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Background: Federal law requires most school districts to develop school wellness policies (SWPs), which state agencies assist in by providing templates. Templates provide standard language, which districts may edit for numerous reasons. We aimed to identify the frequency/consistency of template usage and identify the types of edits districts make when using SWP templates. Methods: We identified SWPs (N = 117) and templates (N = 2) from districts in 1 Texas public health region. We developed template specific coding guides, which allowed us to examine the frequency SWPs used template text within multiple areas (eg, nutrition goals, reporting). We also collected/categorized SWP edits from the template text and conducted a thematic analysis of locally developed SWPs and SWP templates. Results: Of 117 SWPs, 81.2% used a 2020 template, 13.7% used a 2005 template, and 5.1% created their own SWP. Across template-based SWPs, 44 content edits (0.4 per policy) occurred in 9 categories. Thematic analysis revealed: (1) locally developed SWPs created an informed mission statement linked to their goals; (2) Locally developed SWPs provided details that the current template includes in wellness plans. Conclusions: Most districts used exact template language when writing their SWP. Adding spaces where districts can specify details could improve SWP content.

Background: Climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic are large-scale, societal events (ie, forces of change) that affect the timing, settings, and modes of youth physical activity. Despite the impact that forces of change have on youth physical activity and physical activity environments, few studies consider how they affect physical activity promotion. Methods: The authors use 2 established frameworks, the ecological model of physical activity and the youth physical activity timing, how, and setting framework, to highlight changes in physical activity patterns of youth in North America that have resulted from contemporary forces of change. Results: North American countries—Canada, Mexico, and the United States—have faced similar but contextually different challenges for promoting physical activity in response to climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic. Innovative applications of implementation science, digital health technologies, and community-based participatory research methodologies may be practical for increasing and sustaining youth physical activity in response to these forces of change. Conclusions: Thoughtful synthesis of existing physical activity frameworks can help to guide the design and evaluation of new and existing physical activity initiatives. Researchers, practitioners, and policymakers are encouraged to carefully consider the intended and unintended consequences of actions designed to respond to forces of change. [ABSTRACT FROM AUTHOR]

Background: There is a need to understand how schools adopt physical activity approaches (curricula, programs and practices), but few studies report on this process. Purpose: To obtain elementary school staff's perspectives regarding how their schools are currently adopting physical activity approaches. Methods: We recruited 15 participants from four job types in an urban Texas school district to participate in semi-structured interviews. We coded and analyzed interviews using directed content analysis and iterative categorization. Results: We identified four themes pertaining to how the district, schools, and teachers contribute to the adoption of approaches. Themes included: (1) Staff identify new approaches through numerous channels; (2) Adoption occurs at multiple organizational levels; (3) District staff fulfilled a supporting role in the adoption process; and (4) School staff's perceptions of approach characteristics influence adoption. Discussion: We found that schools adopt physical activity approaches at both the district- and school-level. Additionally, multiple stakeholders played a role in the adoption process and those roles varied across approaches. Translation to Health Education Practice: Time, money, space, staff, competing priorities, limited information, the school's mission, and the benefits an approach provides to children are factors that researchers and practitioners should consider when starting a new physical activity approach.

The Multiphase Optimization STrategy (MOST) is a framework that uses three phases—preparation, optimization, and evaluation—to develop multicomponent interventions that achieve intervention EASE by strategically balancing E ffectiveness, A ffordability, S calability, and E fficiency. In implementation science, optimization of the intervention requires focus on the implementation strategies—things that we do to deliver the intervention—and implementation outcomes. MOST has been primarily used to optimize the components of the intervention related to behavioral or health outcomes. However, innovative opportunities to optimize discrete (i.e. single strategy) and multifaceted (i.e. multiple strategies) implementation strategies exist and can be done independently, or in conjunction with, intervention optimization. This article details four scenarios where the MOST framework and the factorial design can be used in the optimization of implementation strategies: (i) the development of new multifaceted implementation strategies; (ii) evaluating interactions between program components and a discrete or multifaceted implementation strategies; (iii) evaluating the independent effects of several discrete strategies that have been previously evaluated as a multifaceted implementation strategy; and (iv) modification of a discrete or multifaceted implementation strategy for the local context. We supply hypothetical school-based physical activity examples to illustrate these four scenarios, and we provide hypothetical data that can help readers make informed decisions derived from their trial data. This manuscript offers a blueprint for implementation scientists such that not only is the field using MOST to optimize the effectiveness of an intervention on a behavioral or health outcome, but also that the implementation of that intervention is optimized. [ABSTRACT FROM AUTHOR]

Compare the diet quality of a meal consumed at a community café (café meals), a pay-what-you-can restaurant, to a meal consumed for an equivalent eating occasion on the day before (comparison meal) by guests with food insecurity. Dietary recalls were collected from café guests with food insecurity to determine the Healthy Eating Index-2020 (HEI-2020) total and component scores. Healthy Eating Index-2020 scores were compared between meals using paired-sample t tests and Wilcoxon signed-rank tests. Most participants (n = 40; 80% male; 42.5% Black) had very low food security (70.0%). Café meal had a higher HEI-2020 total score (46.7 ± 10.5 vs 34.4 ± 11.6; P < 0.001) and total vegetables (2.6 ± 2.0 vs 1.2 ± 1.7; P = 0.004), total fruits (2.1 ± 2.2 vs 0.6 ± 1.5; P < 0.001), whole fruits (1.6 ± 2.0 vs 0.3 ± 0.9; P < 0.001), and refined grains (7.8 ± 3.5 vs 3.9 ± 3.9; P < 0.001) scores than comparison meals. The café meal had better diet quality than the comparison meal, suggesting its potential for improving diet quality among guests with food insecurity. [ABSTRACT FROM AUTHOR]

A seminal report, released in 2001 by the Institute of Medicine, spurred research on the design, implementation, and evaluation of multilevel interventions targeting obesity and related behaviors. By addressing social and environmental factors that support positive health behavior change, interventions that include multiple levels of influence (e.g., individual, social, structural) aim to bolster effectiveness and, ultimately, public health impact. With more than 20 years of multilevel obesity intervention research to draw from, this review was informed by published reviews (n = 51) and identified intervention trials (n = 103), inclusive of all ages and countries, to elucidate key learnings about the state of the science. This review provides a critical appraisal of the scientific literature related to multilevel obesity interventions and includes a description of their effectiveness on adiposity outcomes and prominent characteristics (e.g., population, setting, levels). Key objectives for future research are recommended to advance innovations to improve population health and reduce obesity. [ABSTRACT FROM AUTHOR]

Physical education is a key component to improve youth health, but there is limited information on physical education delivery in different formats. We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio. We distributed questionnaires (2020–2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n = 216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables. Among 165 schools, 10% (n = 17) offered in-person instruction, 31% (n = 51) offered remote instruction, and 59% offered both (n = 97). Results revealed higher in-person PE minutes (77.2 ± 7.3) compared to remote minutes (67.1 ± 14.6), but results were not significantly different (p =.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p <.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p <.001). Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE. Efforts are needed to improve remote PE to reinforce high-quality PE in the future. [ABSTRACT FROM AUTHOR]

Background: Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity. Methods: The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children's and adolescents' physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation. Results: The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure. Conclusions: The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming. [ABSTRACT FROM AUTHOR]

Background: Active transportation (AT) increases physical activity, reducing cardiometabolic risk among non-Hispanic white adults; however, research on these linkages in racial/ethnic minority women is sparse. This study explored these associations in 327 African American and Hispanic/Latina women. Methods: This analysis used sociodemographics, self-reported AT via the International Physical Activity Questionnaire, accelerometer-measured moderate to vigorous physical activity (MVPA), body mass index, systolic and diastolic blood pressures, resting heart rate, and body fat percentage (BF). Unadjusted bivariate associations and associations adjusted for sociodemographic factors were examined. Results: AT users had higher levels of objective MVPA, but this was not statistically significant. AT was not associated with cardiometabolic risk factors in adjusted models (Ps > .05); however, systolic blood pressure was lower for AT users. MVPA was negatively associated with diastolic blood pressure and BF overall, body mass index and BF in African American women, and BF in Hispanic/Latina women (Ps < .05). Conclusions: MVPA was associated with improvements in body mass index, diastolic blood pressure, and BF among minority women, and these relationships may vary by race/ethnicity. Practitioners should recommend increased participation in MVPA. Future research, using longitudinal designs should investigate AT's potential for increasing MVPA and improving cardiometabolic health along with the role of race/ethnicity in these associations. [ABSTRACT FROM AUTHOR]

Implementation of evidence-based interventions (EBIs) can help to increase colorectal cancer screening (CRCS). Potential users of CRCS EBIs are often unclear about the specific features, logic, and core elements of existing EBIs, making it challenging to use or adapt them. We used EBI Mapping, a systematic process developed from Intervention Mapping that identifies an EBI's components and logic, to characterize existing CRCS EBIs from the National Cancer Institute's Evidence-Based Cancer Control Programs website. The resulting information can facilitate intervention adoption, adaptation, and/or implementation. Two trained coders independently coded intervention materials to describe intervention components and logic (n = 20). We display CRCS EBI components (potential mechanism of change) using evidence tables and heat maps. All EBIs addressed completion of at least one CRCS behavior (stool-based test, n = 9; stool-based test or another CRCS test, n = 8; colonoscopy, n = 3; colonoscopy or sigmoidoscopy, n = 1). The psychosocial determinants most frequently addressed by these interventions were knowledge (n = 19), attitudes (n = 17), risk perception/perceived susceptibility (n = 16), skills (n = 15), and overcoming barriers (n = 15). Multi-level EBIs (n = 9) attempted to change an average of 2.1 ± 1.1 conditions in the patients' environment (e.g. accessibility of CRCS); only four EBIs used environmental change agents (e.g. providers, nurses). From the heat maps of EBIs, we describe common theoretical change methods' (e.g. facilitation) used for addressing determinants (e.g. overcoming barriers). EBI Mapping can help users identify important components of a CRCS EBI's logic; these proposed mechanisms of action can inform adoption, adaptation, and implementation in new settings, and facilitate scale up of EBIs. [ABSTRACT FROM AUTHOR]

Multiple types of school staff members (e.g. classroom teachers, principals) are involved in implementing physical activity programs (e.g. classroom-based, gym), but factors specific to their job responsibilities may inhibit their ability to implement programming effectively. Thus, implementation strategies tailored by job type may be needed. We compare perceptions of behavioral constructs related to implementation of school-based physical activity programs, by job type, among school staff. School staff (n = 139), including principals/assistant principals (n = 21), physical education teachers (n = 41), and classroom teachers (n = 77), from elementary schools (n = 25), completed a cross-sectional survey measuring perceptions of attitudes, barriers, knowledge, and outcome expectations related to the implementation of physical activity programs. We compared constructs between job types using complex samples general linear models. Classroom teachers reported more perceived implementation barriers, lower physical activity knowledge, and lower outcome expectations than physical education teachers. Principals reported more perceived implementation barriers than physical education teachers. Classroom teachers reported lower physical activity knowledge than principals. Attitudes towards physical activity were not different by job type. Each job type has a unique constellation of factors affecting their capacity to implement physical activity programs. Understanding these differences enables tailoring of implementation strategies by job type. [ABSTRACT FROM AUTHOR]

We examined individual and parental demographics and home environment factors associated with locomotor skills in predominantly Hispanic preschool-aged children. We used questionnaires to survey parents, included inquiries regarding parenting practices, parents' physical activity levels, and home-based physical activity resources; and we administered the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the CHAMPS Motor Skills Protocol (CMSP) to children to measure the quantity and quality of their locomotor skills. Participants were 144 parents and their children (78.9% Hispanic, 49.3% girls) recruited from urban, community-based childcare and education centers. We examined the relationship between survey measures and PACER and CMSP scores with forward-selection stepwise linear regression models. Overall, 142 children completed the PACER, and 91 completed the CMSP. At the individual level, a child's age was positively associated with both PACER and CMSP scores, and girls had lower PACER scores than boys. In the home environment, parental promotion of more screen time was associated with a higher children's PACER score. In addition, higher parent concern for children's safety was associated with a lower PACER score. We identified several physical activity promoting parent practices as new home environment factors related to the preschool-aged children's locomotor development. Additional studies are needed to test new hypotheses generated from these data. ClinicalTrials.gov Identifier: NCT03261492 (date of registration 8/25/17) [ABSTRACT FROM AUTHOR]