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Summary: Introduction: This manuscript describes the prevalence and attributes of community programmes and policies (CPPs) to address childhood obesity documented as occurring in 130 diverse US communities. Methods: Key informant interviews (N = 1420) and document abstraction were used to identify and characterize CPPs to promote physical activity and healthy nutrition occurring during a 10‐year retrospective study period. Data were collected in 2013–2015 and analysed in 2016. Results: Across all 130 communities, 9681 distinct CPPs were reported as occurring by key informants. Of these, 5574 (58%) focused on increasing physical activity, 2596 (27%) on improving nutrition and 1511 (16%) on both behaviours. The mean number of CPPs per community was 74.0, with a range of 25 to 295 across all communities. Most CPPs occurred more than once (63%) and on average lasted 6.1 years. The greatest number of reported CPPs occurred in school settings (44%). Conclusions: Communities showed a wide range of investment in the amount of CPPs occurring in settings that affect opportunities for children to engage in physical activity and healthy nutrition. The pattern of implementation of CPPs showed variation over time, with an increase in more recent years. This observational study provides new and valuable information about what US communities are doing to prevent childhood obesity. What is already known about this subject? With increases in childhood obesity, agenda‐setting organizations and federal initiatives have called for comprehensive approaches involving multiple community programs and policies.Community efforts to address childhood obesity have included programs, policies, and environmental changes to promote physical activity and healthy nutrition.Little is known about the amount and kind of community programs and policies actually being implemented in communities throughout the U.S. What this study adds? This study provides data on the observed prevalence of community programs and policies addressing childhood obesity in a diverse sample of 130 U.S./ communities.It shows that the observed number of community programs and policies increased in more recent years, with more marked increases seen after 2009.It shows that the observed length of community programs/ policies and types of behavioral objectives targeted varied substantively across communities; while other variables, such as reach or target, were more similar across programs and policies. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Background: The impact of community‐based obesity prevention efforts on child nutrition has not been adequately studied. Objective: Examine relationships between number, type and intensity of community programs and policies (CPPs) and child nutrition. Methods: An observational study of 5138 children (grades K–8) in 130 U.S. communities was conducted in 2013–2015. CPPs were identified by 10–14 key informant interviews per community. CPPs were characterized based on: count, intensity, number of different strategies used and number of different behaviours targeted. Scores for the prior 6 years were calculated separately for CPPs that addressed primarily nutrition, primarily physical activity (PA) or total combined. Child intakes were calculated from a dietary screener and dietary behaviours were based on survey responses. Multi‐level statistical models assessed associations between CPP indices and nutrition measures, adjusting for child and community‐level covariates. Results: Implementing more types of strategies across all CPPs was related to lower intakes of total added sugar (when CPPs addressed primarily PA), sugar‐sweetened beverages (for nutrition and PA CPPs) and energy‐dense foods of minimal nutritional value (for total CPPs). Addressing more behaviours was related to higher intakes of fruit and vegetables (for nutrition and total CPPs) and fibre (total CPPs). Higher count and intensity (PA and total CPPs) were related to more consumption of lower fat compared with higher fat milk. A higher count (PA CPPs) was related to fewer energy‐dense foods and whole grains. No other relationships were significant at P < 0.05. Conclusion: Multiple characteristics of CPPs to prevent obesity appear important to improve children's diets. What is already known about this subject? Multi‐component and multi‐sector community interventions are recommended to prevent child obesity.Little is known about whether community programs and policies implemented in the U.S. are improving child nutrition; a better understanding of these efforts and their relationship to child nutrition can help inform community efforts. What this study adds? We conducted an observational study collecting dietary data from over 5000 children ages 4–15 years and retrospective data on community programs and policies in a diverse sample of 130 communities across the U.S.Different features of community policies and programs were related to better child nutrition – there is likely no 'single' or 'simple' solution.Policy and food environments that support children''s healthy food choices in conjunction with delivering information and enhancing skills are associated with better diets.It is important to target changes in multiple dietary behaviours – not only increasing healthy foods and beverages, but also limiting less healthy ones. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Background: Rational planning of community policies and programs (CPPs) to prevent obesity requires an understanding of CPP objectives associated with dietary behaviours. Objective: The objective of the study is to identify objectives of CPPs associated with healthful dietary behaviours. Methods: An observational study identified 4026 nutrition CPPs occurring in 130 communities in the prior 6 years. Dietary intakes of fruits and vegetables, added sugar and sugar‐sweetened beverages, among others, were reported among 5138 children 4–15 years of age from the communities, using a Dietary Screener Questionnaire with children age 9 years and older (parent assisted) or parent proxies for younger children. CPPs were documented through key informant interviews and characterized by their intensity, count, and objectives including target dietary behaviour and food environment change strategy. Associations between dietary intakes and CPP objectives were assessed using hierarchical statistical models. Results: CPPs with the highest intensity scores that targeted fast food or fat intake or provided smaller portions were associated with greater fruit and vegetable intake (0.21, 0.19, 0.23 cup equivalents/day respectively with p values <0.01, 0.04, 0.03). CPPs with the highest intensity scores that restricted the availability of less healthful foods were associated with lower child intakes of total added sugar (−1.08 tsp/day, p < 0.01) and sugar from sugar‐sweetened beverages (−1.63 tsp/day, p = 0.04). Similar associations were observed between CPP count and dietary outcomes. No other significant associations were found between CPP target behaviours or environmental strategies and dietary intakes/behaviours. Conclusion: CPPs that targeted decreases in intakes of less healthful foods and/or aimed to modify the availability of less healthful foods and portions were associated with healthier child dietary behaviours. What is already known about this subject: Community programs and policies (CPPs) use a range of strategies to prevent obesity, based on 'practice tested' models and those with emerging evidence about their success.Yet, understanding the relationship of types and features of CPPs that contribute to success of CPPs, including program and policy objectives in the context of the whole community effort, would inform rational planning for obesity prevention. What this study adds: We studied dietary intakes of 5138 children 4–15 years of age and objectives of CPPs (dietary behaviours targeted and food environment change strategies) in a diverse sample of 130 communities across the USA.We found significant associations between CPPs that aimed to modify community food environments (by restricting availability of less healthful foods and beverages and instituting smaller portion sizes) and higher fruit and vegetable (FV) intake as well as lower sugar and sugar‐sweetened beverage intake. We also found associations between CPPs that targeted less healthful dietary behaviours (fat, fast food) with higher child FV intake. Yet, dietary intakes of interest were not generally consistent with the dietary targets reported by CPPs, e.g. those targeting FV were not associated with higher intakes of FV.Our findings suggest potential benefits from a greater focus of CPPs on food environments. Further evaluation is recommended to identify causal relationships between objectives of CPPs and child diets, and which combinations of CPP objectives are most successful. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Background: Although a national epidemic of childhood obesity is apparent, how community‐based programmes and policies (CPPs) affect this outcome is not well understood. Objectives: This study examined the longitudinal relationship between the intensity of CPPs in 130 communities over 10 years and body mass index (BMI) of resident children. We also examined whether these relationships differ by key family or community characteristics. Methods: Five thousand one hundred thirty‐eight children in grades K‐8 were recruited through 436 schools located within 130 diverse US communities. Measures of height, weight, nutrition, physical activity and behavioural and demographic family characteristics were obtained during in‐home visits. A subsample of families consented to medical record review; these weight and height measures were used to calculate BMI over time for 3227 children. A total of 9681 CPPs were reported during structured interviews of 1421 community key informants, and used to calculate a time series of CPP intensity scores within each community over the previous decade. Linear mixed effect models were used to assess longitudinal relationships between childhood BMI and CPP intensity. Results: An average BMI difference of 1.4 kg/m2 (p‐value < 0.01) was observed between communities with the highest and lowest observed CPP intensity scores, after adjusting for community and child level covariates. BMI/CPP relationships differed significantly by child grade, race/ethnicity, family income and parental education; as well as community‐level race/ethnicity. Conclusions: These results indicate that, over time, more intense CPP interventions are related to lower childhood BMI, and that there are disparities in this association by sociodemographic characteristics of families and communities. This article is part of the upcoming supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity. [ABSTRACT FROM AUTHOR]

Lewis structures are the simplest model for students to communicate chemical information using chemical symbolic language. Thus, competence in Lewis structures is essential to progress in the study of chemistry. Proposals on how to teach/learn Lewis structures with inert rules abound, nonetheless, scant related educational research has been conducted. The present study is part of a larger investigation into the conceptualisation and use of Lewis structures by novices and experts. This study analysed data from a cross-sectional, 122-participant sample of chemistry majors at a large university in Costa Rica. Participants were prompted to draw Lewis structures, which rendered information on their representational competence. Analysis of mistakes in their representations shed light on participants’ conceptualisation of Lewis structures. Responses to open-ended items further contributed in elucidating their conceptualisation. Findings suggest: (a) participants’ competence to draw Lewis structures is deficient throughout the major; (b) participants relied significantly on memory and familiarity and not on understanding to draw Lewis structures; (c) most participants’ limited understanding of Lewis structures stems from their using mental images and propositional representations for Lewis structures instead of mental models. Use of appropriate mental models could enable individuals to explain and predict chemical behaviour based on Lewis structures.

Context: Dietary sodium is positively associated with blood pressure, and ecological and animal studies both have suggested that high dietary sodium intake increases stroke mortality.Objective: To examine the risk of cardiovascular disease associated with dietary sodium intake in overweight and nonoverweight persons.Design: Prospective cohort study.Setting: The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992.Participants: Of those aged 25 to 74 years when the survey was conducted in 1971 -1975 (14407 participants), a total of 2688 overweight and 6797 nonoverweight persons were included in the analysis.Main Outcome Measures: Dietary sodium and energy intake were estimated at baseline using a single 24-hour dietary recall method. Incidence and mortality data for cardiovascular disease were obtained from medical records and death certificates.Results: For overweight and nonoverweight persons, over an average of 19 years of follow-up, the total number of documented cases were as follows: 680 stroke events (210 fatal), 1727 coronary heart disease events (614 fatal), 895 cardiovascular disease deaths, and 2486 deaths from all causes. Among overweight persons with an average energy intake of 7452 kJ, a 100 mmol higher sodium intake was associated with a 32% increase (relative risk [RR], 1.32; 95% confidence interval [CI], 1.07-1.64; P = .01) in stroke incidence, 89% increase (RR, 1.89; 95% CI, 1.31-2.74; P<.001) in stroke mortality, 44% increase (RR, 1.44; 95% CI, 1.14-1.81; P = .002) in coronary heart disease mortality, 61% increase (RR, 1.61; 95% CI, 1.32-1.96; P<.001) in cardiovascular disease mortality, and 39% increase (RR, 1.39; 95% CI, 1.23-1.58; P<.001) in mortality from all causes. Dietary sodium intake was not significantly associated with cardiovascular disease risk in nonoverweight persons.Conclusions: Our analysis indicates that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all-cause mortality in overweight persons. [ABSTRACT FROM AUTHOR]

BACKGROUND: The results of previous studies on the association between dietary fat intake and coronary heart disease (CHD) incidence are inconsistent. OBJECTIVE: The aim of this study was to examine the association between dietary fat intake and CHD incidence in American Indians in the Strong Heart Study. DESIGN: A total of 2938 participants aged 47-79 y and free of CHD at the second examination (1993-1995) were examined and followed for CHD, nonfatal CHD, and fatal CHD events to 31 December 2002. Dietary intake was assessed by using a 24-h diet recall and was calculated as percentages of energy. RESULTS: Participants were followed for a mean (+/-SD) of 7.2 +/- 2.3 y. During follow-up, 436 incident CHD cases (298 nonfatal CHD and 138 fatal CHD events) were ascertained. Participants aged 47-59 y in the highest quartile of intake of total fat, saturated fatty acids, or monounsaturated fatty acids had higher CHD mortality than did those in the lowest quartile [hazard ratio (95% CI): 3.57 (1.21, 10.49), 5.17 (1.64, 16.36), and 3.43 (1.17, 10.04), respectively] after confounders were controlled for. These associations were not observed for those aged 60-79 y. CONCLUSIONS: Total fat, saturated fatty acid, and monounsaturated fatty acid intake were strong predictors of CHD mortality in American Indians aged 47-59 y, independent of other established CHD risk factors. It may be prudent for American Indians to reduce their fat intake early in life to reduce the risk of dying from CHD. Copyright © 2006 American Society for Nutrition [ABSTRACT FROM AUTHOR]

Objective: Although clinically evident type 2 diabetes is a well-established cause of mortality, less is known about subclinical states of glucose intolerance.Research Design and Methods: Data from the Second National Health and Nutrition Examination Survey Mortality Study, a prospective study of adults, were analyzed. This analysis focused on a nationally representative sample of 3,174 adults aged 30-75 years who underwent an oral glucose tolerance test at baseline (1976-1980) and who were followed up for death through 1992.Results: Using 1985 World Health Organization criteria, adults were classified as having previously diagnosed diabetes (n = 248), undiagnosed diabetes (n = 183), impaired glucose tolerance (IGT) (n = 480), or normal glucose tolerance (n = 2,263). For these groups, cumulative all-cause mortality through age 70 was 41, 34, 27, and 20%, respectively (P < 0.001). Compared with those with normal glucose tolerance, the multivariate adjusted RR of all-cause mortality was greatest for adults with diagnosed diabetes (RR 2.11, 95% CI 1.56-2.84), followed by those with undiagnosed diabetes (1.77, 1.13-2.75) and those with IGT (1.42, 1.08-1.87; P < 0.001). A similar pattern of risk was observed for cardiovascular disease mortality.Conclusions: In the U.S., there was a gradient of mortality associated with abnormal glucose tolerance ranging from a 40% greater risk in adults with IGT to a 110% greater risk in adults with clinically evident diabetes. These associations were independent of established cardiovascular disease risk factors. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about acute necrotizing encephalopathy in the June 16, 2007 issue.