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The COVID-19 pandemic resulted in widespread school closures, reducing access to school meals for millions of students previously participating in the US Department of Agriculture (USDA) National School Lunch Program (NSLP). School-prepared meals are, on average, more nutritious than home-prepared meals. In the absence of recent data measuring changes in children's diets during the pandemic, this article aims to provide conservative, back-of-the-envelope estimates of the nutritional impacts of the pandemic for school-aged children in the United States. We used administrative data from the USDA on the number of NSLP lunches served in 2019 and 2020 and nationally representative data from the USDA School Nutrition and Meal Cost Study on the quality of school-prepared and home-prepared lunches. We estimate changes in lunchtime calories and nutrients consumed by NSLP participants from March to November 2020, compared to the same months in 2019. We estimate that an NSLP participant receiving no school meals would increase their caloric consumption by 640 calories per week and reduce their consumption of nutrients such as calcium and vitamin D. Because 27 to 78 million fewer lunches were served per week in March-November 2020 compared to the previous year, nationally, students may have consumed 3 to 10 billion additional calories per week. As students return to school, it is vital to increase school meal participation and update nutrition policies to address potentially widening nutrition disparities.

Objectives: Schools can provide an optimal environment for promoting children's health behaviours. The Whole School, Whole Community, Whole Child (WSCC) model addresses 10 aspects of the school environment that can be used to promote student health behaviours and academic outcomes: namely, Health Education; Nutrition Environment and Services; Employee Wellness; Social and Emotional School Climate; Physical Environment; Health Services; Counselling, Psychological and Social Services; Community Involvement; Family Engagement; and Physical Education and Physical Activity. Design: Guidelines for practical use of the WSCC model for school professionals are limited, impeding potential impact on school health promotion. Accordingly, in this article, we seek to demonstrate an application of the WSCC model to a specific school-based practice: recess. Setting: School recess. Results: An overview of literature and evidence-informed practices details how recess can facilitate WSCC adoption and initial implementation. Areas requiring further empirical research prior to making additional recommendations are also discussed. Conclusion: Strategies to enhance learning and health are described, attempting to bridge the gap between research and practice in school settings using the WSCC model.

BACKGROUND: At the onset of the COVID‐19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID‐19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school‐based COVID‐19 mitigation strategies. METHODS: Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K‐8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups—lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. RESULTS: The main themes were related to parents' general sentiments regarding COVID‐19, compliance, pandemic‐related changes over time, changes in personal opinions, and in‐person learning. Both groups described challenges related to inconsistent COVID‐19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in‐person learning. CONCLUSIONS: Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school‐based mitigation strategies. [ABSTRACT FROM AUTHOR]

Informed by the social ecological model, which asserts that health behaviors and beliefs are the result of multiple levels of influence, we examined factors related to parents' support for in-school COVID-19 mitigation strategies. Using data from a survey of 567 parents/caregivers of public elementary and middle school students in eight Maryland counties, we employed regression models to examine relationships between parent-, child-, family-, school-, and community-level factors and acceptability of mitigation strategies. Acceptance of COVID-19 mitigation strategies was positively correlated with child- and family-level factors, including child racial identity (parents of Black children were more accepting than those of White children, odds ratio [ OR ]: 2.5, 95% confidence interval [CI] = [1.5, 4.1]), parent receipt of the COVID-19 vaccine (OR : 2.4, 95% CI = [1.5, 3.7]), and parent Democrat or Independent political affiliation (compared with Republican affiliation, OR : 4.2, 95% CI = [2.6, 6.7]; OR : 2.2, 95%CI = [1.3, 3.8], respectively). Acceptance was also positively associated with parents' perceptions of their school's mitigation approach, including higher school mitigation score, indicating more intensive mitigation policies (OR : 1.1, 95% CI = [1.0, 1.1]), better school communication about COVID-19 (OR : 1.7, 95% CI = [1.4, 1.9]) and better school capacity to address COVID-19 (OR : 1.9, 95% CI = [1.5, 2.4]). Community-level factors were not associated with acceptance. Child- and parent-level factors identified suggest potential groups for messaging regarding mitigation strategies. School-level factors may play an important role in parents' acceptance of in-school mitigation strategies. Schools' capacity to address public health threats may offer an underappreciated and modifiable setting for disseminating and reinforcing public health guidance. [ABSTRACT FROM AUTHOR]

Objectives Toddlers are vulnerable to unintentional injuries. A safety intervention targeting low-income families of toddlers, was effective at improving home safety. The current study examined whether the effect varies by initial home safety problems. Methods 277 mother-toddler dyads recruited in the Mid-Atlantic region of the United States during 2007-2010 were randomized into safety promotion (n = 91) or attention-control groups (n = 186). Observers rated participants' homes with a 9-item safety problem checklist at baseline, and at 6- and 12-months follow-up. Initial home safety problems were categorized as multiple ([greater than or equal to] 4 problems) and none/few (< 4). Linear mixed models assessed the moderating effect with a three-way interaction (time, intervention, and initial safety problems). Results At 12 months, the intervention effect was stronger among families with multiple initial problems than no/few initial problems, with a reduction of 1.55 more problems among the families with multiple problems, compared to the families with no/few problems (b = - 1.55, SE = 0.62, p = 0.013). Conclusions Interventions targeting families with multiple safety problems may be more effective than universal programming., Author(s): Yan Wang [sup.1] [sup.2] , Andrea C. Gielen [sup.3] , Laurence S. Magder [sup.2] , Erin R. Hager [sup.1] [sup.2] , Maureen M. Black [sup.1] [sup.2] [sup.4] Author Affiliations: [...]

Despite the benefits of classroom physical activity breaks on student health and academic outcomes, more research is needed to understand what factors may be associated with classroom physical activity break implementation, to bolster buy-in from school stakeholders and increase implementation. This quantitative study examined frequency of classroom physical activity break implementation in relation to (1) objectively measured teachers' physical activity and sedentary behaviors, (2) confidence for leading classroom physical activity breaks, (3) social norms (perceptions of other teachers' classroom physical activity break implementation), and (4) teacher- and school-level demographics. In total, 153 classroom teachers in 20 elementary and middle schools completed a survey including classroom physical activity break frequency, confidence, and social norms, one item each, dichotomized (1 = "most/all the time" OR "agree/strongly agree"). Accelerometry assessed total activity and daytime sedentary behavior. Analyses included multilevel binary logistic regression. Teachers were 90% female, 68% White, and 55% in elementary schools. Odds of implementing classroom physical activity breaks were lower among middle school teachers, 14 times greater among those with greater confidence, and over 17 times greater when teachers perceived others frequently implementing classroom physical activity breaks. Teacher activity was not associated with classroom physical activity break implementation. Future interventions to increase classroom physical activity break implementation should focus on increasing teachers' confidence to lead classroom physical activity breaks and creating more buy-in from classroom teachers to enhance each school's culture of health. By enhancing teacher confidence and social norms for implementing classroom physical activity breaks, we may increase school-based physical activity opportunities. [ABSTRACT FROM AUTHOR]

Background: Recess provides an important opportunity for children to be physically active during weekdays. Updated, nationally representative, prevalence estimates of elementary school recess practices in the United States are needed. Methods: Surveys were sent to a nationally representative sample of 1010 public elementary schools in the 2019‐2020 school year. Results were compared by region (Northeast, Midwest, South, West), urbanicity, size, racial and ethnic composition, and socioeconomic status (percent eligible for free/reduced‐priced meals). Results: A total of 559 responses were obtained. About 87.9% of schools provided at least 20 minutes of daily recess and 26.6% had trained recess supervisors. Most schools did not allow students to voluntarily stay inside during recess (71.6%) and around half prohibited withholding recess for poor behavior (45.6%) or to complete schoolwork (49.5%). Several practices varied by region, and withholding recess was more prevalent among schools with lower student socioeconomic makeup. Implications for School Health Policy, Practice, and Equity: Regular national surveillance of recess practices can inform policy needs and efforts to advance equitable access to recess. Quality and access should be considered when developing recess policies. Conclusions: Most United States elementary schools provide recess. However, regional and economic disparities exist. Promoting supportive practices for recess, particularly for schools serving lower‐income communities, is necessary. [ABSTRACT FROM AUTHOR]

Background: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). Methods: Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. Results: Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (=75%) African-American/Hispanic students, and 25.5% majority (=75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > 0.05). Conclusions: Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.

Purpose: Ankle accelerometry allows for 24-hr data collection and improves data volume/integrity versus hip accelerometry. Using Actical ankle accelerometry, the purpose of this study was to (a) develop sensitive/specific thresholds, (b) examine validity/reliability, (c) compare new thresholds with those of the manufacturer, and (d) examine feasibility in a community sample (low-income, urban adolescent girls). Method: Two studies were conducted with 6th- through 7th-grade girls (aged 10-14 years old): First was a "laboratory study" (n = 24), in which 2 Actical accelerometers were placed on the ankle and worn while measuring energy expenditure (Cosmed K4b2, metabolic equivalents [METs]) during 10 prescribed activities. Analyses included device equivalence reliability (intraclass correlation coefficient [ICC], activity counts of 2 Acticals), criterion-related validity (correlation, activity counts and METs), and calculations of sensitivity, specificity, kappa, and receiver-operating characteristic curves for thresholds. The second was a "free-living study" (n = 459), in which an Actical was worn for more than 7 days on the ankle (full 24-hr days retained). Analyses included feasibility (frequencies, missing data) and paired t tests (new thresholds vs. those of the manufacturer). Results: In the "laboratory study," the Actical demonstrated reliability (ICC = 0.92) and validity (r = 0.81). Thresholds demonstrated sensitivity (91%), specificity (84%), kappa = 0.73 (p = 0.043), area under curve range = 0.81-0.97. In the "free-living study," 99.6% of participants wore the accelerometer; 84.1% had complete/valid data (mean = 5.7 days). Primary reasons for missing/invalid data included: improper programming/documentation (5.2%), failure to return device (5.0%), and wear-time = 2 days (2.8%). The moderate-to-vigorous physical activity threshold (> 3,200 counts/minute) yielded 37.2 min/day, 2 to 4.5 times lower than that of the manufacturer's software (effect size = 0.74-4.05). Conclusions: Validity, reliability, and feasibility evidences support Actical ankle accelerometry to assess physical activity in community studies of adolescent girls. When comparing manufacturers' software versus new thresholds, a major difference was observed.

Objective: The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). Design: We re-enrolled families from two statewide studies (2017–2020) in an observational cohort (May–August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programmes (e.g. Coronavirus Aid, Relief, and Economic Security (CARES) stimulus payment, school meals). Setting: Maryland, USA. Participants: Economically, geographically and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n 496). Results: Prevalence of risk of FI was unchanged (pre-pandemic: 22 %, early-pandemic: 25 %, p = 0·27). Risk of early-pandemic FI was elevated for non-Hispanic Black (adjusted relative risk (aRR) = 2·1 (95 % CI 1·1, 4·0)) and Other families (aRR = 2·6 (1·3, 5·4)) and families earning ≤ 300 % federal poverty level. Among pre-pandemic food secure families, decreased income, job loss and reduced hours were associated with increased early-pandemic FI risk (aRR = 2·1 (1·2, 3·6) to 2·5 (1·5, 4·1)); CARES stimulus payment (aRR = 0·5 (0·3, 0·9)) and continued school meal participation (aRR = 0·2 (0·1, 0·9)) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net programme participation was not associated with early-pandemic FI risk. Conclusions: The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics. [ABSTRACT FROM AUTHOR]