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OBJECTIVE: This study aimed to identify and describe healthful and youth-oriented qualities of the restaurant food environment around high schools. METHODS: Using direct observation data from 58 restaurants located within a half-mile (804.5 meters) of all high schools in a single district, two index measures of the restaurant food environment were created: healthfulness index and youth-oriented index. Wilcoxon signed-rank order was used to examine differences in restaurant features according to index scores. RESULTS: Mean healthfulness score was 8.9 (range = 2–14, max = 19) and mean youth-oriented score was 5.5 (range = 0–11, max = 12). Differences were found in signed-rank order of healthfulness and youth-oriented index restaurant scores (p = 0.02). CONCLUSION: Results suggest that restaurants have room for improvement in offering customers a healthful environment, some restaurants are more likely to appeal to youth, and that youth-oriented restaurants were different than restaurants with high healthfulness scores. Further qualitative exploration of food environment features will help contextualize the influence of restaurants on youth eating behaviors.

Background Partnerships between charitable food systems and healthcare systems have been forming across the country to support individuals and families experiencing food insecurity, yet little research has focused on these partnerships, particularly from a food bank perspective. The objective of this exploratory pilot study was to identify implementation challenges and facilitators of charitable food system and healthcare partnerships from the food bank perspective. Method Texas food banks with existing food bank/healthcare partnerships were identify through website review and support from Feeding Texas. Interview questions were tailored to each interview, but all focused on identify program components of the food bank/healthcare partnership and implementation barriers/facilitators of the partnership. In total, six interviews were conducted with food bank/healthcare partnership leaders (n = 4) and charitable food system experts (n = 2) about their experiences of working with food bank/healthcare partnerships. All interviews were completed via Zoom and took between 30 and 60 min to completed. Detailed notes were taking during each interview, and immediately discussed with the complete research time to formulate broad implementation themes. Results Interviews suggest unique implementation challenges exist at all levels of food bank/healthcare partnerships including the partnership, program, and system levels. Partnership-level implementation challenges focused on issues of partnership scale and data collection, sharing, and analysis. Program-level implementation challenges focused on food and produce expectations. Structural-level implementation challenges included issues of food safety, subsidized food regulations, and patient privacy. Implementation facilitators included leadership support, mission compatibility/organizational readiness, food insecurity training, and identify of partnership champions. Conclusions This study adds to the growing interest in food bank/healthcare partnership as it highlights unique implementation challenges and facilitators for cross-sector partnerships between healthcare systems and community-based charitable food systems. Ultimately, we believe that collaborative discussion among leaders of charitable food systems and healthcare systems is needed to overcome outlined implementation challenges to better facilitate sustainable, equitable implementation of food bank/healthcare partnerships.

Food-based community organizations (FBCO) have positive impacts on community health, yet little is known about best practices that facilitate organization sustainability. To identify strategies among FBCOs used to facilitate member engagement/retention, reach future members/participants, and support organizational growth, key informants from four FBCOs in Texas participated in in-depth interviews. Semi-structured interviews were informed by grounded theory, voice recorded, and transcribed. Results from eight interviews, representing four organizations, indicated five themes for organization sustainability: commitment to a mission, supportive leadership, physical meeting space, clear communication, and community partnerships. Implementation of these strategies may benefit other FBCOs by helping them create sustainable organizations.

OBJECTIVE: To develop an informed, reliable data collection tool to code restaurants found within the youth food environment. METHODS: Registered Dietitians were surveyed and academic literature review was reviewed to determine health centric food environment features. Features were incorporated into an electronic data collection tool. Inter-rater reliability was tested across coders of varying nutrition training on all restaurants located within a half-mile of three high schools. RESULTS: Sixteen restaurant food environment codes were generated. Data collection had a mean inter-rater reliability of 90.7% agreement (range=81.3–100%), suggesting that regardless of nutrition training, the restaurant food environment can be reliability coded. CONCLUSIONS: Academic and public health professionals can use this tool to collect reliable, informed local restaurant food environment data.

Background and objective: In early 2020, the novel COVID-19 virus arrived in the United States and resulted in broad, sweeping changes to safety procedures within healthcare settings, including prenatal care settings. While implemented to protect both providers and patients, this protocol limited fathers' ability to attend prenatal care appointments. At this time, limited research has been published on the effects of COVID-19 healthcare protocols on fathers' experiences and perceptions of prenatal care and parenting. This study aimed to understand how COVID-19 affected expectant fathers and fathers with newborns perceptions and experiences during pregnancy, prenatal care, and early parenting. Materials and methods: Structured interviews were completed with fathers expecting a child and fathers with children born after March 2020. Interviews were completed by video conference and recorded. Audio from each interview was transcribed. Content and thematic analysis was performed. Results: In total, 34 fathers were interviewed. Three broad themes were identified from the data including changing prenatal care policies that did not consider fathers, unique stressors associated with COVID-19, and isolation's negative impact on connecting to the pregnancy and support. Fathers reported limited engagement with the prenatal care system due to pandemic-related organizational and systematic changes in healthcare delivery. Results also suggest that fathers experienced elevated feelings of both stress and isolation from the pregnancy and prenatal care. Conclusions: Ultimately, this study highlights the need for providers and organizations to develop strategies for transforming prenatal healthcare delivery into inclusive, family centered care during emergency situations, as well as use this opportunity to build family centered care into normal prenatal care operations.

Background: Energy drink consumption has become increasingly prevalent among US college students, yet little is known about current rates of consumption and reasons for consumption among current energy drink users, particularly differences related to gender and race/ethnicity. Objectives: To better understand energy drink consumption alone and mixed with alcohol among US undergraduate college students who currently use energy drinks. Methods: Participants included 330 energy drink users ( m age = 18.7; White = 48.5%; Women = 46.1%) and 229 energy drink mixed with alcohol users ( m age = 18.8; White = 51.5%; Women = 51.8%). Students completed an online survey, which measured energy drink consumption alone and energy drinks mixed with alcohol. Descriptive statistics and differences by race/ethnicity and gender are reported for patterns and reasons of use. Results: Among past year energy drink users, 64.9% consumed energy drinks in the past month and 38.5% consumed in the past week. The most common reasons for energy drink consumption alone included studying for an exam and taste. Among past year energy drink mixed with alcohol users, 31.9% consumed within the past month. The most common reasons to mix alcohol and energy drinks included taste and to hide the flavour of alcohol. Key findings include that young men consume energy drinks alone and mixed with alcohol more often than young women. Young men are more likely to report energy drink consumption in the past week and report reasons related to partying than young women, while non-White youth report reasons related to academic performance as compared to White youth. Conclusion: Consideration of patterns and reasons for energy drink consumption may help interventions to ensure appropriate behaviours are targeted and are relevant to the population.

BACKGROUND Weight discrimination has been associated with poor academic performance and decreased school attendance. Little is known about weight discrimination and students' feelings of belonging to their school. This study examined the association between weight discrimination and school connectedness among adolescents. Teacher support was examined as a protective factor. METHODS Middle school students (N = 639; 57% white; Mean age = 12.16 years) completed a health behaviors survey. Weight discrimination from peers and/or good friends was dichotomized into never versus experienced weight discrimination. The mean of 5 school connectedness items assessed level of school connectedness. Teacher support was measured by taking the mean of 4 teacher support items. Hierarchical linear regression was used to examine the association between weight discrimination and school connectedness. Teacher support was tested as a moderator. RESULTS Weight discrimination was associated with lower levels of school connectedness (p

ObjectiveThe purpose of the present study was to explore the relationship between family meals and parental encouragement of healthy eating overall and by ethnicity.DesignFamily meal frequency was measured with one item asking how many times in the past 7 d all or most of the family ate a meal together, which was then categorized to represent three levels of family meals (≤2 times, 3–6 times and ≥7 times). Parental encouragement of healthy eating assessed how often parents encouraged the student to eat fruits and vegetables, drink water, eat wholegrain bread, eat breakfast and drink low-fat milk (never to always). An overall scale of parental encouragement of healthy eating was created. Mixed-effect regression analyses were run controlling for gender, ethnicity, age and socio-economic status. Moderation by ethnicity was explored.SettingMiddle schools.SubjectsParticipants included 2895 US eighth grade students participating in the Central Texas CATCH (Coordinated Approach To Child Health) Middle School Project (mean age 13·9 years; 24·5 % White, 52·7 % Hispanic, 13·0 % African-American, 9·8 % Other; 51·6 % female).ResultsEating more family meals was significantly associated with having parents who encouraged healthy eating behaviours (P for trend P for trend ConclusionsFamilies who eat together are more likely to encourage healthy eating in general. Interventions which promote family meals may include tips for parents to increase discussions about healthy eating.

Few studies of the food environment have collected primary data, and even fewer have reported reliability of the tool used. This study focused on the development of an innovative electronic data collection tool used to document outdoor food and beverage (FB) advertising and establishments near 43 middle and high schools in the Outdoor MEDIA Study. Tool development used GIS based mapping, an electronic data collection form on handheld devices, and an easily adaptable interface to efficiently collect primary data within the food environment. For the reliability study, two teams of data collectors documented all FB advertising and establishments within one half-mile of six middle schools. Inter-rater reliability was calculated overall and by advertisement or establishment category using percent agreement. A total of 824 advertisements (n=233), establishment advertisements (n=499), and establishments (n=92) were documented (range=8–229 per school). Overall inter-rater reliability of the developed tool ranged from 69–89% for advertisements and establishments. Results suggest that the developed tool is highly reliable and effective for documenting the outdoor FB environment.

Aim: Energy drink consumption has been associated with a variety of health risk behaviours, yet little research has explored the relationship between energy drinks and dietary behaviours of emerging adults. Therefore, the purpose of this study was to explore the relationship between energy drink consumption and dietary behaviours among energy drink users and non-users within a sample of college youth. Methods: College freshmen ( n = 585, m age = 18.7 years; 47% non-Hispanic White, 20.9% Hispanic, 25.5% Asian, 2.7% non-Hispanic Black and 4.4% other; 56% female), at a large, southwest university self-reported their energy drink consumption in the past week and a variety of dietary behaviours, including past week soda, diet soda, pre-packaged salty snacks, pre-packaged sweet snacks, fast food, restaurant food, frozen food, fruits, vegetables, milk and breakfast consumption. Linear regression analyses were run to determine associations between energy drink consumption and dietary behaviour among users and non-users of energy drinks. Analyses controlled for gender, race/ethnicity and body mass index (BMI). Results: Overall, 17.5% of students had consumed energy drinks in the past week. Energy drink users were more likely to be male, White and have a greater BMI. Students also reported low past week intake of fruits, vegetables, milk and breakfast. Past week energy drink consumption was associated with increased soda and frozen meal consumption. Conclusion: Given a rapidly expanding energy drink market, future dietary interventions among college youth may want to consider the implications of energy drinks, as results of this study suggest consumption of these beverages is associated with unhealthy dietary behaviours and a greater BMI.

Overweight and obesity have been increasing among youth, with the prevalence of overweight among children and teens in the US tripling since 1980 (Ogden & Carroll, 2010). While the prevalence rates have leveled off in recent years (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010; Ogden, Carroll, Kit, & Flegal, 2012), the rates of obesity-related diseases continue to rise (Knip et al., 2008), and health disparities exist in the prevalence of overweight and obesity across racial/ethnic groups, with African American and Hispanic youth at higher risk of being overweight or obese (Ogden et al., 2012). One factor that has been associated with obesity is exposure to food and beverage advertising (Institute of Medicine, 2006). Additionally, racial ethnic minorities have been disproportionately targeted and exposed to this type of advertising (see Chaps. 16, 17, and 18). One form of food and beverage advertising that has received less attention is outdoor advertising. As such, the purpose of this chapter is to review the literature on outdoor food and beverage advertising and provide researchers and community practitioners with a tool to document and describe this type of advertising in their own communities. We will also present pilot data from our study designed to document and describe food and beverage advertising around schools and end with a discussion on policy implications and future directions for research in this area.

To explore associations between energy drink consumption and alcohol use among college students.Participants included 585 students (m age=18.7; 47.0% White, 21% Hispanic, 25% Asian, 7% other race/ethnicity; 56.0% female). Energy drink behaviors included past month and past week consumption. Alcohol use behaviors included past month and past two week consumption, as well as heavy drinking and quantity of alcohol consumed. Consumption of energy drinks mixed with alcohol was also measured. Linear and logistic regression analyses between energy drink consumption and alcohol use were run controlling for gender, age, and race/ethnicity.For each one unit increase in past month (i.e., additional day used) energy drink use, the likelihood of past month alcohol use increased by 80%, heavy drinking by 80% and past month energy drinks mixed with alcohol use by 90%. Similar results were found for past week energy drink use. A positive relationship between energy drink use and quantity of alcohol consumed during a single episode of drinking was also found (p0.001). Significant gender interactions between energy drink consumption and alcohol use as well as quantity of alcohol consumed were found, with relationships stronger among males than females. There were no significant interactions by race/ethnicity.Energy drinks are readily available to students and pose potential health risks. Students who report greater energy drink consumption also consume more alcohol, are more likely to mix energy drinks and alcohol, and experience heavy episodes of drinking, which is problematic given the potential negative consequences of these drinks.