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In this study, the extent to which Texas public school districts complied with the 65% instructional expenditure ratio mandate was related to student achievement on the Texas Assessment of Knowledge and Skills Science, Math, Reading, Social Studies, and Writing tests for the 2007-2008 school year. Following the grouping of Texas public school districts into seven instructional expenditure categories (i.e., below 60%, 60-60.99%, 61-61.99%, 62-62.99%, 63-63.99%, 64-64.99%, and 65% and greater), statistical analyses were conducted. Statistically significant differences, with small to moderate effect sizes, were revealed for Black, Hispanic, and White students in their achievement scores as a function of school district instructional expenditures. School districts that spent less than 60% on instruction had lower passing rates in all five subject areas than districts that spent more than 65%. Implications for further research are discussed. (Contains 4 tables.)

Performance evaluation of leaders is challenging in contexts where production processes are complex and there are conflicting pressures from interest groups. In the education context, school accountability systems assemble rich data and report both categorical rating and the underlying student pass rates that determine it, permitting the investigation of how different information affects labor market outcomes of school leaders. Applying regression discontinuity methods that by design hold effectiveness constant, we find sizable positive impacts on Texas elementary school principal retention and salaries for crossing the unacceptable–acceptable boundary but not for crossing higher rating cutoffs. These patterns suggest that public stigma from receiving an unacceptable rating plays a role in the unequal treatment of equally effective principals. While the labor market penalty could theoretically improve the distribution of principal quality through well-targeted departures, there is substantial overlap in principal value-added distributions across rating categories, and failure to cross the acceptable threshold does not lead to future improvements in school performance. [ABSTRACT FROM AUTHOR]

In this investigation, we examined the extent to which instructional expenditures were related to student academic achievement for students enrolled in Texas public schools for the 2005-2006 through the 2009-2010 school years. Student performance on the state-mandated assessments for all school districts in Texas for these five school years was analyzed as a function of school district instructional expenditure ratio group (i.e., less than 55, 55-57.49, 57.5-59.99, 60-62.49, 62.5-65, and 65% and higher). Statistically significant differences were present in reading, math, writing, science, and social studies passing rates for all five school years. As the instructional expenditure ratio increased, student achievement increased, especially in math and science. Further, when pairwise groups were analyzed, school districts in the 55-57.49% group consistently scored lower than other groups for all 5 years. School districts with higher instructional expenditure ratios consistently had higher student achievement results than districts with lower instructional expenditure ratios. Implications of our findings for policy are provided.

Purpose/Objectives: The new nutrition standards for the school meal programs implemented in 2012 align the school meal patterns with the US Dietary Guidelines for Americans, including more fruit, vegetable and whole grain offerings and minimum and maximum amount of calories per meal averaged over a week. The purpose of this study was to assess cafeteria staff perceptions about the new school food standards. Methods: Cafeteria staff (N = 72) in 12 schools, 8 elementary (EL) and 4 intermediate (INT), from a school district in the Houston, TX area were surveyed. The school district had 37,000 students [59% White, 26% eligible for free/reduced price meals (FRP)]. Half of the EL and INT schools were low income schools based on eligibility for FRP meals (49-79% EL; ~34% INT). Frequencies were calculated for all variables by grade level (EL and INT). Chi square analysis was conducted to assess whether responses differed by grade level. Results: The survey had a response rate of 100% (N = 72) with different sample sizes per question. More EL staff than INT staff (71% vs 40%; p< 0.01) agreed that children like the vegetables served for school lunch and that they encouraged students to eat more fruits and vegetables (95% vs 77%; p< 0.05). Significantly more EL school food service staff (64% vs 43%; p< 0.01) reported that the reason "students know exactly what they want" was a barrier for food recommendations, and this was also the barrier that most INT staff chose. Applications to Child Nutrition Professionals: A combination of interventions, such as offering healthy food options, providing nutrition education, marketing healthy choices, verbally encouraging students to eat fruits and vegetables, and facilitating opportunities for students to try new healthy foods may be more effective in influencing student dietary patterns than any single intervention.

Purpose/Objective: Providing a school breakfast to students may be a practical intervention that improves energy balance, nutrient intake, and school academic achievement variables. This purpose of this pilot study was to identify the ecological factors influencing middle school student school breakfast participation and possible strategies to promote school breakfast, and to evaluate a pilot intervention to improve school breakfast participation. Methods: Formative research with middle school students, their parents, teachers, and child nutrition managers were conducted to identify barriers to school breakfast participation and possible promotional strategies. Based on the results, a free school breakfast intervention was developed and pilot tested in low income schools. School breakfast participation was compared for the intervention semester (Spring, 2008) and 3 previous semesters for 3 intervention schools and 2 control schools. Results: Interviews with 47 sixth- to eighth-grade students and 41 parents were conducted, in addition to four focus groups with teachers and one with child nutrition managers. The information was used to develop the free school breakfast intervention that included school staff support and promotion to students and parents. During the intervention semester, there was a 242% increase in total school breakfast participation rate in the intervention schools, compared to the average of the previous three semesters (17.1% to 58.8%). The control school increase was about 20% (from 29.9% to 34.5%). Applications to Child Nutrition Professionals: A free SBP, with encouragement from school staff, dramatically increased school breakfast participation by students in low-income middle schools, by 242%. Future research should employ larger samples of middle schools, carefully document costs, and assess important school-related outcomes such as discipline and nurse referrals, attendance, tardiness, and school achievement. (Contains 1 table and 1 figure.)

Background: This study evaluates the relationship of goal setting to low-fat vegetable (LV) and fruit/100% juice (FJ) consumption and physical activity (PA) change. Methods: A total of 473 10- to 14-year-old Boy Scouts from Houston took part in a 9-week intervention. A two-group (LV and FJ or PA) intervention design was used with each group serving as the control for the other. Internet-based activities included goal setting at home. Food frequencies measured dietary intake. Results: Goals attained were not related to LV intake or PA. Immediate posttest FJ consumption increased about 0.7 servings as home FJ availability increased, but social desirability of response appeared to confound reports of FJ intake at posttest 6 months assessment. Conclusions: Goals attained were not related to LV intake or PA but was related to FJ intake, but only when home FJ availability was high and the relationship was confounded by social desirability of response. Further research is needed with higher quality measures of dietary intake to clarify these relationships. (Contains 3 tables and 2 figures.)

Purpose/Objectives: The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. Methods: Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburgh, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n = 21 schools) or control (n = 21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. Results: At baseline, 15 intervention and 15 control schools had beverage and/or snack vending machines, compared with 11 intervention and 11 control schools at the end of the study. At the end of study, all of the intervention schools with beverage vending machines, but only one out of the nine control schools, met the beverage goal. The snack goal was met by all of the intervention schools and only one of the four control schools with snack vending machines. Applications to Child Nutrition Professionals: The HEALTHY study's vending machine beverage and snack goals were successfully achieved in intervention schools, reducing access to less healthy food items outside the school meals program. Although the effect of these changes on student diet, energy balance and growth is unknown, these results suggest that healthier options for snacks can successfully be offered in school vending machines. (Contains 3 tables.)

Background: This study compares the impact of the Texas Public School Nutrition Policy on lunch consumption of low- and middle-income students in sixth through eighth grades. Methods: Students in 1 middle socioeconomic status (SES) and 1 low SES school completed lunch food records before (2001/2002) and after (2005/2006) implementation of the Texas policy. Students recorded amount and source of foods/beverages consumed. Two-way analyses of variance with year and school SES as factors were performed to compare consumption by school SES before and after implementation of the Texas policy. Results: Regardless of year, the low SES group consumed less fat, sweetened beverages, and candy and more vitamin C and calcium than the middle SES group. There were more significant improvements in dietary patterns for the middle SES school students post-policy, particularly from the National School Lunch Program (NSLP) meal. The middle SES school students reported significantly higher percentages of less healthy items from home post-policy. Conclusions: Overall, low SES school students consumed more healthy lunches at school compared with middle SES school students, and the Texas policy improved middle SES school student dietary intakes. Whether the dietary behaviors in school influence dietary intake for the entire day is unknown. (Contains 4 tables.)

Objective: To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. Design: Two-group randomized control trial; intervention versus usual EFNEP curriculum. Setting: Texas EFNEP classes. Participants: 1,104 EFNEP clients in 100 classes. Intervention: Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. Main Outcome Measures: Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. Analysis: Mixed-model repeated measures analysis of variance. Results: 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. Conclusion and Implications: Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted. (Contains 3 tables.)

Simple Summary: The ability of ultra-high dose rate FLASH radiation therapy (RT) to reduce normal tissue toxicity without affecting tumor response relative to conventional dose rate radiation therapy could fundamentally change the way we treat cancer. However, this field is still in its early stages, and the magnitude of the sparing effect between treatment centers differs greatly for reasons as yet unknown, which has put the robustness of the effect into question. In this study, we show that when similar irradiation beam parameter settings are used, the induced sparing effect is robust and reproducible across institutions. These settings should serve as a reference for further optimization of the FLASH effect. FLASH radiation therapy (RT) is a promising new paradigm in radiation oncology. However, a major question that remains is the robustness and reproducibility of the FLASH effect when different irradiators are used on animals or patients with different genetic backgrounds, diets, and microbiomes, all of which can influence the effects of radiation on normal tissues. To address questions of rigor and reproducibility across different centers, we analyzed independent data sets from The University of Texas MD Anderson Cancer Center and from Lausanne University (CHUV). Both centers investigated acute effects after total abdominal irradiation to C57BL/6 animals delivered by the FLASH Mobetron system. The two centers used similar beam parameters but otherwise conducted the studies independently. The FLASH-enabled animal survival and intestinal crypt regeneration after irradiation were comparable between the two centers. These findings, together with previously published data using a converted linear accelerator, show that a robust and reproducible FLASH effect can be induced as long as the same set of irradiation parameters are used. [ABSTRACT FROM AUTHOR]

The impact of goal attainment in a dietary change program to increase fruit, 100% juice, and vegetable consumption was assessed among fourth-grade students. At each session, the students were given goals related to increasing fruit, juice, and vegetable consumption. Baseline consumption and postconsumption were assessed with up to 4 days of computerized dietary recalls. Analyses included regression models predicting postconsumption from the numbers of fruit-juice goals, vegetable goals, or total number of general goals attained, respectively. For students with low baseline fruit-juice preferences, attaining more fruit-juice goals resulted in increased post-fruit-juice consumption. Among those with low baseline vegetable consumption, attaining one vegetable goal was related to higher post-vegetable consumption. For boys and those with high baseline fruit, juice, and vegetable consumption, attaining three general goals was related to increased fruit, juice, and vegetable intake. The results show that goal attainment was somewhat effective in promoting dietary change among children. (Contains 4 tables.)

Purpose: This study assessed student perceptions of school meals under the new federal meal patterns for the National School Lunch Program (NSLP). Student feedback is instrumental in developing strategies to increase and maintain NSLP participation, satisfaction, and ultimately provide students with a healthy meal. Methods: Anonymous questionnaires were completed by 1,867 6th to 8th grade students in the Houston, Texas area during Spring 2013. Analysis of variance was used to assess whether student perceptions about school meals, fruit/vegetables/whole grain consumption, and staff attentiveness varied by grade level, gender, school free/reduced price (FRP) meal eligibility, or frequency of eating school lunch. The top five reasons why participants choose to eat school lunch were also assessed. Results: Sixth graders (p < 0.001) reported greater satisfaction with the NSLP meal than other grades, while students from schools with higher FRP eligibility reported less satisfaction (p < 0.001) than other schools. Sixth graders (p < 0.001), as well as boys (p = 0.015), were more likely to report selecting and consuming fruits, vegetables, and whole grains. Students from schools with higher FRP eligibility (p < 0.001) and students who reported eating school lunch more frequently (p < 0.001) were more satisfied with staff attentiveness. The most popular reason for eating school lunch was "I am hungry". The least popular reasons for participating in the NSLP were "I get a balanced meal", and "It prepares me for after school activities".

Introduction: Cardiovascular comorbidities may predispose to adverse outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). However, across the USA, the burden of cardiovascular comorbidities varies significantly. Whether clinical outcomes of hospitalized patients with COVID-19 differ between regions has not yet been studied systematically. Here, we report differences in underlying cardiovascular comorbidities and clinical outcomes of patients hospitalized with COVID-19 in Texas and in New York state. Methods: We established a multicenter retrospective registry including patients hospitalized with COVID-19 between March 15 and July 12, 2020. Demographic and clinical data were manually retrieved from electronic medical records. We focused on the following outcomes: mortality, need for pharmacologic circulatory support, need for mechanical ventilation, and need for hemodialysis. Univariate and multivariate logistic regression analyses were performed. Results: Patients in the Texas cohort (n = 296) were younger (57 vs. 63 years, p value <0.001), they had a higher BMI (30.3 kg/m2 vs. 28.5 kg/m2, p = 0.015), and they had higher rates of diabetes mellitus (41 vs. 30%; p = 0.014). In contrast, patients in the New York state cohort (n = 218) had higher rates of coronary artery disease (19 vs. 10%, p = 0.005) and atrial fibrillation (11 vs. 5%, p = 0.012). Pharmacologic circulatory support, mechanical ventilation, and hemodialysis were more frequent in the Texas cohort (21 vs. 13%, p = 0.020; 30 vs. 12%, p < 0.001; and 11 vs. 5%, p = 0.009, respectively). In-hospital mortality was similar between the 2 cohorts (16 vs. 18%, p = 0.469). After adjusting for differences in underlying comorbidities, only the use of mechanical ventilation remained significantly higher in the participating Texas hospitals (odds ratios [95% CI]: 3.88 [1.23, 12.24]). Median time to pharmacologic circulatory support was 8 days (interquartile range: 2, 13.8) in the Texas cohort compared to 1 day (0, 3) in the New York state cohort, while median time to in-hospital mortality was 16 days (10, 25.5) and 7 days (4, 14), respectively (both p < 0.001). In-hospital mortality was higher in the late versus the early study phase in the New York state cohort (24 vs. 14%, p = 0.050), while it was similar between the 2 phases in the Texas cohort (16 vs. 15%, p = 0.741). Conclusions: Geographical differences, including practice pattern variations and the impact of disease burden on provision of health care, are important for the evaluation of COVID-19 outcomes. Unadjusted data may cause bias affecting future regulatory policies and proper allocation of resources. [ABSTRACT FROM AUTHOR]

In this investigation, we examined the extent to which instructional expenditures were related to student academic achievement for students enrolled in Texas public schools for the 2005-2006 through the 2009-2010 school years. Student performance on the state-mandated assessments for all school districts in Texas for these five school years was analyzed as a function of school district instructional expenditure ratio group (i.e., less than 55, 55-57.49, 57.5-59.99, 60-62.49, 62.5-65, and 65 % and higher). Statistically significant differences were present in reading, math, writing, science, and social studies passing rates for all five school years. As the instructional expenditure ratio increased, student achievement increased, especially in math and science. Further, when pairwise groups were analyzed, school districts in the 55-57.49 % group consistently scored lower than other groups for all 5 years. School districts with higher instructional expenditure ratios consistently had higher student achievement results than districts with lower instructional expenditure ratios. Implications of our findings for policy are provided. [ABSTRACT FROM AUTHOR]

Objective To investigate changes in student food selection and consumption in response to the new National School Lunch Program meal patterns during fall 2011. Design Eight elementary and four intermediate schools in one Houston area school district were matched on free/reduced-price meal eligibility and randomized into control or intervention conditions. Intervention Both intervention and control school cafeterias served the same menu. The intervention school cafeterias posted the new meal pattern daily; students could select one fruit and two vegetable servings per reimbursable meal. Control school students could only select the previous meal pattern: a total of two fruit and vegetable servings per meal. Main outcome measures Students were observed during lunch: student sex and foods selected/consumed were recorded. Diet analysis software was used to calculate energy/food groups selected/consumed. Statistical analyses performed Cochran-Mantel-Haenszel χ 2 tests examined differences in the percent of students selecting each meal component by condition, controlling for sex, grade, and school free/reduced-price meal eligibility. Analysis of covariance assessed differences in amount of energy/food groups selected and consumed, and differences in percent of food groups consumed. Results Observations were conducted for 1,149 elementary and 427 intermediate students. Compared with students in the control schools, significantly more intervention elementary and intermediate school students selected total ( P <0.001, P <0.05) and starchy vegetables ( P <0.001, P <0.01); more intervention intermediate school students selected fruit ( P <0.001), legumes ( P <0.05), and protein foods ( P <0.01). There were significantly greater amounts of these foods selected and consumed, but no differences in the proportion of the foods consumed by condition. Fewer calories were consumed by elementary and intermediate school intervention students. Conclusions More intervention students selected fruit and vegetables at lunch and consumed them compared with control condition students. Future studies with larger and more diverse student populations are warranted. [ABSTRACT FROM AUTHOR]

Woody vegetation in 30 quadrats, 15 each in a riparian and upland area of an urban forest located in Marshall, TX (32°33′N; 94°22′W), was assessed for relative frequency, relative density, relative dominance, and importance. Additionally, the riparian area and adjacent upland area were assessed for the potential impact of beaver in the riparian area. The most important tree species in the canopy were white oak {Quercus alba), southern red oak (Q. falcata), loblolly pine (Pinus taeda), slippery elm (Ulmus rubra), and sweet gum {Liquidambar styraciflua). Beech (Fagus grandifolia) and red maple (Acer rubrum) were found in the understory in greater frequencies than in the canopy. Composite species richness was 16.9 ± 1.8 in the canopy. The species richness of the riparian area was moderately higher (12.8 ± 1.5) than the upland area (11.8 ± 1.5), but not significantly different (z = 0.577; P = 0.282). The Shannon-Wiener index of diversity was greater for the upland area (2.86 bits) than the riparian area (2.57 bits). The Morisita coefficient of similarity between the two areas was 0.84 in the canopy and 0.97 in the understory. [ABSTRACT FROM AUTHOR]

Study Question: What is the relationship between semen parameters and mortality in men evaluated for infertility?Summary Answer: Among men undergoing an infertility evaluation, those with abnormal semen parameters have a higher risk of death, suggesting a possible common etiology between infertility and mortality.What Is Known Already: Conflicting data exist that suggest either an inverse relationship or no relationship between semen quality and mortality.Study Design, Size, Duration: A study cohort was identified from two centers, each specializing in infertility care. In California, we identified men with data from 1994 to 2011 in the Stanford Reproductive Endocrinology and Infertility semen database. In Texas, we identified men with data from 1989 to 2009 contained in the andrology database at the Baylor College of Medicine Special Procedures Laboratory who were evaluated for infertility. Mortality was determined by data linkage to the National Death Index or Social Security Death Index. Comorbidity was estimated based on calculation of the Charlson Comorbidity Index or Centers for Medicare & Medicaid Services-Hierarchical Condition Categories Model.Participants/materials, Setting, Methods: In all, 11,935 men were evaluated for infertility from 1989 to 2011. During 92 104 person years of follow-up, 69 of 11,935 men died (0.58%). The mean age at infertility evaluation was 36.6 years with a mean follow-up of 7.7 years.Main Results and the Role Of Chance: Compared with the general population, men evaluated for infertility had a lower risk of death with 69 deaths observed compared with 176.7 expected (Standardized mortality rate 0.39, 95% CI 0.30-0.49). When stratified by semen parameters, however, men with impaired semen parameters (i.e. male factor infertility) had significantly higher mortality rates compared with men with normal parameters (i.e. no male factor infertility). Low semen volume, sperm concentration, sperm motility, total sperm count and total motile sperm count were all associated with higher risk of death. In contrast, abnormal sperm morphology was not associated with mortality. While adjusting for current health status attenuated the association between semen parameters and mortality, men with two or more abnormal semen parameters still had a 2.3-fold higher risk of death compared with men with normal semen (95% CI 1.12-4.65).Limitations, Reasons For Caution: Our cohort represents infertile men, which may limit generalizability. As comorbidity relied on administrative data, granular information on each man regarding infertility diagnosis and lifestyle factors was unavailable.Wider Implications Of the Findings: Men with impaired semen parameters have an increased mortality rate in the years following an infertility evaluation suggesting semen quality may provide a marker of health.Study Funding/competing Interest(s): This study is supported in part by P01HD36289 from the Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health (to D.J.L. and L.I.L.). The project was also partially supported by an NIH CTSA award number UL1 RR025744. None of the authors has any conflict of interest to declare. [ABSTRACT FROM AUTHOR]

This randomized clinical trial tested the impact of a website promoting nutrition and physical activity for adolescents (Teen Choice: Food and Fitness). Participants, (408) 12- to 17-year-old adolescents in the Houston area, completed online surveys measuring diet, physical activity, sedentary behavior and diet/physical activity mediators at baseline. After randomization, they were asked to log onto either the intervention or the control condition website weekly for 8 weeks to review web content and set goals to improve dietary and physical activity behaviors. Post-test occurred after 8 weeks. Logistic regression analyses and one-way analyses of covariance were used in the analyses. At post, more intervention group adolescents reported eating three or more daily vegetable servings in the past week compared with the control group (P < 0.05); both groups reported significant increases in physical activity (P < 0.001) and significant decreases in TV watching (P < 0.01). Average log on rate was 75% over the 8 weeks; there was no difference by condition. The website enabled adolescents to improve vegetable intake and daily physical activity, reduce sedentary behavior and had a high log on rate. Future research should identify effective methods for disseminating this website to wider audiences. [ABSTRACT FROM PUBLISHER]

Purpose. Type 2 diabetes increases risk of chronic disease. The recommendations are for youth to attain at least 60 minutes of daily physical activity (PA). Fewer than 20% achieve this goal. This study examines differences between blood glucose control and PA in youth with type 2 diabetes. Methods. A1c levels and PA were tested in youth 9 to 17 years old with newly diagnosed type 2 diabetes during clinic visits. Average daily minutes of moderate to vigorous physical activity (MVPA) was calculated. Differences in MVPA were investigated. Results. Slightly more than half of youth had well-controlled diabetes. All engaged in less PA than recommended. Youth with well-controlled diabetes engaged in slightly less MVPA than those whose diabetes was not in control. There were no significant differences in minutes of MVPA by gender, race, or diabetes control. Conclusions. It is necessary to identify ways to increase PA among youth with type 2 diabetes. [ABSTRACT FROM PUBLISHER]

Computerized point-of-sale (POS) machine software that allows parents to place restrictions on their child's school meal accounts is available. Parents could restrict specific foods (eg, chips), identify specific days the child can purchase extra foods, or set monetary limits. This descriptive study examines the use of parental restrictions on student cafeteria POS accounts in a convenience sample of 2 school districts. POS alerts, with student gender, grade, ethnicity, and students' free or reduced-price meal eligibility, were obtained from 2 school food service departments for the 2007-2008 school year. The alerts were coded into 5 categories: financial, medical, restrictions, snacks OK, and extras OK. The distribution of alerts by district, students, and demographics was then tabulated. District A (4839 students) had more students with alerts (n = 789, 16%) than District B (8510 students; n = 217, 2.6%), and 94 District A students had a second alert. District A parents had to provide written permission for their child to purchase snacks (n = 654, 13.5%) and extra meal items (n = 113, 2.3%). Most alerts were for full-pay students in both districts (74% and 66%) and varied by demographics of the students. Few parents actually used this system to limit student purchases of foods outside the school meal. Future studies should investigate the influence of these restrictions on student food choices. [ABSTRACT FROM AUTHOR]

Objective: The relationship between combat stress and post-concussive symptoms in service members with mild traumatic brain injuries (mTBI) is poorly understood. It was hypothesized that the co-occurrence of combat stress would have a significant effect on the severity of post-concussive complaints, specifically on emotional and cognitive symptoms. Methods: Four hundred and seventy-two combat-deployed service members with mTBI completed self-report inventories of post-traumatic stress and post-concussive symptoms. Two groups were formed based on post-traumatic stress symptoms (High Combat Stress and Low Combat Stress). Results: A 3-8-fold increase in post-concussive symptoms was observed when comparing the High and Low Combat Stress Groups. Elevations in post-concussive symptom reporting were not limited to emotional and/or cognitive symptoms, but rather were inclusive of all measured post-concussive symptoms. Conclusions: The findings of the present study suggest that non-brain injury-related factors, such as high-levels of combat stress, may impact post-concussive symptom reporting in this population, further confounding the accuracy of the post-concussion syndrome (PCS) diagnosis. Considerable caution should be exercised in making the diagnosis of PCS in concussed service members with co-occurring combat-stress disorders. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study compares the impact of the Texas Public School Nutrition Policy on lunch consumption of low- and middle-income students in sixth through eighth grades. METHODS: Students in 1 middle socioeconomic status (SES) and 1 low SES school completed lunch food records before (2001/2002) and after (2005/2006) implementation of the Texas policy. Students recorded amount and source of foods/beverages consumed. Two-way analyses of variance with year and school SES as factors were performed to compare consumption by school SES before and after implementation of the Texas policy. RESULTS: Regardless of year, the low SES group consumed less fat, sweetened beverages, and candy and more vitamin C and calcium than the middle SES group. There were more significant improvements in dietary patterns for the middle SES school students post-policy, particularly from the National School Lunch Program (NSLP) meal. The middle SES school students reported significantly higher percentages of less healthy items from home post-policy. CONCLUSIONS: Overall, low SES school students consumed more healthy lunches at school compared with middle SES school students, and the Texas policy improved middle SES school student dietary intakes. Whether the dietary behaviors in school influence dietary intake for the entire day is unknown. [ABSTRACT FROM AUTHOR]

Abstract: Low fruit and vegetable (FV) intakes are associated with excess body weight. The United States Department of Agriculture sponsors a Free Fruit and Vegetable Program in schools whereby students receive free FV snacks daily. This study assessed whether the program improved student exposure to and preferences for FV in a Houston high school in 2006–2007. Anonymous, post-intervention only FV exposure and preference surveys were completed by 2000 intervention school students and 1600 students in a comparison school during May, 2007. Differences in FV exposure and preferences were assessed, as well as differences in preferences between those students who tasted the item for the first time at school compared to those who had tasted the item before. The comparison school average scores for prior FV exposure and vegetable preferences were significantly higher than the intervention school scores. Intervention school students who had tasted the item previously reported significantly higher preferences than students who had tasted it for the first time at school. Access to the Free Fruit and Vegetable Program did not appear to improve high school student reported FV exposure and preferences. Future research should investigate the connection between food exposure, preferences and consumption in adolescents. [Copyright &y& Elsevier]

Objectives. We assessed the statewide impact of the 2004 Texas Public School Nutrition Policy on foods and beverages served or sold in schools. Methods. We collected lunch food production records from 47 schools in 11 Texas school districts for the school years before (2003-2004) and after (2004-2005) policy implementation. Cafeteria servings of fruit, vegetables (regular and fried), and milk served each day were calculated. Twenty-three schools from 5 districts provided records of a la carte sales of candy, chips, desserts, drinks, ice cream, and water. We examined aggregated school-level differences in total items served or sold per day per student between study years. Results. School demographics were similar to state data. Regardless of district and school size, cafeterias served significantly fewer high-fat vegetable items per student postpolicy (P<.001). Postpolicy snack bar sales of large bags of chips were significantly reduced (P=.006), and baked chips sales significantly increased (P=.048). Conclusions. School food policy changes have improved foods served or sold to students. It is not known whether improved lunch choices influence consumption for the whole day. (Am J Public Health. 2009;99:706-712. doi: 10.2105/AJPH. 2007.129387) [ABSTRACT FROM AUTHOR]

The article provides information on a study on the intake of sweetened beverages, fruits, vegetables and calories by parochial school students in grades 4 through 6 in Houston, Texas. In the study, servings of soft drinks and fruit-flavored drinks were added together as sweetened beverages and the caloric intake was obtained by means of Nutrition Data Systems software, version 2.1. The study found that more than 50% of total beverages consumed by these fourth- to sixth-grade students were sweetened beverages and students with the highest consumption of total sweetened beverages consumed more calories.

Background: Teens do not meet guidelines for healthy eating and physical activity. The Internet may be an effective method for delivering programs that help them adopt healthy behaviors. Objective: To collect information to design content and structure for a teen-friendly website promoting healthy eating and physical activity behaviors. Methods: Qualitative research, encompassing both focus group and interview techniques, were used to design the website. Participants were 12-17 year olds in Houston, Texas, and West Lafayette, Indiana. Results: A total of 133 participants took part in 26 focus groups while 15 participated in one-on-one interviews to provide guidance for the development of teen-friendly content and structure for an online behavior change program promoting healthy eating and physical activity to 12-17 year olds. The youth made suggestions to overcome common barriers to healthy eating and physical activity. Their feedback was used to develop "Teen Choice: Food & Fitness," a 12-week online behavior change program, populated by 4 cartoon character role models. Conclusions: It is critical that members of the target audience be included in formative research to develop behavior change programs that are relevant, appealing, and address their needs and interests. [ABSTRACT FROM AUTHOR]

Background Children may not receive nutritional benefits from school lunch meals if they do not eat the foods served. Objective This study investigated whether there were differences in school lunch foods consumed and wasted by grade level of elementary school students. Design In this cross-sectional study, anonymous meal observations were conducted after students selected their reimbursable school lunch meals in the cafeteria lunch line. The amounts of foods selected and consumed were recorded using the quarter waste method and food waste was calculated using the information recorded. Participants/setting During the spring of 2013, eight elementary schools (50% low income) enrolling children in kindergarten through grade 5 in one school district in the Houston, TX, area were selected by the Child Nutrition Director. Main outcome measures The amount of calories and foods consumed and the percentage wasted were assessed. Statistical analyses performed Analysis of covariance and post hoc analysis were used to examine food consumption and plate waste by grade level (kindergarten and grade 1 [K-Gr1], grades 2 and 3 [Gr2-3], and grades 4 and 5 [Gr4-5]), controlling for student sex and school-level free/reduced priced meal eligibility. Results There were 568 nonrandom lunch meal observations of students included in the analyses. Approximately 48% of the observations were from boys; 50% were from low-income schools, and were evenly divided by grade. In general, students in K-Gr1 consumed fewer calories than both Gr2-3 and Gr4-5, and Gr2-3 students consumed significantly fewer calories than Gr4-5. K-Gr1 students also consumed less and wasted more total and red-orange vegetables, total/whole/refined grains, and total protein foods than the older students. Gr2-3 students wasted more calories and total grains than Gr4-5 students. K-Gr1 students wasted more fruit than Gr2-3 students. Conclusions Overall, younger students in elementary schools (K-Gr-1) consumed less of the foods they selected for their lunch meals, and wasted more than older elementary school students. Future studies should investigate why younger children wasted more food and potential strategies to reduce food waste by younger students. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Low-income Hispanic women are at greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program participation and dietary intake among 661 Hispanic women aged 26–44years living in Texas. Methods: Cross-sectional data was collected using standard methods. Analysis of variance and logistic regression examined the influence of Supplemental Nutrition Assistance Program on diet after adjusting for household characteristics, body mass index, and food security status. Results: Most women did not meet recommended dietary guidelines. Supplemental Nutrition Assistance Program participants consumed higher amounts of total sugars, sweets–desserts, and sugar-sweetened beverages than Supplemental Nutrition Assistance Program nonparticipants. High sodium intakes and low dairy consumption were observed in both groups. Only 27% of low-income eligible women received Supplemental Nutrition Assistance Program benefits. Discussion: Low-income Hispanic women participating in Supplemental Nutrition Assistance Program reported less healthful dietary patterns than nonparticipants. This may contribute to the increased obesity prevalence and related comorbidities observed in this population. Conclusion: Supplemental Nutrition Assistance Program should play an important role in enhancing the overall dietary quality of low-income households. Policy initiatives such as limiting the purchase of sugar-sweetened beverages and education to enable women to reduce consumption of high sodium processed foods deserve consideration as means to improve the dietary quality of Supplemental Nutrition Assistance Program participants. Effective measures are needed to increase Supplemental Nutrition Assistance Program participation rates among Hispanics. [Copyright &y& Elsevier]

Abstract: Self-administered instruments offer a low-cost diet assessment method for use in adult and pediatric populations. This study tested whether 8- to 13-year-old children could complete an early version of the Automated Self Administered 24-hour diet recall (ASA24) and how this compared to an interviewer-administered 24-hour diet recall. One-hundred twenty 8- to 13-year-old children were recruited in Houston from June through August 2009 and randomly assigned to complete either the ASA24 or an interviewer-administered 24-hour diet recall, followed by the other recall mode covering the same time interval. Multivariate analysis of variance, testing for differences by age, sex, and ethnic/racial group, were applied to percentages of food matches, intrusions, and omissions between reports on the ASA24 and the interviewer-administered 24-hour diet recall. For the ASA24, qualitative findings were reported regarding ease of use. Overall matches between interviewer-administered and ASA24 self-administered 24-hour diet recall was 47.8%. Matches were significantly lower among younger (8- to 9-year-old) compared with older (10- to 13-year-old) children. Omissions on ASA24 (18.9% overall) were most common among 8-year-olds and intermediate among 9-year-olds. Eight- and 9-year-olds had substantial difficulties and often required aid in completing ASA24. Findings from this study suggest that a simpler version of an Internet-based diet recall program would be easier for children to use. [Copyright &y& Elsevier]

Purpose: To investigate the degree to which offenders expect to be stigmatized or reintegrated after conviction and punishment in the justice system and the factors that influence variations in expectations. Methods: A total of 1,031 adult male subjects convicted in Texas in 1993 and sentenced to a boot camp program were surveyed about their expectations regarding how they would be treated after they were released. Data was also collected on items related to prior criminal activity, race, ethnicity, and selected criminological theories. The data was analyzed with descriptive statistics and OLS regression. Results: The results show that most offenders do not feel as though they will be stigmatized as a result of their convictions. Most expect to be reintegrated when they re-enter the community. Although there is some overlap, different sets of variables influence expectations of stigmatization and reintegration. Conclusions: The results have implications for restorative justice and other post-conviction treatment programs. [Copyright &y& Elsevier]