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Background The Environmental Nutrition Program (ENP) as an environmental intervention offers voluntary involvement with students, but persists in exposure. This study aimed to investigate the effect of ENP on students’ dietary intake and nutritional knowledge. Methods A quasi-experimental study was conducted with a control school. ENP comprises four activities: the use of uniform food serving tools, nutrition fact displays, food and nutrition information displays, and body weighing awareness. The ENP emphasized voluntary involvement with students but persisted in exposure for over 8-weeks. Multiple passes of 24-hour food recall and validated questionnaires were used in the assessments by a nutritionist. Multiple linear regressions were performed to analyze the effectiveness of ENP. Results A total of 113 female high school students, with a median age of 16 years, were recruited. At baseline, all students had a lower dietary intake than the national recommendation. Except for the stipend, no differences in the characteristics were found among the students. The students’ carbohydrate intake and nutritional knowledge significantly increased after the ENP in the intervention school ( p < 0.001). Total energy, protein, and fat intake also improved after ENP. Conclusion ENP activities effectively increased students’ daily carbohydrate intake and nutritional knowledge. Thus, ENP may be appropriate for enhancing nutrition literacy among female students. Future studies with a longer time frame are encouraged to yield sustained, favorable dietary practices.

On college campuses, environmental science education largely takes place in classrooms, thereby limiting impact on the full student body. By implementing an educational intervention in an informal campus setting, this study tested an approach aimed at expanding the reach of environmental learning. Students at a mid-size Midwestern university were exposed to a food-focused environmental and climate education intervention consisting of sustainability trivia and marketing materials displayed in dining halls. Prior to exposure, students completed a pre-test, followed by a 5-week intervention, then a post-test. Comparing correct responses between pre-test and post-test, we found a significant increase in environmental and climate impact knowledge. The intervention was especially effective for women such that knowledge increased significantly more among women than among men. Additionally, we found a significant decrease in red meat consumption post-intervention. There were no significant differences between major categories or race and ethnicity. Results indicate that sustainability interventions implemented outside classrooms can be effective. Emphasizing connections between environmental health and sustainable food choices is important in improving students' environmental awareness. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a significant public health issue affecting working adults because it can increase the risk of noncommunicable diseases. Objectives: The objective is to determine the outcomes of a multi-component workplace environmental intervention that incorporated physical activity self-regulation (PASR) to promote physical activity (PA) among employees. Materials and Methods: This was a 6-month intervention with a two-group, parallel, quasi-experimental study. A total of 11 workplaces were randomly assigned to intervention group (IG) or control group (CG) using a 1:1 allocation ratio. In each group, 84 eligible participants were recruited. The IG was exposed to the organizational support and the PA support components throughout the study. The PASR Scale, International PA Questionnaire, and pedometer were used to measure the outcome at the baseline, 3rd-month, and 6th-month follow-ups, respectively. The repeated measures-analysis of variance analysis was used to determine the changes in the PASR skills, MET-min/week, and step/week over time. Results: The IG had 75 participants (51 females and 24 males) and the CG had 73 participants (52 females and 21 males) at the 6th-month follow-up. Despite there was no statistically significant difference in the outcomes between groups over time, the IG showed significant improvements in total PASR (ηp2 = 0.021), goal setting (ηp2 = 0.024), total MET-min/week (ηp2 = 0.031), housework-related PA (ηp2 = 0.101), and step/week (ηp2 = 0.827) throughout this intervention. Conclusion: This intervention was found to be effective in improving the PASR skills, MET-min/week, and step/week of IG participants. Meanwhile, because some effect sizes were small, these findings should be interpreted with caution.

BackgroundEnvironmental and behavioral interventions hold promise to reduce sugar-sweetened beverage (SSBs) consumption.PurposeTo test, among frequent SSB consumers, whether motivations to consume SSBs moderated the effects of (a) a workplace SSB sales ban (environmental intervention) alone, and (b) a "brief motivational intervention" (BI) in addition to the sales ban, on changes in SSB consumption.MethodsWe assessed whether (1) baseline motivations to consume SSBs (craving, psychological stress, or taste enjoyment) impacted changes in daily SSB consumption at 6-month follow-up among frequent (>12oz of SSBs/day) SSB consumers (N = 214); (2) participants randomized to the BI (n = 109) versus to the sales ban only (n = 105) reported greater reductions in SSB consumption at follow-up; and (3) motivations to consume SSBs moderated any changes in SSB consumption.ResultsIn response to the sales ban alone, individuals with stronger SSB cravings (+1 SD) at baseline showed significantly smaller reductions in daily SSB consumption at 6-month follow-up relative to individuals with weaker (-1 SD) SSB cravings (2.5 oz vs. 22.5 oz), p < .01. Receiving the BI significantly increased reductions for those with stronger SSB cravings: Among individuals with stronger cravings, those who received the BI evidenced significantly greater reductions in daily SSB consumption [M(SE) = -19.2 (2.74) oz] than those who did not [M(SE) = -2.5 (2.3) oz, p < .001], a difference of 16.72 oz.ConclusionsFrequent SSB consumers with stronger SSB cravings report minimal reductions in daily SSB consumption with a sales ban only, but report greater reductions if they also receive a motivational intervention. Future multilevel interventions for institutions should consider both environmental and individualized multi-level interventions.Clinical trial informationNCT02585336.

The added value of natural environments in rehabilitation exercise is unclear. This study aimed to investigate whether there are more acute health benefits for older adults after a single rehabilitation exercise session performed in an outdoor natural environment compared with an indoor environment. Twenty-two nursing home residents were randomly assigned to the outdoor (n = 11, 79.5 ± 2.1 years) or indoor group (n = 11, 78.8 ± 5.2 years). Performance test outcomes were measured pre- and post-training session. The indoor group had a significantly higher blood pressure, greater increase in heart rate, higher perceived exercise intensity and physiological fatigue than the outdoor group. The combination of rehabilitation exercise with an outdoor natural environment may reduce exercise fatigue and improve cardiovascular health in older adults, with greater acute health benefits compared with an indoor environment. Rehabilitation exercise in the natural environments may be a highly valued environmental intervention for physiotherapy in older adults. [ABSTRACT FROM AUTHOR]

BackgroundWithout consideration for the food system in which healthy food-store interventions (HFIs) are implemented, their effects are likely to be unsustainable. Co-creation of HFIs by interventionists and food-store actors may improve contextual fit and therefore the effectiveness and sustainability of interventions, but there are few case studies on the topic. This study aims to provide insights into the integration of knowledge from contextual actors into HFI designs, through a co-creative process, to illustrate potential challenges, advantages, and outcomes. Methods We describe the co-creative design of an HFI in a Dutch supermarket chain, conducted through three increasingly in-depth design phases. Each phase consisted of a cycle of theorizing (gather insights from literature, feedback, and pilot studies), building (develop intervention designs), and evaluating (interviews or workshops with supermarket actors, to explore barriers and facilitators for sustainable implementation), feeding back into the next phase (drafting adapted intervention designs, based on feedback, and research input). Interview transcripts underwent a qualitative content analysis. Results We co-creatively designed four types of interventions to promote healthier food choices in supermarkets: (1) price strategies, (2) product presentation and positioning, (3) signage, and (4) interactive messaging. Interventions were aligned with the culture, structures and practices of the supermarket chain, while simultaneously challenging these system characteristics. For example, the idea of price promotions on healthy foods was well-received and encountered only practical barriers, which were easily resolved. However, the specification of tax-like price increases on unhealthy foods led to substantial resistance on cultural and commercial grounds, which were resolved through support from a key supermarket actor. Conclusion Our results illustrate the potential benefits of co-creation approaches in HFI design. We reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes.

The Green Heart Project is a controlled, community-based clinical trial to evaluate the effects of increasing greenery on community health. The study was initiated in 2018 in a low-to-middle-income residential area of nearly 30,000 racially diverse residents in Louisville, KY. Community engagement was maintained throughout the project, with feedback integrated into its design and implementation. Based on land use, demographics, and greenness in the area, we designated 8 paired clusters of demographically- and environmentally matched "target" (T) and adjacent "control" (C) areas (total of 16 clusters). Levels of ultrafine particles, ozone, and nitrogen oxides were measured in each cluster. In-person exams were conducted for 735 participants in Wave 1 (2018-2019) and 545 participants in Wave 2 (2021). Blood, urine, nail, and hair samples were collected to evaluate cardiovascular risk, inflammation, stress, and pollutant exposure. Demographic and psychosocial data were collected as well. Cardiovascular function was assessed by measuring arterial stiffness and flow-mediated dilation. After Wave 2, more than 8,000 mature, mostly evergreen, trees and shrubs were planted in the T clusters. Post planting data were collected during Wave 3 (2022) from 561 participants. We plan to follow changes in area characteristics and participant health to evaluate the long-term impact of the greening intervention., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Abstract Background Sugar overconsumption is a major contributor to overweight and obesity, with daily consumption greatly exceeding the WHO’s recommendations. The aim of the present study was to determine whether using a functionally modified sugar shaker as a food environment nudge could be an effective means to reduce the sugar used in hot beverages. Methods Sugar shakers were functionally modified to reduce the amount of sugar in each pour by 47%. A real-world experiment was conducted to compare the amount of added sugar per hot beverage during default and nudge conditions over the course of four weeks (17,233 hot beverages sold) in a university take-away café. In addition, 59 customers were surveyed to evaluate the acceptance of the intervention. Results Modifying the functional design of sugar shakers resulted in a reduction of added sugar by 20% (d = 1.35) compared to the default condition. In the survey, most participants evaluated the intervention strategy positively. Conclusion The present real-world experiment demonstrates that a simple environmental intervention can significantly reduce sugar consumption in public places while meeting with consumer approval, making it a promising means of reducing sugar overconsumption.

Exposure and sensitization to environmental factors play a fundamental role in asthma development and is strongly associated with asthma morbidity. While hereditary factors are critical determinants of asthma, exposures to environmental factors are implicated in the phenotypic expression of asthma and have been strongly associated in the risk of its development. Significant interest has thus been geared toward potentially modifiable environmental exposures which may lead to the development of asthma. Allergen exposure, in particular indoor allergens, plays a significant role in the pathogenesis of asthma, and remediation is a primary component of asthma management. In the home, multifaceted and multitargeted environmental control strategies have been shown to reduce home exposures and improve asthma outcomes. In addition to the home environment, assessment of the school, daycare, and workplace environments of patients with asthma is necessary to ensure appropriate environmental control measures in conjunction with medical care. This article will discuss the role of the environment on asthma, review targeted environmental therapy, and examine environmental control measures to suppress environmental exposures in the home and school setting. [ABSTRACT FROM AUTHOR]

Purpose: Aimed to explore more practical interventions for handwashing compliance (HWC) and protect the minor' health with the pandemic background, this study tested whether micro architectural interventions would promote HWC of adolescents through active experience. Background: Despite the well-documented benefits of handwashing (HW), low compliance is common among adolescents. HW space in schools has always been treated as attached spaces of little matter, which is unfavorable to public health. According to environment behavior perspective, personal motivation of HWC may be motivated by active environment. Method: A school-based investigation and a 30-week environmental behavior experiment were conducted when students returned to school after the COVID-19 pandemic closure in 2020 in China to evaluate the effects of active environment interventions selected by previous survey on promoting adolescents' HW rate. Digital infrared counters were used to unobtrusively document their behavior. Results: Results in summer revealed a positive effect on all intervention groups. The effects of combined interventions were higher than the effect of any single intervention. However, HW rates of all groups declined sharply in the coldest month and the between-group differences decreased. Significant correlations were found between HW rates and satisfaction with the intervention schemes. Conclusions: Findings suggest that architectural environmental intervention may potentially be a positive, friendly, and one-time investment mean to expand the HWC intervention scope from passive policies to positive experience, and HW space design for adolescents should be treated as a public health strategy. [ABSTRACT FROM AUTHOR]

Background: Without consideration for the food system in which healthy food-store interventions (HFIs) are implemented, their effects are likely to be unsustainable. Co-creation of HFIs by interventionists and food-store actors may improve contextual fit and therefore the effectiveness and sustainability of interventions, but there are few case studies on the topic. This study aims to provide insights into the integration of knowledge from contextual actors into HFI designs, through a co-creative process, to illustrate potential challenges, advantages, and outcomes. Methods: We describe the co-creative design of an HFI in a Dutch supermarket chain, conducted through three increasingly in-depth design phases. Each phase consisted of a cycle of theorizing (gather insights from literature, feedback, and pilot studies), building (develop intervention designs), and evaluating (interviews or workshops with supermarket actors, to explore barriers and facilitators for sustainable implementation), feeding back into the next phase (drafting adapted intervention designs, based on feedback, and research input). Interview transcripts underwent a qualitative content analysis. Results: We co-creatively designed four types of interventions to promote healthier food choices in supermarkets: (1) price strategies, (2) product presentation and positioning, (3) signage, and (4) interactive messaging. Interventions were aligned with the culture, structures and practices of the supermarket chain, while simultaneously challenging these system characteristics. For example, the idea of price promotions on healthy foods was well-received and encountered only practical barriers, which were easily resolved. However, the specification of tax-like price increases on unhealthy foods led to substantial resistance on cultural and commercial grounds, which were resolved through support from a key supermarket actor. Conclusion: Our results illustrate the potential benefits of co-creation approaches in HFI design. We reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes. [ABSTRACT FROM AUTHOR]

Background: Actions focused on age-friendly environments contribute to promote and maintain older people’s functional ability and may enable them to contribute to their communities and enjoy life. As such, age-friendly practices require collaboration between diverse stakeholders across multiple sectors responsible for natural, built, and social environments, which can be particularly relevant during public health emergencies when socio-ecological vulnerabilities become more salient and may disproportionally affect older people. This paper presents a protocol for a scoping review aiming to investigate the breadth of evidence concerning the development, implementation, and evaluation of age-friendly practices during the COVID-19 pandemic. The protocol sets out the objectives, methods, and dissemination plans for the review. Methods: The scoping review will be conducted in line with the Joanna Briggs Institute (JBI) scoping review methodology. We will search databases (PubMed, Web of Science, Embase, CINAHL, Scopus, PsychNet) and grey literature sources. Publications relating to practices across the 8 domains of the World Health Organization’s age-friendly cities and communities’ framework will be included. A tabular data extraction tool will be used to facilitate a narrative synthesis of results. Ethics and dissemination: Ethical approval is not required as the methods proposed for this scoping review consist of collecting publicly available data. Findings will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and submitted to a journal for academic dissemination. Lay dissemination plans include an infographic and a blog-style article presenting our core results. Conclusion: The publication of this protocol allows for transparency in the systematic process of a scoping review focused on age-friendly practices during COVID-19. Findings emerging from the scoping review will provide insights into the evidence available regarding age-friendly activities during COVID-19 and may inform future age-friendly practices during public health emergencies and beyond.

This paper discusses the dynamics of environmental interventions supported by aid projects and community responses as the subject of intervention. Drawing on ethnographic fieldwork, I looked into how connections between local and global entities occurred, between the local villagers in Central Kalimantan and the climate mitigation project of REDD +. Both of these entities met when the global discourse on climate change started to gain ground. This paper discusses how environmental interventions lead to different expectations and unintended consequences. I see community responses as choices and decisions which were historically constructed. These choices, expectations, and decisions are related to people’s experience with previous intervention agents and local livelihood dynamics. This local-global interaction has yielded unintended outcomes and led to different expectations for a REDD+’s demonstration activities project. When these two entities - local people and KFCP (Kalimantan Forest Climate Partnership) - meet in the global agenda to mitigate climate change, friction emerges due to a variety of interests in the village. My findings demonstrate how a reforestation program could lead to a socio-economic inequality. Land conflicts are likely to occur because of alternative livelihood programs which introduced rubber seeds. [ABSTRACT FROM AUTHOR]

Abstract Background Choice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors – and on related intentions or health outcomes – in presence of the intervention and after removal of the intervention (i.e. post-intervention, regardless of the time elapsed). Methods We systematically searched PubMed, Embase, PsycINFO and the Cochrane Library for (quasi) experimental studies published up to December 2019 that evaluated the effect of choice architecture interventions on physical activity and sedentary behavior, as well as on intentions and health outcomes related to physical activity/sedentary behavior. Studies that combined choice architecture techniques with other behavior change techniques were excluded. All studies were screened for eligibility, relevant data was extracted and two independent reviewers assessed the methodological quality using the QualSyst tool. Results Of the 9609 records initially identified, 88 studies met our eligibility criteria. Most studies (n = 70) were of high methodologic quality. Eighty-six studies targeted physical activity, predominantly stair use, whereas two studies targeted sedentary behavior, and one targeted both behaviors. Intervention techniques identified were prompting (n = 53), message framing (n = 24), social comparison (n = 12), feedback (n = 8), default change (n = 1) and anchoring (n = 1). In presence of the intervention, 68% of the studies reported an effect of choice architecture on behavior, whereas after removal of the intervention only 47% of the studies reported a significant effect. For all choice architecture techniques identified, except for message framing, the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention. Conclusions The results suggest that prompting can effectively encourage stair use in adults, especially in presence of a prompt. The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review. More (controlled) studies are needed to assess the (sustained) effectiveness of choice architecture interventions on sedentary behavior and other types of physical activity than stair use.

Background: Sugar overconsumption is a major contributor to overweight and obesity, with daily consumption greatly exceeding the WHO's recommendations. The aim of the present study was to determine whether using a functionally modified sugar shaker as a food environment nudge could be an effective means to reduce the sugar used in hot beverages. Methods: Sugar shakers were functionally modified to reduce the amount of sugar in each pour by 47%. A real-world experiment was conducted to compare the amount of added sugar per hot beverage during default and nudge conditions over the course of four weeks (17,233 hot beverages sold) in a university take-away café. In addition, 59 customers were surveyed to evaluate the acceptance of the intervention. Results: Modifying the functional design of sugar shakers resulted in a reduction of added sugar by 20% (d = 1.35) compared to the default condition. In the survey, most participants evaluated the intervention strategy positively. Conclusion: The present real-world experiment demonstrates that a simple environmental intervention can significantly reduce sugar consumption in public places while meeting with consumer approval, making it a promising means of reducing sugar overconsumption. [ABSTRACT FROM AUTHOR]

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents' access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

Poor housing conditions have been associated with increased risks of respiratory infections. This review aims to determine whether modifying the physical environment of the home has benefits in reducing respiratory infections. We performed a systematic review and meta-analysis of the effectiveness of home environmental interventions for preventing respiratory tract infections. Ten electronic databases were searched to identify randomized controlled trials published from inception to July 31, 2020. Random-effects meta-analyses were used to assess the study outcomes. Our search identified 14 eligible studies across 12 countries, which comprised 87,428 households in total. The type of interventions on home environment included kitchen appliance and design, water supply and sanitation, house insulation, and home heating. Meta-analysis indicated a potential benefit of home environmental interventions in preventing overall respiratory tract infections (Absolute RR=0.89, 95% CI=0.78–1.01, p=0.07; Pooled adjusted RR=0.72, 95% CI=0.63–0.84, p<0.0001). Subgroup analyses depicted that home environmental interventions had no significant impact on lower respiratory tract infections, pneumonia, and severe pneumonia. A protective effect against respiratory infections was observed in high income country setting (RR=0.82, 95% CI=0.78–0.87, p<0.00001). Home environmental interventions have the potential to reduce morbidity of respiratory tract infections. The lack of significant impact from stand-alone housing interventions suggests that multicomponent interventions should be implemented in tandem with high-quality health systems. [ABSTRACT FROM AUTHOR]

The objective of this review is to evaluate evidence for the effectiveness of workplace cafeteria and other supporting multicomponent interventions to promote healthy eating and reductions in health risks among adults. We conducted an electronic search in EMBASE, CINAHL, EconLit, Ovid, Cochrane, Web of Science and PubMed for English-language articles published from 1985 to July 2019. Studies were original articles reporting the results of workplace cafeteria interventions to promote healthy eating and reduction in health risks. Outcomes were classified as changes in fruit and vegetable intake, health risk indicators, dietary intake, and food sales. Interventions were categorized as interventions targeting food quality or quantity, targeting price, targeting food choice at point of purchase, targeting improved supply, targeting client’s information, education or motivation and targeting organization policies. Behavioral change conditions used in interventions were identified using the COM-B system of behavioral change. Results were presented in a narrative summary. A total of 55 studies out of 6285 articles were identified for this review. Several studies used multicomponent interventions and the most featured interventions included interventions targeting food quality or quantity, targeting client’s information, education or motivation and targeting food choice at point of purchase. There is evidence that workplace cafeteria and other supporting multicomponent interventions resulted in higher intake of fruit and vegetables, improved dietary intake, improved health outcomes and healthy food sales. The findings of this review have the potential to inform future cafeteria-based and other supporting multicomponent workplace health interventions.The review protocol was not registered in a repository.

Background: To explore existing literature on the association between environmental risk factors and delirium, and to investigate the effectiveness of environmental modifications on prevention or management of delirium. Methods: This is a scoping review of peer-reviewed studies in PubMed and the reference lists of reviewed articles. Observational studies reporting the effect of noise, light, and circadian rhythm on delirium and interventional studies assessing delirium in modified environments were reviewed. Results: 37 studies were included, 21 of which evaluated the impact of environment on delirium and 16 studied possible solutions to mitigate those impacts. Mixed findings of the reviewed studies yielded inconclusive results; a clearly delineated association between high noise levels, abnormal amounts of light exposure, and sleep disruption with delirium could not be established. The environmental interventions targeted reducing noise exposure, improving daytime and mitigating night-time light exposure to follow circadian rhythm, and promoting sleep. The overall evidence supporting effectiveness of environmental interventions was also of a low confidence; however, quiet-time protocols, earplugs, and bright light therapy showed a benefit for prevention or management of delirium. Conclusions: Environmental modifications are non-invasive, risk-free, and low-cost strategies that may be beneficial in preventing and managing delirium, especially when used as part of a multi-component plan. However, given the limited evidence-based conclusions, further high-quality and larger studies focusing on environmental modifications and delirium outcomes are strongly recommended.

Background: Due to the importance of sleep in brain development of infants, this study was designed to compare the effects of environmental and behavioral Interventions on sleep cycle of preterm infants in NICU. Methods: In this prospective crossover clinical trial, 40 preterm infants with fetal age of 32 to 36 weeks hospitalized in NICU were selected. Infants were randomly divided into the two groups of environmental-behavioral intervention and behavioral -environmental intervention, based on the order of the performed interventions. The study included three courses of control, first intervention and second intervention each held for 2 hours. Sleep states were assessed by Prechtl sleeping and waking assessment tool. Results: Mean of quiet sleep time in three different courses showed significant differences and in behavioral intervention course was more in comparison to the two other courses (p

Abstract Background Consumption of foods and beverages rich in sugar remains high across all races and ages in the United States. Interventions to address childhood obesity and decrease sugar intake are needed, particularly in low-income settings. Methods B’more Healthy Communities for Kids (BHCK) was a group-randomized, controlled trial implemented among 9–15-year olds in 30 low-income areas of Baltimore. We increased access to low-sugar foods and beverages at wholesalers and small food stores. Concurrently, we encouraged their purchase and consumption by children through youth-led nutrition education in recreation centers, in-store promotions, text messaging and a social media program directed at caregivers. Sugar consumption (sugar sweetened beverage (SSB), sweets) in youth was assessed pre- (n = 534) and post-intervention (n = 401) using the Block Kids Food Frequency Questionnaire. Purchasing of 38 healthier and 28 less healthier food/beverage varieties in the previous 7 days was assessed via self-report. Multilevel models at the community and individual levels were used. Analyses were stratified by age (younger: 9–12-year olds (n = 339) vs older: 13–15 (n = 170)). Models were controlled for child’s sex, race, total daily caloric intake, and caregiver’s age and sex. Results Overall baseline mean healthier food purchasing was 2.5 (+ 3.6; min. 0, max. 34 items per week), and unhealthier food purchasing 4.6 (+ 3.7; 0–19 items per week). Mean intake at baseline for kcal from SSB was 176 (+ 189.1) and 153 (+ 142.5), and % of calories from sweets (i.e. cookies, cakes, pies, donuts, candy, ice cream, sweetened cereals, and chocolate beverages) was 15.9 (+ 9.7) and 15.9 (+ 7.7) in comparison and intervention youth, respectively. Intervention youth increased healthier foods and beverages purchases by 1.4 more items per week than comparison youth (β = 1.4; 95% CI: 0.1; 2.8). After the intervention, there was a 3.5% decrease in kcal from sweets for older intervention youth, compared to the control group (β = − 3.5; 95% CI: -7.76; − 0.05). No impact was seen on SSB consumption. Conclusion BHCK successfully increased healthier food purchasing variety in youth, and decreased % calories from sweet snacks in older youth. Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. Trial registration NCT02181010 (July 2, 2014, retrospectively registered).

Abstract Background Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial “Healthful & Tasty: Sure!” in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics. Methods Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees’ average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples. Discussion Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees. Trial registration German Clinical Trials Register, DRKS00006790. Registered 23 September 2014.

Many major cities that witnessed heavy air pollution by nitrogen dioxide (NO2) and particulate matter (PM) have experienced a high rate of infection and severity of the coronavirus disease pandemic (COVID-19). This phenomenon could be explained by the overexpression of the angiotensin converting enzyme 2 (ACE-2) on epithelial cell surfaces of the respiratory tract. Indeed, ACE-2 is a receptor for coronaviruses including the severe acute respiratory syndrome coronavirus 1 and 2 (SARS-CoV), and ACE-2 is overexpressed under chronic exposure to air pollution such as NO2 and PM2.5. In this review, we explain that ACE-2 acts as the sole receptor for the attachment of the SARS-CoV-2 via its spike protein. The fact that respiratory and vascular epithelial cells express ACE-2 has been previously observed during the 2003 epidemic of the SARS-CoV-1 in China, and during the 2012 Middle East respiratory syndrome in Saudi Arabia. High ACE-2 expression in respiratory epithelial cells under air pollution explains the positive correlation between the severity in COVID-19 patients and elevated air pollution, notably high NO2 and PM2.5 levels. Specific areas in India, China, Italy, Russia, Chile and Qatar that experience heavy air pollution also show high rates of COVID-19 infection and severity. Overall, we demonstrate a link between NO2 emissions, PM2.5 levels, ACE-2 expression and COVID-19 infection severity. Therefore, air pollution should be reduced in places where confirmed cases of COVID-19 are unexpectedly high. [ABSTRACT FROM AUTHOR]

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Using standing desks to reduce sedentary behavior has emerged in the literature of instruction and learning. However, the impact that these desks have on self-regulation of on-task behavior has yet to be determined. This study examined the impact that standing desks had on student behavior in a group (n = 40) of fourth grade students. Using the Behavioral Observations of Students in Schools (BOSS) instrument, on-task behavior was observed for a total of six weeks, including three-weeks while using traditional school desks (baseline) and three-weeks while using standing desks (intervention). Furthermore, students using traditional desks were also observed for the entire six-weeks to serve as a control group. The author found that students who used standing desks showed significant increases (t = 7.2, p = .000) in on-task behavior when compared to when they used traditional desks. Furthermore, students who used standing desks also had significantly higher on-task behavior (t = 2.16, p = .037) when compared to the control group of students who used traditional desks. These results demonstrate that replacing traditional desks with standing desks can have a positive impact on self-regulating student behavior during class instruction. [ABSTRACT FROM AUTHOR]

Background: Choice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors – and on related intentions or health outcomes – in presence of the intervention and after removal of the intervention (i.e. post-intervention, regardless of the time elapsed). Methods: We systematically searched PubMed, Embase, PsycINFO and the Cochrane Library for (quasi) experimental studies published up to December 2019 that evaluated the effect of choice architecture interventions on physical activity and sedentary behavior, as well as on intentions and health outcomes related to physical activity/sedentary behavior. Studies that combined choice architecture techniques with other behavior change techniques were excluded. All studies were screened for eligibility, relevant data was extracted and two independent reviewers assessed the methodological quality using the QualSyst tool. Results: Of the 9609 records initially identified, 88 studies met our eligibility criteria. Most studies (n = 70) were of high methodologic quality. Eighty-six studies targeted physical activity, predominantly stair use, whereas two studies targeted sedentary behavior, and one targeted both behaviors. Intervention techniques identified were prompting (n = 53), message framing (n = 24), social comparison (n = 12), feedback (n = 8), default change (n = 1) and anchoring (n = 1). In presence of the intervention, 68% of the studies reported an effect of choice architecture on behavior, whereas after removal of the intervention only 47% of the studies reported a significant effect. For all choice architecture techniques identified, except for message framing, the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention. Conclusions: The results suggest that prompting can effectively encourage stair use in adults, especially in presence of a prompt. The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review. More (controlled) studies are needed to assess the (sustained) effectiveness of choice architecture interventions on sedentary behavior and other types of physical activity than stair use. [ABSTRACT FROM AUTHOR]

There is growing evidence of an association between the built environment and walking activity, but knowledge of street microenvironmental factors and older adults’ walking is limited and inconsistent. We used a socio-ecological model as the theoretical framework for this study, aiming to investigate longitudinally the important influences of the street microenvironment on older people’s walking by manipulated street photographs and whether there are different groups of older people with different environmental preferences, and to determine the influence of environmental factors in the socio-ecological model. The clustering analysis method was used to divide the samples into four groups, and those four subgroups were put in a comparative analysis regarding their street environments by methods of semantic differential (SD). The preferences of various subgroups were checked by the variance analysis and post hoc tests, and the structural equation model (SEM) was applied to discuss the relations of correlation and influence among each factor. The results showed that “parking on the sidewalk” was rated the lowest in the pre-intervention photos, and “shaded” and “hedge” were rated the highest in the post-intervention photos, and the environmental requirements were different for the older, poorer and higher income and education subgroups. There was a significant positive relationship between residential status and architectural interventions as well as self-efficacy and physical condition. These findings suggest that when developing environmental interventions to promote walking among older adults, priority should be given to those factors that need to be improved most. In addition, attention should be paid to the differences in walking needs among different groups of older adults, with particular attention on the impact of self-selected living environments on street-level environmental interventions.

Background and aim: Continuation of healthy nutritional behaviors is one of the important factors in effectiveness of educational intervention programs. The aim of this research is to compare the Health Belief Model and the Ecological-social model in reducing consumption of rice contaminated with toxic metals after completion of environmental intervention and continuation of consumption of healthy rice. Methods: This research was the implementation of a six-month randomized controlled trial interventional program in two groups’ interventions along with a control group, with 80 people for each group totally, amounting to 240 women, between 18 and 50 years of age in Ilam, Iran in 2014. The questionnaires of the three groups consisted of demographic information, knowledge, the constructs of the models, performance of rice consumption. Friedman test and repeated measures used for data analysis with SPSS (version 20), and confidence interval of 95% were considered. Results: The results of the Friedman test indicated a significant increase in the number of women consuming healthy rice over six months after intervention in both intervention groups (p

Objective: To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviours (acquisition, preparation, fruit and vegetable (FV) consumption) on youths' primary caregivers.Design: B'More Healthy Communities for Kids (BHCK) group-randomized controlled trial promoted access to healthy foods and food-related behaviours through wholesaler and small store strategies, peer mentor-led nutrition education aimed at youths, and social media and text messaging targeting their adult caregivers. Measures included caregivers' (n 516) self-reported household food acquisition frequency for FV, snacks and grocery items over 30 d, and usual FV consumption in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical models assessed average treatment effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated correlation between behavioural change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities.Setting: Thirty Baltimore City low-income neighbourhoods, USA.ParticipantsAdult caregivers of youths aged 9-15 years.Results: Of caregivers, 90·89 % were female; mean age 39·31 (sd 9·31) years. Baseline mean (sd) intake (servings/d) was 1·30 (1·69) fruits and 1·35 (1·05) vegetables. In ATE, no significant intervention effect was found on caregivers' food-related behaviours. In TTE, each point increase in BHCK exposure score (range: 0-6·9) increased caregivers' daily fruit consumption by 0·2 servings (0·24 (se 0·11); 95 % CI 0·04, 0·47). Caregivers reporting greater social media exposure tripled their daily fruit intake (3·16 (se 0·92); 95 % CI 1·33, 4·99) and increased their frequency of unhealthy food purchasing v. baseline.Conclusions: Child-focused community-based nutrition interventions may also benefit family members' fruit intake. Child-focused interventions should involve adult caregivers and intervention effects on family members should be assessed. Future multilevel studies should consider using social media to improve reach and engage caregiver participants. [ABSTRACT FROM AUTHOR]

Abstract Background The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. Methods Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. Results The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P

Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children’s diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students’ food choice behaviors.

Background: Due to the importance of sleep in brain development of infants, this study was designed to compare the effects of environmental and behavioral Interventions on sleep cycle of preterm infants in NICU. Methods: In this prospective crossover clinical trial, 40 preterm infants with fetal age of 32 to 36 weeks hospitalized in NICU were selected. Infants were randomly divided into the two groups of environmental-behavioral intervention and behavioral -environmental intervention, based on the order of the performed interventions. The study included three courses of control, first intervention and second intervention each held for 2 hours. Sleep states were assessed by Prechtl sleeping and waking assessment tool. Results: Mean of quiet sleep time in three different courses showed significant differences and in behavioral intervention course was more in comparison to the two other courses (p<0.05). Mean of active sleep time in the behavioral course was significantly less than that in other courses. But, there was no significant difference between the control and environmental courses. Conclusions: Both behavioral and environmental interventions can increase total time of sleep and quiet sleep but behavioral intervention has more effect on quiet sleep. Therefore, infants sleep in NICU can be improved by behavioral interventions. [ABSTRACT FROM AUTHOR]

Extensive literature examines the relation between land use patterns and obesity, but less work explores whether local employment centers may reduce obesity. Local employment centers may affect obesity via providing agglomeration benefits such as increased job/transportation opportunities and closer proximity to local facilities/destinations. We utilized a large serial cross-sectional health survey from Los Angeles, California, conducted over three periods, to examine whether the presence of local employment centers modifies the association between land use patterns and individual body mass index. We retrieved individual health and sociodemographic data from the Los Angeles County Health Survey (2002, 2005, and 2007). To this Health Survey, we linked land use attributes at the census tract level collected from the Southern California Association of Governments. Our log-transformed regression models present interactions between local employment centers, neighborhood urban form features, and body mass index. Although most findings are consistent with previous studies, some of land use factors hypothesized to reduce the risk of obesity could have counterintuitive associations unless local employment centers were controlled. The unexpected results of our land use coefficients indicate that the tenet of New Urbanism may not necessarily promote health benefits. Our findings suggest that modifying the built environment may be effective in reducing obesity only in areas with high degree of local employment centers. Future studies would benefit from longitudinal and experimental, rather than cross-sectional, study designs that rigorously test the potential causal role of New Urbanism on obesity. [ABSTRACT FROM AUTHOR]

Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia. [ABSTRACT FROM AUTHOR]

Abstract: This paper introduces a systemic methodology for reviewing professional responses to abuse between young people. The approach, “contextual case reviewing,” draws upon constructivist structuralism to assess the extent to which safeguarding practices engage with the social and public contexts of abuse. The paper conceptually compares the methodologies of contextual case review and other serious case review methods before drawing upon findings from 2 studies, which used the contextual case review methodology to explore the extrafamilial nature of peer‐on‐peer abuse and the ability of child protection practices to engage with this dynamic. Thematic findings from these studies regarding the practical interpretation of “significant harm” and “capacity to safeguard,” as well as their use within child protection assessments, are used to challenge conclusions of other case reviews, which imply that child protection procedures are sufficient for safeguarding young people. Contextual case reviews suggest that safeguarding practices, and the legislation that underpins them, are culturally, procedurally, and organisationally wedded to the context of the home, whereas insufficiently engaged with extrafamilial contexts of significant harm. The application of these issues require interrogation if social work systems are to provide sufficient mechanisms for safeguarding young people and families at risk of significant harm. [ABSTRACT FROM AUTHOR]

Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies. [ABSTRACT FROM AUTHOR]

Urban alleys are perceived as unsafe, especially by women. We conducted a photograph-questionnaire survey to examine gender difference in perceived safety of alley scenes. Photograph simulation technology was used to create three categories of intervention scenes: Cleaning, Vegetation, and Urban Function & Vegetation. For the existing (Baseline) and Cleaning scenes, perceived safety remained low for both genders, though men's perceived safety was significantly higher than women's. Vegetation scenes were perceived as moderately safe for both genders, but men's ratings were still significantly higher. For Urban Function & Vegetation scenes, perceived safety was high for both genders, and the gender difference largely disappeared. Geometric vegetation yielded higher perceived safety than naturalistic vegetation for both genders. These findings provide clear evidence to support the efforts of policy makers, environmental designers, and community associations seeking to create safe and vital back alley environments for men and women in high-density cities across the world. [ABSTRACT FROM AUTHOR]