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Objectives. To detail baseline drinking water sample lead concentrations and features of US state-level programs and policies to test school drinking water for lead in 7 states’ operating programs between 2016 and 2018. Methods. We coded program and policy documents using structured content analysis protocols and analyzed state-provided data on lead concentration in drinking water samples collected in public schools during initial testing phases. Results. We analyzed data from 5688 public schools, representing 35% of eligible schools in 7 states. The number of samples per school varied. The proportion of schools identifying any sample lead concentration exceeding 5 parts per billion varied (13%–81%). Four states exceeded 20%. Other program features varied among states. Instances of lead above the state action level were identified in all states. Conclusions. In 2018, many US public school students attended schools in states without drinking water lead-testing programs. Testing all drinking water sources may be recommended. Public Health Implications. Initiating uniform school drinking water lead testing programs and surveillance over time could be used to reduce risk of lead exposure in drinking water. (Am J Public Health. 2022;112(S7):S679–S689. https://doi.org/10.2105/AJPH.2022.306961 )

Context New approaches to education and pedagogy are needed in athletic training education to better support developmental benchmarks that cultivate skills for lifelong learning. Objective Explore and understand students' perceptions of their education and how those perceptions support their development toward self-authorship through the complexity of their meaning making. Design Qualitative, grounded theory. Setting Division I Commission on Accreditation of Athletic Training Education athletic training programs. Patients or Other Participants Twelve participants (9 female, 3 male; age = 24 ± 2 years) in their second year of athletic training education were recruited for the study. Of the 12 participants, 11 were engaged in an immersive clinical experience. Data Collection and Analysis Participants engaged in a semistructured video conference interview. Data were analyzed using grounded theory approach to understand the complexity of students' ways of making meaning cognitively, intrapersonally, and interpersonally. Data saturation, peer review, member checks, and theoretical triangulation were used to establish credibility. Results Participants exhibited meaning making in 2 distinct ways: (1) external guidance and (2) movement toward internal guidance. The categories were further broken down by theme. Placing responsibility for knowledge on authorities, need for step-by-step guidance, and seeking approval marked the themes of external guidance. Building confidence and role identity development marked themes of movement toward internal guidance. Conclusions Participants who were reliant on external guidance required external authorities for knowledge acquisition and learning. Some participants demonstrated deeper meaning making when discussing their experiences with clinical education.

Context Transition to clinical practice is a topic receiving substantial attention. Many reports have focused on the educational program's role and have stopped short of identifying the impact of the initial year of employment on desire to persist and future career goals. Objective To examine the career aspirations of athletic trainers in their first year of employment who graduated from professional master's programs. Design Qualitative. Setting Nine professional master's athletic training programs, variety of employment settings. Patients or Other Participants Seven men and 7 women (age = 25.6 ± 3.7 years). Data Collection and Analysis A general inductive approach was used to analyze data from individual interviews conducted 6 and 12 months into the first year of clinical practice. Multiple-analyst triangulation and peer review ensured credibility. Results Graduates of professional master's programs in athletic training plan to stay in the profession. However, newly credentialed athletic trainers do not plan to remain with their initial employer beyond 2 years; 11 of 14 participants (79%) stated their first job was transitional. The first year of employment did not change participants' perceptions, as the graduates knew upon taking their first job that it would be temporary. Though participants planned to change jobs, most (79%) planned to continue to engage in clinical practice as athletic trainers. Conclusions Understanding newly credentialed athletic trainers' perceptions of the impact of the first year of employment can provide educators and employers important insight to assist in retention and persistence of young professionals. Graduates regard their first years of employment as impermanent. However, the majority do not wish to leave clinical practice. Participants viewed their first job as a way to gain valuable experience that did not dissuade them from continuing in the field. Recent graduates demonstrated ambitions to experience different work settings and higher-level positions with greater responsibilities.

Objective: To quantify the potential population-wide costs, number of individuals reached, and impact on obesity of five effective interventions to reduce children's television viewing if implemented nationally. Study Design: Utilizing evidence from systematic reviews, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost, population reach, and impact on childhood obesity from 2020 to 2030 of five hypothetical policy strategies to reduce the negative impact of children's TV exposure: (1) eliminating the tax deductibility of food and beverage advertising; (2) targeting TV reduction during home visiting programs; (3) motivational interviewing to reduce home television time at Women, Infants, and Children (WIC) clinic visits; (4) adoption of a television-reduction curriculum in child care; and (5) limiting noneducational television in licensed child care settings. Results: Eliminating the tax deductibility of food advertising could reach the most children [106 million, 95% uncertainty interval (UI): 105–107 million], prevent the most cases of obesity (78,700, 95% UI: 30,200–130,000), and save more in health care costs than it costs to implement. Strategies targeting young children in child care and WIC also cost little to implement (between $0.19 and $32.73 per child reached), and, although reaching fewer children because of the restricted age range, were estimated to prevent between 25,500 (95% UI: 4600–59,300) and 35,400 (95% UI: 13,200–62,100) cases of obesity. Home visiting to reduce television viewing had high costs and a low reach. Conclusions: Interventions to reduce television exposure across a range of settings, if implemented widely, could help prevent childhood obesity in the population at relatively low cost.

Context The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation. Objective To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs. Design Qualitative study. Setting Telephone interviews. Patients or Other Participants Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs. Data Collection and Analysis Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach. Results We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies. Conclusions The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

Context Professional identity is a process in which individuals forms a self-concept in the context of their profession, and includes an ability to articulate a professional philosophy. Professional identity relates to many aspects of a profession, including practices, ethics, and the requirements for success. Professional development is a component of professional identity and represents the growth of professionals as they acquire skills and confidence in autonomous practice. Currently, little is known in regard to the role age and years of experience play in the professional development of athletic trainers (ATs). Objective To determine the relationships of age and years of experience to professional development. Design Cross-sectional online survey. Setting Collegiate athletic training clinical setting. Patients or Other Participants Four hundred twenty-three (193 men, 230 women) ATs. Intervention(s) Data were collected via a Web-based survey instrument consisting of demographic and Likert-scale questions relating to professional development. Main Outcome Measure(s) Likert responses were summed, and demographic information was analyzed for frequency and distribution. Pearson correlations were run to evaluate the relationships between variables and linear regression was used to determine if age or years of experience could predict professional development scores. Results A positive relationship exists between professional development scores and both age and years of experience. Both age (R2 = 0.066) and years of experience (R2 = 0.075) were statistically significant predictors of variance in overall professional development scores. Conclusions Although age and years of experiences were both positively correlated with, and predicted variance in, overall professional development scores, the predicted variance of both variables was relatively small. Although we can say that both age and years of experience are prognostic in the professional development of collegiate ATs, their impact is statistically minimal.

The Healthy, Hunger-Free Kids Act of 2010 strengthened nutrition standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks Programs, affecting fifty ...

ContextTransition to practice is a current topic in athletic training and needs to be explored from a longitudinal perspective. Many athletic training programs and employing organizations are supporting transition to practice, yet little is known about the most common methods. Moreover, transition to practice is an ongoing process that can persist up to a year while current literature draws from snapshots.ObjectiveLongitudinally explore the educational and organizational socialization practices used to support transition to practice.DesignQualitative study.SettingNine higher education institutions.Patients or Other ParticipantsFourteen athletic training students (7 male, 7 female, age = 26 ± 4 years) participated.Data Collection and AnalysisParticipants completed semistructured interviews over the phone 3 times over the course of a 15-month period (before graduation, 4–6 months, and 10–12 months during their first job). All transcribed interviews were analyzed using a general inductive approach. Member checks, multiple analyst triangulation, and peer review were used to ensure trustworthiness.ResultsTwo main educational mechanisms were found to support transition to practice; they included (1) mentorship and (2) past experience. Three main organizational mechanisms were identified to support transition to practice: (1) mentorship, (2) orientation to the job, and (3) living the job.ConclusionsA blend of educational and organizational mechanisms is necessary to help support newly credentialed athletic trainers as they transition into clinical practice. Mentorship is important throughout the process, before and after newly credentialed athletic trainers enter their professional role.

The Healthy, Hunger-Free Kids Act of 2010 strengthened nutrition standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks Programs, affecting fifty million children daily at 99,000 schools. The legislation's impact on childhood obesity is unknown. We tested whether the legislation was associated with reductions in child obesity risk over time using an interrupted time series design for 2003-18 among 173,013 youth in the National Survey of Children's Health. We found no significant association between the legislation and childhood obesity trends overall. For children in poverty, however, the risk of obesity declined substantially each year after the act's implementation, translating to a 47 percent reduction in obesity prevalence in 2018 from what would have been expected without the legislation. These results suggest that the Healthy, Hunger-Free Kids Act's science-based nutritional standards should be maintained to support healthy growth, especially among children living in poverty.

Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity.We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters],25), overweight (25 to30), moderate obesity (30 to35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes.The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).

Context Newly credentialed athletic trainers are expected to be independent practitioners capable of making their own clinical decisions. Transition to practice can be stressful and present challenges for graduates who are not accustomed to practicing independently. Objective Explore the perceptions of professional master's students as they prepare to experience role transition from students to autonomous clinical practitioners. Design Qualitative study. Setting Nine higher education institutions. Patients or Other Participants Fourteen athletic training students (7 male, 7 female, age = 25.6 ± 3.7 years) participated. Main Outcome Measure(s) Participants completed a semistructured interview over the phone which focused on the perception of preparedness to enter clinical practice. All transcribed interviews were analyzed using a general inductive approach. Multiple-analyst triangulation and peer review were used to ensure trustworthiness. Results We found themes for facilitators and challenges to transition to autonomous clinical practice. Students felt prepared for independent practice due to (1) mentoring networks they had developed, (2) exposure to the breadth of clinical practice, and (3) autonomy allotted during clinical education. Potential challenges included (1) apprehension with decision making and (2) a lack of confidence. Conclusions Our findings suggest graduates from professional master's programs, although ready for clinical practice, may require more time and exposure to autonomous practice to build confidence. Professional master's program administrators should work to provide clinical education experiences that expose students to a wide variety of clinical situations (patients, settings, preceptors) with appropriate professional role models while providing decision making autonomy within accreditation standards.

Context Athletic trainers pursue higher education to obtain positions in academia, which often include scholarship and/or teaching responsibilities. Previous research has investigated the preparation and transition phases for doctoral students moving from student to junior faculty member as well as their professional socialization. However, the reasons for the pursuit of a doctoral degree and doctoral students' career goals postgraduation are not yet understood. Objective To explore the motivational factors and attractors for the pursuit of a doctoral degree among athletic trainers in doctoral programs. Secondarily, to examine how doctoral experiences shape career goals and aspirations. Design Qualitative phenomenology. Setting Higher education institutions. Patients or Other Participants Twelve academic doctoral students (8 female, 4 male; 6.0 ± 4 years Board of Certification–certified; 5.0 ± 3.0 years clinical athletic training practice) completed the study. Main Outcome Measure(s) Participants completed a single one-on-one telephone interview, which was recorded and transcribed. Analysis followed the phenomenological paradigm. Credibility was established through peer review and multi-analyst triangulation. Results Past experiences, mentorship, and professional development served as motivators for pursuit of an academic doctoral degree. Past experiences were supported by (1) previous educational experiences and (2) time in a nonacademic role. Additionally, our participants' career aspirations were shaped through mentorship and legitimization during their doctoral programs. Conclusions Pursuit of a doctoral degree was primarily influenced by the previous educational experiences that provided students with exposure to responsibilities that accompany a faculty role. Strong mentorship helped support the decision to pursue a doctoral degree, as well as to develop a career plan. Engaging in the role of faculty member via an assistantship also supported the development of career plans.

ContextThe role of a faculty member in higher education includes engaging in the 3 facets of research, service, and teaching. Allied health faculty members face additional responsibilities such as administration, patient care, and addressing external accreditation. It is not understood how junior faculty members balance these multiple roles.ObjectiveGain an understanding of athletic training and physical therapy junior faculty members' ability to find and maintain role balance.DesignQualitative phenomenology.SettingAccredited athletic training and physical therapy programs.Patients or Other ParticipantsTwenty-six participants—13 physical therapists (7 male, 6 female) and 13 athletic trainers (4 male, 9 female)—completed interviews. All participants held academic terminal degrees (21 doctor of philosophy, 5 doctor of education).Main Outcome Measure(s)Data were collected using a one-on-one semistructured phone interview, which was digitally recorded and professionally transcribed. Following saturation, data were analyzed using the interpretive phenomenological analysis method. Trustworthiness was ensured through peer review, multiple analyst triangulation, and member checking.ResultsTwo primary themes were identified: role overload and strategies. Role overload describes overwhelming responsibilities placed on junior faculty and the conflict they face when attempting to balance each of these responsibilities. Strategies articulate the participants' reliance on time management, scheduling and planning, and keeping work and home lives separate.ConclusionsJunior faculty members are overloaded by the plethora of responsibilities they must assume, causing role strain. The time-management techniques of scheduling and planning allow junior faculty members to attempt to balance their roles by designating chunks of time for each responsibility. They also keep their work and home lives separate to buffer the strain. Though faculty members have developed adaptations, the primary way to reduce role overload is to decrease the number of duties for which they are responsible.

Context:It is the educator's responsibility to prepare the students to be clinicians who think and reason critically while integrating research evidence into practice. Those new to the role of faculty member, who lack clinical and teaching experience, face challenges in the classroom application of those concepts.Objective:To discuss the challenges facing new faculty members and present strategies for addressing them. Specific faculty challenges addressed include learning their roles as educators and teaching multifaceted concepts, such as clinical reasoning and evidence-based medicine.Background:Experience provides a framework for a professional to balance multiple demands, whether as a new instructor teaching or a clinician synthesizing information to determine a course of action. Many new educators do not have extensive experience either clinically or in the classroom. This can cause anxiety as educators are confounded by their roles and responsibilities. Students likewise lack experience and may not possess the ability to systematically analyze patient encounters or research evidence. Constructivist learning theory paired with adult learning principles can address the learning needs of faculty members and students alike.Recommendation(s):Programs must provide assistance for new faculty and implement strategies for students to learn reasoning skills. Use of constructivist learning theory and application of the adult learning model are ways to address these deficiencies. Integrating concepts of active learning and self-direction while aligning expectations and creating overlap between classroom and clinical domains can assist in addressing the challenges faced by new faculty and students.Conclusion(s):The systematic process of evidence-based decision making is grounded in utilizing evidence. Strategies must be identified and implemented throughout curricula to target and enhance students' abilities to organize and synthesize information. Educators must use new methods in their own learning and teaching to enhance their students' abilities. New faculty members in particular require assistance in negotiating their roles.

Background: Institutions of higher education suffer from a shortage of appropriately prepared faculty members in athletic training and physical therapy programs. Both professional programs have recently undergone curricular reform and degree change. We sought gain an understanding of the preparation mechanisms experienced by athletic training and physical therapy practitioners for their junior faculty positions. Method: Twenty-six athletic trainers and physical therapists participated in this phenomenological study. Data from one-on-one phone interviews were analyzed following the inductive process of interpretive phenomenological analysis. Content experts, pilot interviews, multiple analysts and member checking ensured trustworthiness. Results: Findings indicate two primary mechanisms prepared the practitioners to become junior faculty members: doctoral degree programs and clinical practice. Doctoral degree programs did not provide experiences for all future faculty roles. Hands-on patient care practice provided participants the context for their teaching and confidence in knowledge aptitude. Conclusion: Doctoral institutions should provide a variety of hands on active learning experiences to doctoral students. Future faculty members can maximize the amount of time they provide clinical care to patients, following the attainment of their professional credential. Clinical competence and proficiency will serve as the foundational basis for their future teaching endeavors and may increase credibility and respect.

Context: Women are largely underrepresented in science fields in academe, and most often issues with motherhood and career-life balancing are identified as reasons. In athletic training, career-life balancing has become the dominant factor in women leaving the field, as they feel they cannot fulfill the roles of mother, spouse, and athletic trainer adequately. Objective: To better understand the perceptions of women athletic training faculty members regarding balancing their roles in higher education and those outside of the workplace. Design: Interpretative phenomenological analysis study, with semistructured interviews. Setting: Higher education institutions sponsoring Commission on Accreditation of Athletic Training Education–accredited athletic training programs. Patients or Other Participants: Sixteen (8 with children, 8 without children) women athletic training faculty participated. Ten were married at the time of the interview, 3 were single, 2 were engaged, and 1 was in the process of getting a divorce. Main Outcome Measure(s): Each participant completed a one-on-one interview with a researcher and all data were coded following interpretative phenomenological analysis. Data saturation was attained. We completed member checks, peer review, and researcher triangulation for credibility. Results: We found that motherhood was perceived to be a challenge and balancing the role of motherhood created conflict. Despite concerns for motherhood and balancing faculty roles, higher education was perceived to provide flexibility. Support networks and individual strategies were common to manage the responsibilities of faculty as well as nonfaculty roles. Conclusions: Our results demonstrated that higher education cultivates a climate of balance through flexible workplace arrangements and that support networks are necessary to create role balancing in and out of the workplace. Finally, time management and organization are necessary for women to establish balance, regardless of roles outside of the workplace (eg, spouse, mother, friend).

Women in athletic training face barriers when working with male sports teams; the reasons are multifactorial, including traditional sex stereotyping and the social networking of male leaders (i.e.,...

Context:Formal mentoring programs can help to socialize new faculty members in higher education and orient them to faculty life. Organizations may implement formal mentoring programs to create connections between professionals, and formal mentoring is occurring in athletic training.Objective:To explore the experiences of athletic training faculty as they participate in a formal mentoring program.Design:Qualitative phenomenology.Setting:Higher education institutions.Patients or Other Participants:Ten members of the 2015 National Athletic Trainers' Association (NATA) Foundation Mentor Program, 6 mentees and 4 mentors. Mentees: 2 male and 4 female with an average of 3 years (±4; range, 1–12) in their current position. Mentors: 2 male and 2 female with an average of 10 years (±3; range, 6–12) of experience in their current positions.Main Outcome Measure(s):Participants completed 1 telephone interview prior to starting the NATA Mentor Program and completed 1 telephone interview upon completion of the mentor program. Participants also completed 3 online structured journals at 3-month increments while participating in the program. Two investigators independently analyzed data with a phenomenological approach, and a third investigator reviewed findings as a peer reviewer. Trustworthiness was addressed with member checking, piloting, and peer review of the interview guides, and multiple analyst triangulation.Results:Mentors completed the program as a way to stimulate collaboration and give back to the athletic training profession. Mentees sought out the program as a means to gain support in their research endeavors and to stimulate networking opportunities.Conclusions:The NATA Foundation Mentor Program offers a mutually beneficial experience for mentors and mentees, and participants were satisfied with their experiences. Mentee participants recognized the program gave them a chance to gain an external perspective and advance their research agendas, while mentors learned from their mentees and were able to use the program as a means to gain professional service.

Context: Selection of one's occupation can be influenced and determined by several variables and is often studied through the lens of the socialization framework. Career choice has been examined in athletic training, with scholars focusing on identifying initial attractors to the education programs as well as the traditional employment settings. However, little is understood about why an athletic trainer (AT) pursues a role in higher education, specifically women ATs. Objective: Gain an understanding of the factors that influence and motivate women ATs to pursue a career as a faculty member. Design: Qualitative study. Setting: Commission on Accreditation of Athletic Training Education professional programs. Patients or Other Participants: Sixteen women faculty members, average age 35 (±6.2, range 28–49; 2 did not report ages) with 11 average years of experience teaching in athletic training programs (1 did not report) and an average of 14 years of experience as certified ATs (±5.9, range 7–25). Main Outcome Measure(s): Participants completed one-on-one phone interviews, which were digitally recorded and transcribed. Analysis of the data followed the interpretative phenomenological approach. Credibility was established through pilot testing, peer review, and researcher triangulation. Results: Women ATs who have selected a role in higher education were attracted to their positions for three main reasons: (1) connection to the role of being a faculty member, employment goals aligned with the tenets of higher education, teaching, and research; (2) flexibility of schedule the women were able to maintain, accommodating schedule shaped to fit their needs; (3) selecting current jobs due primarily to logistics and location, allowing them to live in a desired location also acceptable to their spouse. Conclusions: Pursuing a faculty role in higher education for women ATs appears to be stimulated by personal and organizational factors, including an attraction to the roles of the faculty member and job responsibilities that can afford flexibility.

Purpose: To assess predictors of stated support for policies promoting physically active transportation. Design: Cross-sectional. Setting: US counties selected on county-level physical activity and obesity health status. Participants: Participants completing random-digit dialed telephone survey (n = 906). Measures: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle–pedestrian projects. Analysis: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. Results: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs $1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (Conclusion: Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.

Context: Mentoring is a beneficial mechanism to support junior faculty members as they navigate job expectations, institutional nuances, and the professional landscape during the first few years as a faculty member. Whereas effective characteristics of informal mentoring relationships are generally understood, less is known about factors that contribute to formal mentoring relationships. Objective: Gain mentor and mentee perceptions of effective mentoring in a formal setting. Design: Qualitative phenomenology. Setting: Higher education institutions. Patients or Other Participants: Six mentees (4 women and 2 men with 3 ± 4 years in their current faculty position) and 4 mentors (2 women and 2 men with an average of 10 ± 3 years in their current faculty position) participating in the 2015 National Athletic Trainers' Association Foundation mentor-program cohort. Main Outcome Measure(s): Participants completed one telephone interview before starting the mentor program and one interview upon program completion 11 months later. Participants also completed 3 structured online journals at 3-month increments throughout their participation in the program. Two researchers independently analyzed the interview and journal data using a phenomenological approach. To improve trustworthiness, we used peer review and pilot testing of the interview guides, member-checks, and multiple-analyst triangulation. Results: Participants described effective mentoring relationships as those that facilitated collaboration and demonstrated humanistic qualities. Participants who collaborated on scholarly activities during their mentoring experience perceived this to be a highly valuable aspect of the experience that increased the potential for a long-lasting relationship. Whereas the mentoring focused on professional development, humanistic attributes such as approachability and personal connections further enriched participants' mentoring experiences. Conclusions: Participants in formal mentoring experiences describe effective mentoring characteristics similarly to those who have participated in informal mentoring and should be encouraged to exhibit them. Additionally, coordinators of formal mentoring programs should provide participants with resources and guidance to facilitate their experiences.

Context: Female athletic trainers (ATs) can face barriers to employment within the profession. Although there is evidence for an increasing percentage of women in athletic training, the portion providing medical care to male sport teams within the professional sport and collegiate settings continues to be small. Objective: To investigate the experiences of female ATs when seeking employment with male sport teams within the Division I setting. Design: Qualitative study. Setting: National Collegiate Athletic Association (NCAA) Division I. Patients or Other Participants: A total of 15 NCAA Division I female ATs providing medical care to a male sport team participated in our study. Their mean age was 33 ± 9 years, and they had a mean of 11 ± 9 years of overall clinical experience. Data Collection and Analysis: All participants completed one-on-one phone interviews, which were recorded and transcribed. Analysis of the data followed thematic analysis using a phenomenologic approach. Credibility was established through credibility checks, peer review, and researcher triangulation. Results: Factors that played a role in women gaining employment with male sport teams were (1) preexisting professional relationships, (2) prior experience with a male sport, and (3) perseverance. Participants in our study were most attracted to their current positions because of (1) the environment of the collegiate setting and (2) the location of the university. Conclusions: Job access for female ATs in this study was not viewed as a challenge. Familiarity through previous connections with the university and staff and commitment to career goals helped these women obtain the positions they held. The desire to work in male sports was not a primary contributing factor to the decision-making process. Progress continues for women in athletic training, as evidenced by the reported ease of job access with male sport teams.

Context: Mentorship is a valuable resource for athletic trainers who are transitioning to new roles such as a student, preceptor, or autonomous clinician. While mentorship has been identified as an important component of education, little is known about the role of mentorship during the transition from doctoral student to faculty member during the first several years in academia. Objective: Obtain faculty members' perspectives on the role of mentorship as it relates to their experiences as a tenure-track faculty member. Design: Qualitative, phenomenological research. Setting: Higher education institutions with Commission on Accreditation of Athletic Training Education-accredited programs. Patients or Other Participants: Twelve novice faculty members (9 female, 3 male) and 12 experienced faculty members (3 female, 9 male) participated in this study. Main Outcome Measure(s): We developed and piloted an interview guide designed to gain participants' perspectives on their experiences with and perceptions of mentorship in relation to their faculty roles and responsibilities. Semistructured telephone interviews were completed with each individual and transcribed verbatim. Data were analyzed using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple-analysts triangulation, and data source triangulation. Results: Two themes emerged regarding roles of mentorship: (1) support and guidance and (2) navigating institutional politics and expectations. Mentors supported novice faculty members in their responsibilities of teaching, research, and service, particularly when mentees perceived a weakness in 1 area. Mentors also helped novice faculty members navigate the tenure and promotion process and politics of their institution. Conclusions: Mentorship appears to be an important mechanism of support for novice faculty members as they transition to their tenure-track faculty roles. Mentorship appears to be particularly valuable when there is a perceived lack of preparation for 1 aspect of a faculty position. Novice faculty members should seek out mentors within and beyond their institution for support.

Objective To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. Methods MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students’ self-reported health behaviors were measured in intervention communities at baseline and post intervention. Results Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (−2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (−2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P

Objective To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]). Methods The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site. Results Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (−0.16 units/y; 95% confidence interval: −0.21 to −0.12). No evidence of an effect was found in Intervention Site #1 (n = 111). Conclusions The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.

Context: Although doctoral education provides ample opportunities for skill development, the new faculty member may still require further support and guidance. Mentorship is often the mechanism whereby continued encouragement is provided. Limited understanding exists of the mentoring relationships developed between a new faculty member and a seasoned one. Objective: To understand the mentoring relationship from the perspectives of new and seasoned faculty members who have engaged in mentoring relationships. Design: Qualitative study, phenomenology. Setting: Selected higher education institutions with Commission on Accreditation of Athletic Training Education–accredited programs. Patients or Other Participants: From the National Athletic Trainers' Association (NATA) Foundation Research Mentor program we successfully recruited 7 mentors (5 male, 2 female) and 7 mentees (2 male, 5 female). We additionally recruited 7 mentors (5 male, 2 female) and 7 mentees (2 male, 5 female) who had not completed the NATA Foundation Research Mentor program. Main Outcomes Measure(s): We completed semistructured phone interviews following an interview script. Interviews were transcribed and saturation was obtained. Analysis was grounded by the general inductive approach. Peer review and researcher triangulation were completed for trustworthiness. Results: Two major themes materialized: (1) positive mentoring relationships and (2) challenges. Three primary attributes emerged as necessary for positive mentoring relationships between new and experienced faculty members: (1) active engagement from both mentor and mentee (this theme was furthered divided by the subthemes of reciprocity, motivation, and availability), (2) communication, and (3) similar interests. Mentees' resistance to mentoring and mentors' time constraints emerged as challenges. Conclusions: Mentoring relationships develop when there is shared interest, ongoing communication, and an investment made by both parties. New faculty members may be resistant to mentoring because of struggles receiving feedback, while experienced faculty may have competing time constraints that limit availability.

Context:Athletic training students' ability to transition into professional practice is a critical component for the future of the profession. However, research on professional master's students' transition to practice and readiness to provide autonomous care is lacking.Objective:To determine professional master's athletic training students' perceptions regarding how they were prepared to transition to practice as clinicians.Design:Qualitative study.Setting:Professional master's athletic training programs.Patients or Other Participants:Sixteen students, 8 program directors, and 5 faculty members from professional master's athletic training programs.Main Outcome Measure(s):An online questionnaire was distributed via Qualtrics and analyzed using an inductive technique. Participants responded to a series of open-ended questions related to the structure and curricular offerings of their respective programs. We secured trustworthiness through multiple analyst triangulation and peer review.Results:We found that both students and faculty identified clinical education as the major facilitator in the socialization process used to prepare students for the transition into clinical practice. Three further subthemes emerged: (1) Both stakeholder groups felt that students gained experience through diverse and immersive clinical education experiences; (2) Preceptors provided mentorship; and (3) Students developed confidence to enter clinical practice as a result of these supported experiences.Conclusions:Professional master's programs provide clinical education experiences designed to help athletic training students gain the skills and confidence necessary to become autonomous practitioners. The diversity and mentorship contained within these experiences facilitates confidence and preparedness.

The commissioners of the Commission on Accreditation of Athletic Training Education (CAATE) and the Board of Directors of the National Athletic Trainers’ Association (NATA) have acted to move the professional degree in athletic training from a bachelor’s degree to a graduate degree. The decision was largely based upon growth of the profession and aligning with the face of healthcare education. Therefore, we wanted to understand the perceived benefits of the graduate model. Using a qualitative paradigm, we electronically interviewed 29 students and faculty members (13 athletic training faculty and program directors, 16 students) currently in Professional Masters Athletic Training Programs (PM ATP). These represented 13 of the 29 (45%) CAATE-accredited PM ATPs. Five themes emerged from the data: (1) engagement and time spent in clinical education allows students to prepare for their roles as athletic trainers, (2) faculty stress the importance of interprofessional education, (3) expecting prior foundational knowledge allows focused education training at the graduate level, (4) increased professional commitment to stay in athletic training rather than use the training/education as a stepping-stone to other career paths, and (5) higher student maturity facilitates deeper learning. Based on these results, the perceived benefits of the PM ATP model are multifactorial.

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.

Clinical education provides the backbone for the socialization process for athletic trainers. It is the chance for students to engage in the role, within a real-time learning environment that allows for not only the adoption of knowledge, skills, and critical decision making, but also the profession’s foundational behaviors of professional practice. Recent criticisms of the current education model, in which the degree is conferred, center on the lack of critical thinking and confidence in clinical practice for newly-credentialed athletic trainers, as many suggest there is concern for the abilities of students to transition to practice smoothly. We offer three areas of focus for clinical education experiences for students (autonomy, mentorship, and feedback), believing this could support the development of independent thinking and confidence in skills. Our discussions are focused on the evidence available, as well as personal experiences as educators and program administrators.

Objective This study aimed to estimate the cost-effectiveness and impact on childhood obesity of installation of chilled water dispensers ("water jets") on school lunch lines and to compare water jets' cost, reach, and impact on water consumption with three additional strategies. Methods The Childhood Obesity Intervention Cost Effectiveness Study(CHOICES) microsimulation model estimated the cost-effectiveness of water jets on US childhood obesity cases prevented in 2025. Also estimated were the cost, number of children reached, and impact on water consumption of the installation of water jets and three other strategies. Results Installing water jets on school lunch lines was projected to reach 29.6 million children (95% uncertainty interval [UI]: 29.4 million-29.8 million), cost $4.25 (95% UI: $2.74-$5.69) per child, prevent 179,550 cases of childhood obesity in 2025 (95% UI: 101,970-257,870), and save $0.31 in health care costs per dollar invested (95% UI: $0.15-$0.55). In the secondary analysis, installing cup dispensers next to existing water fountains was the least costly but also had the lowest population reach. Conclusions Installating water jet dispensers on school lunch lines could also save almost half of the dollars needed for implementation via a reduction in obesity-related health care costs. School-based interventions to promote drinking water may be relatively inexpensive strategies for improving child health.

Many children are not sufficiently physically active. This study uses a quasi-experimental design to evaluate whether participation in a before-school physical activity program called Build Our Kids' Success (BOKS) increases physical activity. Participants (n = 426) were students in Fall, 2016 enrolled in BOKS programming and matched non-BOKS control students from the same grades (Kindergarten-6) and schools in Massachusetts and Rhode Island. Analyses conducted in 2017 examined differences between children in BOKS versus controls in total daily steps, minutes of moderate-to-vigorous (MVPA), vigorous (VPA), and total physical activity (TPA) assessed via Fitbit Charge HR™ monitors. Additional analyses compared physical activity on program days and non-program days. Students (mean age = 8.6 y; 47% female, 58% White, Non-Hispanic) wore monitors an average of 21.7 h/day on 3.2 days during the school week. Compared with controls, on BOKS days, BOKS participants accumulated more steps (1147, 95% confidence interval (CI): 583–1712, P, Highlights • Activity programs before school may increase physical activity levels. • Program participants were more active than non-participants. • Program participants accumulated more physical activity on days they participated.

Context: Doctoral education is the mechanism whereby athletic trainers can develop an awareness of their future roles and responsibilities in higher education. Evidence suggests that doctoral education may provide an incomplete understanding of these roles and responsibilities, warranting further investigation. Objective: To gain a better understanding on how athletic training faculty members are socialized into their role. Design: Qualitative study. Setting: Higher education institutions. Patients or Other Participants: Twenty-eight athletic training educators (14 men, 14 women) who had completed doctoral training. Participants' average age was 39 ± 6 years, with 11.6 ± 5.6 years of experience working in education. Main Outcome Measure(s): One-on-one interviews were completed with all participants following a semistructured framework. Data saturation drove sampling. Inductive analysis was used to evaluate the data. Member checks, peer review, and researcher triangulation established rigor. Results: The first theme, professional socialization, was defined by participants as those experiences in their doctoral training that provided role understanding. The second theme, organizational socialization, speaks to those experiences that occurred once the athletic training faculty member was employed full time in higher education. The category of mentorship was articulated, in both themes, as impactful in both professional preparations at the doctoral level and during the institutional socialization process once a novice faculty member is hired. Conclusions: Doctoral education provides the platform for role understanding, which allows the athletic trainer to be prepared to transition into the faculty member role. Specifically, engagement in the role and mentoring provided this role awareness, which is common within the socialization framework. Institutions also offer formalized orientation sessions as a means to assimilate, and mentoring is also available for support.

Context: Mentorship has been identified as a contributor to the socialization of athletic training preceptors. Understanding how mentorship occurs and contributes to preceptor development may help athletic training educators facilitate effective mentorship within their athletic training programs. Objective: Examine preceptors' perceptions of mentoring as part of their socialization into this role. Design: Qualitative study. Setting: Commission on Accreditation of Athletic Training Education programs. Patients or Other Participants: Twelve athletic trainers representing 4 National Athletic Trainers' Association districts, including 5 men and 7 women, average age = 32 ± 10.5 years, and average of 5 ± 5.0 years' experience as a preceptor. Main Outcome Measure(s): Participants responded to 14 interview questions regarding their perceptions of mentoring. Two researchers analyzed data using an inductive approach to identify themes and supporting categories. Trustworthiness was established by piloting the interview, using multiple analyst triangulation, and peer review. Results: Four themes emerged from the data: (1) characteristics, (2) processes, (3) mentoring by emulating, and (4) roles of mentoring. Participants identified that communication and commitment are characteristics of effective mentorship. Preceptors learn to mentor by emulating other preceptors, and mentoring relationships develop through both formal and informal processes. Mentoring serves multiple roles for preceptors, including providing a support system and facilitating reciprocal learning for both mentors and protégés. Conclusions: Participants perceive mentoring as beneficial to their initial and ongoing development as preceptors. Preceptors learn to mentor by emulating current and past mentors, emphasizing the importance of modeling for both preceptors and students. Clinical education coordinators can facilitate the mentoring of preceptors by educating them on the benefits of engaging in it as well as connecting experienced preceptors with newer preceptors.

Context: Burnout, a psychological state of mental weariness that occurs when work stresses become overwhelming, has frequently been documented in athletic trainers and has been hypothesized to affect professional retention. Experiences of burnout may be influenced by individual-level factors such as gender or personality, though few researchers have investigated such interactions in athletic trainers.Objective: To investigate the relationship between personalities, as measured by the Big Five Personality Inventory, and burnout.Design: Cross-sectional study.Setting: Online Web-based survey.Patients or Other Participants: A total of 189 athletic trainers working in the collegiate setting, 65 men (34.4%) and 124 women (65.6%), with an average of 5 ± 3 years certified and 2.5 ± 2 years working in their current position.Main Outcome Measure(s): Data were collected using a Web-based survey instrument consisting of 3 sections: (1) demographics, (2) burnout survey, and (3) Big Five Personality Inventory. Likert responses for the burnout score were summed. Independent t tests, Pearson correlations, and multiple regressions were calculated to evaluate the relationships between demographics and burnout and between burnout and personality.Results: This group of athletic trainers experienced moderate burnout, regardless of gender. A weak negative correlation was present between burnout score and both agreeableness and extraversion. A weak positive correlation existed between burnout and neuroticism. These variables did not predict burnout scores; only neuroticism added significantly to the weak predictive value. Personality explained only 17.3% of the variability in burnout scores.Conclusions: Our study confirms the findings of previous researchers highlighting moderate burnout in athletic trainers employed in the collegiate setting. We did not find that personality significantly predicted burnout, though it did account for a small amount of the variance in burnout scores. Thus, organizational-level factors may play a greater role in determining burnout in athletic trainers than individual-level factors such as personality.

Context: Mentorship is a developmental process whereby a novice individual, as he/she becomes inducted into his/her area of expertise, is guided by a more experienced person. Speculation exists that years of experience can impact this relationship. Objective: To determine the impact mentoring can have on athletic training student development and evaluate if experience as a preceptor is viewed as influential on the mentor experience. Design: Mixed-methods study. Setting: Commission on Accreditation of Athletic Training Education accredited programs. Patients or Other Participants: We recruited 17 (14 females, 3 males) athletic training students to participate in our study. On average, our participants were 21 ± 1 years old and represented varying levels of academic standing (1 sophomore, 9 juniors, 7 seniors). All participants indicated they currently had a mentor when asked directly. Main Outcome Measure(s): Participants responded to the Athletic Training Perceptions of Effective Mentoring survey and 14 open-ended interview questions regarding their perceptions of mentoring. An inductive approach was used to identify themes and supporting categories. Trustworthiness was established by using multiple-analyst triangulation, peer review and piloting of the instruments, and triangulation of data using a mixed-methods approach. Results: Athletic training students perceive their mentoring experiences as those that provide support and understanding, advance their clinical practice, and allow for the development of career goals. Age and experience did not appear to impact the overall experience of the student but rather facilitates the type of mentoring relationship developed. Conclusions: Mentoring was perceived to be an advantageous aspect of the socialization process for the athletic training student. It provided support and understanding during times of increased stress, allowed for the development of clinical skills, and provided the chance to cultivate a professional identity.

Context: The professional socialization process enables athletic training students (ATSs) to gain insights into behaviors, values, and attitudes that characterize their chosen profession. However, the process often focuses on skill development over professional issues. ATSs may be exposed to burnout and work-life conflict, which may impact their professional perceptions.Objective: Examine the cumulative impact of professional socialization on the ATS regarding their perceptions of burnout and work-life balance.Design: Qualitative research.Setting: Semistructured interviews with 6 individuals and 4 focus groups.Patients or Other Participants: Twenty-three ATSs enrolled in their final semester of Commission on Accreditation of Athletic Training Education–accredited programs at 5 universities (9 male, 14 female; average age = 22 years).Main Outcome Measure(s): Data collection occurred from 2 cohorts over a 2-year period. Participants completed focus group or individual interviews following the same interview guide. Interviews were transcribed verbatim. A general inductive analysis was used to evaluate the data. Themes were enumerated by counting the frequency with which a viewpoint was mentioned. Not all students answered each question. Member checks and a peer review established data credibility.Results: Three major themes emerged from our analysis, where ATSs reported (1) perceiving burnout, (2) recognizing burnout in their preceptors and professors, and (3) that work-life imbalance may be a challenge in the future. Athletic training students described experiencing feelings they attributed to burnout while recognizing similar signs in classmates and preceptors or professors, and acknowledged that having a family could be difficult in the future.Conclusions: Despite these seemingly negative findings, this group of ATSs was not influenced to leave the profession. Observing their preceptors use strategies and positive behaviors gave them hope for the future. Professionals must understand the importance of appropriate socialization when students are exposed to potentially negative situations so they remain optimistic about entering the field.

Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity.

Physical activity engagement during childhood helps create lifelong patterns of health and fitness. Summer camps are an important domain of influence for health promotion, with over 14 million American children attending annually. No known studies have evaluated the impact of sports-focused camps on activity levels. We test the hypothesis that children attending a sports camp (STEC) spend more time in moderate-to-vigorous physical activity (MVPA) compared to children attending general day camps. A repeated measures design used waist-worn accelerometers to measure MVPA and vigorous physical activity (VPA) among children at a sports camp in Dorchester, Massachusetts (n = 40). We compared these data with data from a similar study at five Boston-area non-sports-focused summer day camps (BSC) (n = 142), resulting in 764 total person-days analyzed. Multivariable linear regression models estimated differences in percent of accelerometer-monitored time spent in physical activity, adjusting for potential confounders and clustering of observations. STEC children spent a higher percentage of time in MVPA and VPA compared to BSC children (MVPA: 11.4%, p = .005; VPA: 2.4%, p = .023). These findings support the hypothesis that sports-focused camps can provide children with significantly more activity than general day camps. STEC children also spend a higher percent of time in MVPA than do children in a school-day national sample (NHANES). This is the first study to document that a sports-oriented camp generates more physical activity compared to a general summer camp. Our findings are relevant for public health efforts to promote physical activity and prevent chronic disease.

Objectives. To evaluate a community-level sodium-reduction intervention in Boston, Massachusetts. Reducing sodium in the food offerings of community settings may help reduce hypertension disparities. Methods. We examined changes in the proportion of prepackaged foods with greater than 200 milligrams of sodium in 7 hospitals, 8 YMCAs, 4 community health centers, and 2 organizations serving homeless populations. Research assistants documented prepackaged items in cafeterias, kiosks, and vending machines before and after the intervention (2013–2015). We assessed intervention change via linear mixed models accounting for repeated observations. Results. There were 161 access points at baseline (4347 facings) and 171 (4996 facings) at follow-up. The percentage of prepackaged products with greater than 200 milligrams of sodium decreased from 29.0% at baseline to 21.5% at follow-up (P = .003). Changes were driven by improvements in hospital cafeterias and kiosks (P = .003). The percentage of products with greater than 200 milligrams of sodium in YMCA vending decreased 58% (from 27.2% to 11.5%; P = .017); other organizations had nonsignificant declines. Conclusions. We found modest reductions in the percentage of higher-sodium prepackaged products across community institutions. Community-level interventions may increase availability of lower-sodium products in the food supply.

Introduction Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state “active PE” policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. Methods A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6–11 years. Data were analyzed in 2014. Results An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million). Conclusions Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.

Introduction The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). Methods Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015–2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. Results Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. Conclusions The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.

Context: Mentorship is a helpful resource for individuals who transition from doctoral student to tenure-track faculty member. The National Athletic Trainers' Association (NATA) Research & Education Foundation offers a Research Mentor Program to provide mentorship to promising investigators, particularly as they work to establish independent lines of research. Objective: To gain the perspectives of promising and established investigators on their participation in the NATA Foundation Research Mentor Program. Design: Qualitative, phenomenological research. Setting: Higher education institutions. Patients or Other Participants: Seven promising investigators (5 women, 2 men) and 7 established investigators (2 women, 5 men), all of whom had completed the NATA Foundation Research Mentor Program. Data Collection and Analysis We developed and piloted intervi: ew guides designed to gain participants' perspectives on their experiences participating in the NATA Foundation Research Mentor Program. Semistructured telephone interviews were completed with each individual and transcribed verbatim. Data were analyzed using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple-analyst triangulation, and data-source triangulation. Results: Three themes emerged from the interviews: (1) motivation, (2) collaboration, and (3) resources. Participants were motivated to become involved because they saw the value of mentorship, and mentees desired guidance in their research. Participants believed that collaboration on a project contributed to a positive relationship, and they also desired additional program and professional resources to support novice faculty. Conclusions: Promising and established investigators should be encouraged to engage in mentoring relationships to facilitate mentees' research agendas and professional development. The NATA Foundation and athletic training profession may consider providing additional resources for novice faculty, such as training on effective mentoring; grant writing and other research-related tasks; and support for broader faculty responsibilities, such as teaching, service, and work-life balance.