularly intake of sugar-sweetened beverages and screen time, are similar to others that used a multi-level approach to realize change in behavior. These results support the efficacy of a multi-level and systems-based approach for promoting the behavioral changes necessary for childhood obesity prevention. [ABSTRACT FROM AUTHOR]

Objective: To explore children's motivations for and perceived benefits and barriers to nutrition research participation. To explore children's perspectives on how to improve the research experience. Design: Seven focus group sessions were conducted during March 2008 with research participants from a trial that examined the effects of pre-exercise snacks on physical activity and exercise stress in children. The Health Belief Model for Behavior Change served as the framework for understanding perceived benefits and barriers to research participation and cues to action to help children's readiness for future research participation. Setting: Indoor sports center in Acton, Massachusetts. Participants: Thirty-five children, 15 males and 20 females, aged 7-10 years. Phenomenon of Interest: Children's participation in nutrition research. Analysis: Transcripts were reviewed, coded, and sorted according to recurring trends and patterns using NVIVO software. Results: Participants were overwhelmingly motivated to participate in research because of financial incentives. The biggest barrier to participation was anxiety over finger pricks. Children suggested demonstrating different aspects of data collection during recruitment to reduce trepidation and using distraction techniques to improve the experience during anxiety-provoking data collection. Conclusion and Implications: Themes for benefits and barriers to research participation were identified. Data also provide a guide to promote readiness and to improve the research experience for children in future nutrition trials. [ABSTRACT FROM AUTHOR]

Introduction: Most children do not meet the recommendations for school-time and daily moderate-to-vigorous physical activity, with significant demographic disparities and declines over the elementary school years. Investigators examined the impact of Fueling Learning through Exercise study school-based physical activity programs on school-time and total daily moderate-to-vigorous physical activity among lower-income school children.Design, Participants, and Intervention: Urban elementary schools (N=18) were cluster randomized to 100 Mile Club, Just Move, or control. Data collection and analyses occurred from 2015 to 2019 among third- and fourth-grade school children (N=1,008) across 2 academic years.Main Outcome Measures: Student's moderate-to-vigorous physical activity was measured by 7-day accelerometry (Actigraph GT3X+) at baseline (before intervention), midpoint (6 months), and endpoint (18 months). Mixed-effects linear regression models examined program impact on school-time and daily moderate-to-vigorous physical activity, adjusting for clustering, demographics, weight status, free/reduced-price lunch eligibility, school physical activity environment, wear time, and weather. Program reach by sex, weight status, race/ethnicity, and baseline activity levels was explored.Results: Of the 979 participants analyzed (aged 8.7 [SD=0.7] years, 44% male, 60% non-White, 40% overweight/obese, 55% eligible for free/reduced-price lunch), 8.4% (18.2 [SD=7.9] minutes per day) and 19.8% (45.6 [SD=19.4] minutes per day) fulfilled the 30-minute school-time and 60-minute daily moderate-to-vigorous physical activity recommendations at baseline, respectively. Overall, daily moderate-to-vigorous physical activity decreased from baseline to 18 months (p<0.001, -5.3 minutes, 95% CI= -8.2, -2.4) with no effect of programming. However, for school-time moderate-to-vigorous physical activity, intervention schools maintained school-time moderate-to-vigorous physical activity across the 2 academic years, whereas school-time moderate-to-vigorous physical activity decreased in control schools (p=0.004, -2.3 minutes, 95% CI= -4.3, -0.4). Program reach on school-time moderate-to-vigorous physical activity appeared equitable by sex and weight status but was different by race/ethnicity (p<0.001).Conclusions: Two different school-based physical activity programs were effective in preventing the decline in school-time moderate-to-vigorous physical activity that is typical across the elementary years, with similar reach by sex and weight status. Multiple opportunities for physical activity during school are needed to promote meeting school-time moderate-to-vigorous physical activity recommendations among diverse children.Trial Registration: This study is registered at www.clinicaltrials.gov NCT02810834. [ABSTRACT FROM AUTHOR]

Let's Move! Active Schools (LMAS), now Active Schools, is a national initiative in the United States (US) that aims to engage schools to increase students' opportunities to be physically active. This evaluation describes changes in school-level practices related to physical education (PE) and physical activity (PA) among schools that received an LMAS-partner grant from ChildObesity180 or Fuel Up to Play 60 (FUTP60). ChildObesity180 and FUTP60 asked grantee schools to complete nine common questions, between October 2013 and August 2014, before and after receiving the grants to assess progress in implementing practices for PE and PA. "Yes" responses indicated presence of PE/PA-supportive practices. For schools with complete pre and post data (n=972), frequencies of "yes" responses were calculated for each practice at pre/post. Schools receiving a FUTP60 partner grant reported statistically significant improvements from pre to post across five practices for PE and PA, and ChildObesity180 grantees reported significant increases on all practices except daily recess, which was already in place at 95% of schools at pre-survey. Schools across both grant programs reported the largest increases for promoting PA via messaging, implementing classroom PA breaks, and providing PA before and after school. Schools in both programs reported smaller, but statistically significant, increases in requiring the recommended minutes of PE. This study illustrates the feasibility of offering small grants, at a national scale, for schools to make changes that support PA throughout the day. Results suggest that schools can shift PA policies and practices over the course of a school year. [ABSTRACT FROM AUTHOR]

Introduction: New immigrants are likely to be employed in occupations that provide physical activity; however, these positions may place workers at risk for adverse health outcomes. Relationships between occupational physical activity (OPA); weight-related behaviors; obesity; and depression remain underexplored among recent immigrants.Methods: Participants (N=385) were Brazilian, Haitian, and Latino mothers enrolled in a community-based participatory research lifestyle intervention among immigrant mothers (<10 years in U.S.). Baseline BMI was calculated using objectively measured height and weight. Self-reported baseline data included sociodemographics; physical activity (Pregnancy Physical Activity Questionnaire); depressive symptoms (Center for Epidemiological Studies-Depression Scale); and prepared food purchasing frequency. Logistic regression models estimated the odds of obesity (BMI ≥30.0); high depressive symptoms (score ≥16); and purchasing prepared foods (≥1 times/week) by OPA quartile. Models adjusted for covariates, including household composition, origin group, maternal age, education, household income, and recruitment year (2010, 2011). Data were analyzed in 2013.Results: Employed participants (49%) primarily worked as domestic workers, nursing assistants, and food service staff. In adjusted models, women in the highest OPA quartile versus lowest had 65% lower obesity odds (95% CI=0.16, 0.76) and approximately twice the odds of presenting high depressive symptoms (2.01, 95% CI=1.02, 4.27) and purchasing takeout food (1.85, 95% CI=0.90, 3.90), which was attenuated after adjusting for income and education (unadjusted OR=1.98, 95% CI=1.10, 3.52).Conclusions: OPA contributes to energy expenditure and may protect against obesity among new immigrant mothers; however, it is also associated with high depressive symptoms. Implications for physical and psychosocial well-being are mixed. [ABSTRACT FROM AUTHOR]

The article offers information on a study in which parents' perspectives about nutrition and physical activity (PA) during out-of-school time (OST). It mentions that 600 parents with a school-aged child participated in programs from selected OST organizations. It adds that about two thirds of parents agreed that OST programs should promote healthy environments for children, whereas one third agreed that parents alone should be responsible for children's nutrition and PA.

Objective To describe correlates of physical activity (PA) in structured exercise and structured sports sessions among low-income, overweight children participating in a community-based PA program. Methods A total of 93 children (55% male; 91% Hispanic) aged 8–14 years were included. Participants wore pedometers in a sample of 10 of 59 total sessions offered; mean steps per minute were calculated for structured exercise and sports sessions. Separate multivariable regression models tested associations between steps per minute in exercise and sports sessions and 5 potential correlates: baseline body mass index z -score, aerobic fitness (Progressive Aerobic Cardiorespiratory Endurance Run laps), perceived athletic competence (Harter self-perception profile), sex, and age. Results Only age (ß = –2.9; P = .02) significantly predicted steps per minute in exercise sessions. Age (ß = –4.3; P = .007), fitness (ß = 0.45; P = .03), and male sex (ß = 8.7; P = .02) significantly predicted steps per minute in sports. Conclusion and Implications In structured exercise and sports, perceived competence may not influence overweight and obese children’s PA. However, girls and older or less fit children may engage less actively, especially in sports. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Develop rural-specific assessment tools to be used by researchers and practitioners to measure the activity-friendliness of rural communities. Method: The tools were created through a mixed-methods investigation into the determinants of physical activity among rural populations. This informed the development of a conceptual framework defining activity-friendly rural environments. Questions were generated to reflect applicable existing urban-based variables and rural conceptual model elements. Pilot testing was conducted in seven rural US communities during the fall of 2008. Inter-rater reliability was assessed. Results: The Rural Active Living Assessment (RALA) Tools include three components: Town-Wide (18 town characteristic questions, and inventory of 15 recreational amenities), Program and Policy (20 questions), and Street Segment (28 questions). We found that the Town-wide and Program and Policy tools were feasible for community members to implement. The observed agreement and κ statistic across all items for the Street Segment Assessment were substantial (91.9% and 0.78, respectively). Conclusions: The RALA Tools were shown to be feasible and reliability was supported. They assess features believed to be supportive of active living in rural environments, offer users a resource to assess rural environments for activity-friendliness, and may also inform the design of interventions to help rural communities become more active and healthy. [Copyright &y& Elsevier]