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BackgroundA decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown. ObjectiveThe objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications. MethodsWe will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients’ medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control. ResultsOur study was funded in July 2020. As of May 2021, we have enrolled 6 participants. ConclusionsOur findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials. Trial RegistrationClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242 International Registered Report Identifier (IRRID)PRR1-10.2196/18984

BackgroundSevere obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. ObjectiveThis study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. MethodsStudy outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. ResultsThis study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. ConclusionsThe results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID)PRR1-10.2196/18098

The National Center for Advancing Translational Sciences (NCATS) has defined translation as the process of turning observations into interventions that are adopted, sustained, and improve health. Translation must attend to research and community systems and context at multiple levels, and to key stakeholders. Dissemination and implementation (D&I) sciences are informed by an understanding of the critical role of people and systems in disseminating, adopting, and sustaining innovations within real-world settings. Thus, the D&I sciences provides a set of principles that can guide the translational work of Clinical and Translational Science Award (CTSA) programs from basic research to public health. In this special communication, our cross-domain working group of the CTSA consortium, comprised of experts in methods and processes, workforce development, evaluation, stakeholder engagement, and D&I sciences, share a vision of how CTSAs can enhance translation across the translational spectrum through the integration of D&I sciences into the critical areas of methods and processes, workforce development, and evaluation. We propose a set of recommendations for NCATS national and local leaders that are intended to move D&I sciences out of a position of unfamiliarity and ancillary value and into the core identity of who CTSAs are, how they think, and what they do, to advance translation and health.

Physical activity (PA) policies have the potential to ensure adequate opportunities for children to develop PA behaviors for a lifetime. Examples include mandating that schools provide recess and physical education for a specified amount of time per week; ensuring that physical education teachers are licensed; providing activity breaks in academic classrooms; and mandating the implementation of policies at federal, state, and local levels. Collectively, these policies help to promote and support Comprehensive School Physical Activity Programs (CSPAP). However, there is little guidance on how PA policies can be implemented at the school and district level, limiting their impact on promoting student behaviors. Therefore, the purpose of this paper is to provide an overview of research conducted on CSPAP policy development, adoption, and implementation and how best to support local implementation efforts in schools to increase PA and its impact on children's health. We provide pragmatic recommendations for how school and district leadership can use implementation science principles to assess current policy implementation and advocate for more comprehensive PA policies which support systems change.

Purpose: The Comprehensive School Physical Activity Program (CSPAP) model has recently been adopted as a national framework for physical activity (PA) promotion in schools. As a result, there is a need to develop an instrument to help leaders of PA measure policies and practices across the five component areas of a CSPAP. To address this gap, our team systematically developed and assessed the psychometric properties of the CSPAP-Q, an instrument designed to assess school policies and practices related to the five components of CSPAP. Methods: The instrument development process began by reviewing existing school health and PA surveys. The Delphi method was then used to evaluate face and content validity through expert feedback. Thirty-eight physical education teachers completed the CSPAP-Q twice over a 14-day period to further establish validity and to assess test-retest reliability. Results: In total, 117 items were identified for the initial review. Upon completion of expert feedback, 22 items were eliminated and 66 items were revised. After reliability testing, three additional items were eliminated due to low test-retest agreement levels (Kappa <0.40; non-significant X[superscript 2]). Ninety-two items were retained in the final version of the CSPAP-Q and kappa values indicated moderate to substantial agreement among items. Conclusions: After validity and reliability testing, results suggest that the CSPAP-Q is a valid and reliable tool for assessing policies and practices related to CSPAP.

A comprehensive school physical activity program (CSPAP) is a multi-component approach that aims to provide opportunities for students to meet the nationally recommended 60 minutes of moderate-to-vigorous physical activity (MVPA) per day and for students to be well-equipped to be active for life. In order for a CSPAP to be effectively implemented, it should be led by a trained physical activity leader (PAL). This review summarizes recent literature related to the roles and responsibilities of a PAL, various outlets in which aspiring PALs can be trained, and the potential effectiveness of PAL-led CSPAPs.

This commentary argues that reducing sedentary behavior (SB) is an effective strategy for preventing cardiovascular disease (CVD) in young adults, particularly college-based young adults (CBYA). The average American, including CBYA, spends about 8 hours per day engaged in SB. CVDs are occurring at younger ages, and many young adults have asymptomatic CVD or CVD risk factors. College campuses provide an accessible and suitable environment for multilevel lifestyle interventions to promote healthy behaviors. The authors suggest that SB reduction is a prime target for intervention to reduce CVD risk in young adults. [Extracted from the article]

Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11–13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effect of skill modifications on head motion experienced during women's artistic gymnastics skills. Nine gymnasts (four beginner and five advanced) completed three trials of up to 24 skill progressions, each consisting of a skill and two progressive safety modifications. Gymnasts were instrumented with mouthpiece sensors embedded with an accelerometer and gyroscope collecting motion data at 200, 300, and 500 Hz during each skill performance. Peak-to-peak linear and rotational kinematics during contact phases and peak rotational kinematics during non-contact phases were computed. A mixed-effects model was used to compare differences in modification status nested within skill categories. Timer skills (i.e. drills that simulate performance of a gymnastics skill) resulted in the highest median ΔLA and ΔRA of all skill categories, and 132 skill performances exceeded 10 g ΔLA during a contact phase. Modifications were associated with significant reductions in head kinematics during contact phases of timers, floor skills, bar releases, and vault skills. Gymnasts can be exposed to direct and indirect head accelerations at magnitudes consistent with other youth contact sports, and common safety modifications may be effective at reducing head motion during contact and non-contact phases of gymnastics skills. [ABSTRACT FROM AUTHOR]

Background: Traditional health measurement tools use a pathogenic, or disease origins framework, to assess for the absence of disease or risk factors. Good or positive health, however, is more than the absence of disease and current tools do not reflect this. Purpose: The purpose of this study was to test the psychometric properties of the adult version of the multidimensional Salutogenic Wellness Promotion Scale (SWPS), a tool designed to measure positive health. Methods: Building on the previously validated young adult version of the SWPS, new scale items were developed for working adults. A sample of 304 administrative, academics, and staff personnel tested the psychometric properties of the adult version of the SWPS. Results: The SWPS demonstrated it had a seven factor multidimensional structure, had good internal consistency, and was positively correlated with perceived health (p less than 0.0001) and life satisfaction (p less than 0.001). Validity was also supported by negative correlations between the SWPS and both a depression and symptom measure. Discussion: The SWPS demonstrated good evidence of reliability and validity and fills a positive health status assessment need. Translation to Health Education Practice: Using the SWPS with adult populations could assist health educators in their development of effective health promotion practices. (Contains 2 tables.)

Background: The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. Aims: (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. Method: HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework (Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Results: Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p = 0.001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p = 0.01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Conclusions: Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Background: We examined the effectiveness of Peaceful Playgrounds™ (P2) to decrease antisocial behaviors (ASB) while increasing physical activity (PA) and prosocial behaviors (PSB) in elementary school children. Methods: A longitudinal, cluster-randomized design was employed in 4 elementary school playgrounds where students (third to fifth) from 2 intervention and 2 control schools were observed during recess periods. The intervention included environmental changes (eg, marked surfaces) and student education. Data were collected using systematic observations of youth behavior and semistructured interviews conducted with key informants. Mixed-effects regression models controlling for scans nested within days nested within schools estimated the interaction of measurement period and treatment condition on children's PA, PSB, and ASB. It was hypothesized that children in intervention, but not control schools, would demonstrate increased PA/PSB and decreased ASB. Results: Contrary to the hypotheses, intervention and control schools showed favorable changes for all dependent variables except for PSB, but 1 intervention and 1 control school drove these effects. Follow-up interviews indicated variability in implementation and lack of adherence to the control condition. Conclusions: P2 may promote increased PA during recess, but these results demonstrate the complexity of intervention implementation and the need for rigor when measuring intervention fidelity in real-world settings.