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Kuhn AP, Parker EA, Lane HG, Deitch R, Wang Y, Turner L, Hager ER. Physical Activity, Confidence, and Social Norms Associated With Teachers' Classroom Physical Activity Break Implementation. Health Promot Pract 2024; 25:358-367. [PMID: 36415177 DOI: 10.1177/15248399221136857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Despite the benefits of classroom physical activity breaks on student health and academic outcomes, more research is needed to understand what factors may be associated with classroom physical activity break implementation, to bolster buy-in from school stakeholders and increase implementation. This quantitative study examined frequency of classroom physical activity break implementation in relation to (1) objectively measured teachers' physical activity and sedentary behaviors, (2) confidence for leading classroom physical activity breaks, (3) social norms (perceptions of other teachers' classroom physical activity break implementation), and (4) teacher- and school-level demographics. In total, 153 classroom teachers in 20 elementary and middle schools completed a survey including classroom physical activity break frequency, confidence, and social norms, one item each, dichotomized (1 = "most/all the time" OR "agree/strongly agree"). Accelerometry assessed total activity and daytime sedentary behavior. Analyses included multilevel binary logistic regression. Teachers were 90% female, 68% White, and 55% in elementary schools. Odds of implementing classroom physical activity breaks were lower among middle school teachers, 14 times greater among those with greater confidence, and over 17 times greater when teachers perceived others frequently implementing classroom physical activity breaks. Teacher activity was not associated with classroom physical activity break implementation. Future interventions to increase classroom physical activity break implementation should focus on increasing teachers' confidence to lead classroom physical activity breaks and creating more buy-in from classroom teachers to enhance each school's culture of health. By enhancing teacher confidence and social norms for implementing classroom physical activity breaks, we may increase school-based physical activity opportunities.
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Affiliation(s)
| | | | | | - Rachel Deitch
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yan Wang
- The George Washington University, Washington, DC, USA
| | | | - Erin R Hager
- University of Maryland School of Medicine, Baltimore, MD, USA
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Tsai MM, Olarte DA, Hager ER, Cohen JFW, Turner L. Prevalence of Recess and Supportive Practices at a Nationwide Sample of Public Elementary Schools in the United States. J Sch Health 2024; 94:366-373. [PMID: 37395014 DOI: 10.1111/josh.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Recess provides an important opportunity for children to be physically active during weekdays. Updated, nationally representative, prevalence estimates of elementary school recess practices in the United States are needed. METHODS Surveys were sent to a nationally representative sample of 1010 public elementary schools in the 2019-2020 school year. Results were compared by region (Northeast, Midwest, South, West), urbanicity, size, racial and ethnic composition, and socioeconomic status (percent eligible for free/reduced-priced meals). RESULTS A total of 559 responses were obtained. About 87.9% of schools provided at least 20 minutes of daily recess and 26.6% had trained recess supervisors. Most schools did not allow students to voluntarily stay inside during recess (71.6%) and around half prohibited withholding recess for poor behavior (45.6%) or to complete schoolwork (49.5%). Several practices varied by region, and withholding recess was more prevalent among schools with lower student socioeconomic makeup. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Regular national surveillance of recess practices can inform policy needs and efforts to advance equitable access to recess. Quality and access should be considered when developing recess policies. CONCLUSIONS Most United States elementary schools provide recess. However, regional and economic disparities exist. Promoting supportive practices for recess, particularly for schools serving lower-income communities, is necessary.
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Affiliation(s)
- Marisa M Tsai
- University of California Berkeley, School of Public Health, Division of Epidemiology, Berkeley Way West, Berkeley, CA
| | - Deborah A Olarte
- Center for Health Inclusion, Research and Practice, Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, North Andover, MA
| | - Erin R Hager
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, MD
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice, Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA; Adjunt Professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
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Klein LM, Habib DRS, Edwards LV, Hager ER, Berry AA, Connor KA, Calderon G, Liu Y, Johnson SB. Parents' Trust in COVID-19 Messengers and Implications for Vaccination. Am J Health Promot 2024; 38:364-374. [PMID: 37766398 DOI: 10.1177/08901171231204480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE To characterize factors associated with parents' trust in messengers of COVID-19 guidance and determine whether trust in their doctors is associated with COVID-19 vaccination. DESIGN Web-based and mailed survey (January-June 2022). SETTING Maryland, USA. SUBJECTS 567 parents/caregivers of public elementary and middle school students. MEASURES Parents rated trust in 9 messengers on a 4-point scale ["not at all" (0) to "a great deal" (3)], dichotomized into low (0-1) vs high (2-3). They reported on health insurance, income, race, ethnicity, education, sex, urbanicity, political affiliation, and COVID-19 vaccination. ANALYSIS ANOVA and t-tests were computed to compare overall trust by parent characteristics. Multivariable logistic regression was run to evaluate factors associated with high trust for each messenger. Multivariable logistic regression was used to evaluate the relationship between trust in doctors and odds of COVID-19 vaccination. RESULTS Most trusted messengers were doctors (M = 2.65), family members (M = 1.87), and schools (M = 1.81). Parents' trust varied by racial identity, sex, urbanicity, health insurance, and political affiliation. Greater trust in their or their child's doctor was associated with greater odds of child (aOR: 2.97; 95% CI: 1.10, 7.98) and parent (aOR: 3.30; 95% CI: 1.23, 1.47) vaccination. CONCLUSION Parent characteristics were associated with trust, and trust was linked to vaccination. Public health professionals should anticipate variability in trusted messengers to optimize uptake of public health guidance.
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Affiliation(s)
- Lauren M Klein
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel R S Habib
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Lorece V Edwards
- School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Erin R Hager
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea A Berry
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine A Connor
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gabriela Calderon
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yisi Liu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Prichett L, Berry AA, Calderon G, Wang J, Hager ER, Klein LM, Edwards LV, Liu Y, Johnson SB. Parents' and Caregivers' Support for in-School COVID-19 Mitigation Strategies: A Socioecological Perspective. Health Promot Pract 2024:15248399231221160. [PMID: 38174691 DOI: 10.1177/15248399231221160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Informed by the social ecological model, which asserts that health behaviors and beliefs are the result of multiple levels of influence, we examined factors related to parents' support for in-school COVID-19 mitigation strategies. Using data from a survey of 567 parents/caregivers of public elementary and middle school students in eight Maryland counties, we employed regression models to examine relationships between parent-, child-, family-, school-, and community-level factors and acceptability of mitigation strategies. Acceptance of COVID-19 mitigation strategies was positively correlated with child- and family-level factors, including child racial identity (parents of Black children were more accepting than those of White children, odds ratio [OR]: 2.5, 95% confidence interval [CI] = [1.5, 4.1]), parent receipt of the COVID-19 vaccine (OR: 2.4, 95% CI = [1.5, 3.7]), and parent Democrat or Independent political affiliation (compared with Republican affiliation, OR: 4.2, 95% CI = [2.6, 6.7]; OR: 2.2, 95%CI = [1.3, 3.8], respectively). Acceptance was also positively associated with parents' perceptions of their school's mitigation approach, including higher school mitigation score, indicating more intensive mitigation policies (OR: 1.1, 95% CI = [1.0, 1.1]), better school communication about COVID-19 (OR: 1.7, 95% CI = [1.4, 1.9]) and better school capacity to address COVID-19 (OR: 1.9, 95% CI = [1.5, 2.4]). Community-level factors were not associated with acceptance. Child- and parent-level factors identified suggest potential groups for messaging regarding mitigation strategies. School-level factors may play an important role in parents' acceptance of in-school mitigation strategies. Schools' capacity to address public health threats may offer an underappreciated and modifiable setting for disseminating and reinforcing public health guidance.
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Affiliation(s)
- Laura Prichett
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea A Berry
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - June Wang
- Johns Hopkins University, Baltimore, MD, USA
| | - Erin R Hager
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren M Klein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Yisi Liu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sara B Johnson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dou N, Deitch R, Kowalski AJ, Kuhn A, Lane H, Parker EA, Wang Y, Zafari Z, Black MM, Hager ER. Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study. Contemp Clin Trials 2024; 136:107408. [PMID: 38072192 PMCID: PMC10922699 DOI: 10.1016/j.cct.2023.107408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. METHODS The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. CONCLUSION Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.
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Affiliation(s)
- Nan Dou
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Rachel Deitch
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Alysse J Kowalski
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Ann Kuhn
- Department of Exercise and Nutrition Sciences, University at Buffalo, The State University of New York, 401 Kimball Tower, Buffalo, NY 14214, USA.
| | - Hannah Lane
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701, USA.
| | - Elizabeth A Parker
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, USA.
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC 20052, USA.
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 20 North Pine Street, Baltimore, MD 21201, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, 737 West Lombard Street, Baltimore, MD 21201, USA; RTI International, Research Triangle Park, NC 27709, USA.
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
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Dou N, Kowalski AJ, Lane H, Hatton R, Black MM, Hager ER. Perceptions of Parental Support for Physical Activity and Healthy Eating among School-age Children During COVID-19 pandemic. J Healthy Eat Act Living 2023; 3:76-99. [PMID: 38077293 PMCID: PMC10699858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Family routines play a key role in promoting child health behaviors. This study 1) describes changes in children's perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explores how sex, age, and pandemic-related economic stressors relate to changes. Children's perceptions of family routines were assessed using four subscales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Linear mixed models assessed changes in perceptions and associated factors (child age and sex; caregiver(s) job loss during pandemic). Children (N=277) were aged 9.3-15.5y at pandemic onset (March 2020), dichotomized by median age (12.1y) as younger and older. Children's perceptions of PA-policies (pre-pandemic mean=15.4) and Diet-policies (pre-pandemic mean=26.3) increased significantly from pre- to early (b=1.2 and 2.3, respectively) and mid-pandemic (b=1.0 and 1.2, respectively). Diet-rules (pre-pandemic mean=10.8) decreased significantly from pre- to early (b=-1.1) and mid-pandemic (b=-2.0), with no PA-Diet-role-model changes. Younger children had a greater increase in perceived PA-policies and Diet-policies across the pandemic. Females (59.9%) had a greater decrease in perceived Diet-rules across the pandemic and less increase in Diet-policies and PA-Diet-role-model from pre- to early pandemic. Children whose caregiver(s) lost employment (51.8%) perceived a greater increase in PA-policies. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules for diet during the pandemic. Future research is needed to understand how changes in family routines relate to PA and healthy eating behaviors.
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Affiliation(s)
- Nan Dou
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA 21205
| | - Alysse J. Kowalski
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA 21205
| | - Hannah Lane
- Department of Population Health Sciences, Duke University School of Medicine, USA
| | - Ross Hatton
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA 21205
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, USA
| | - Erin R. Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA 21205
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Summers A, Calderon GV, Klein LM, Wang J, Dinh J, Suliman T, Hager ER, Edwards L, Collins ME, Johnson SB. Development of a community-informed communication toolkit to prevent spread of viral illness in schools, including SARS-COV-2. Front Public Health 2023; 11:1285453. [PMID: 37954051 PMCID: PMC10634313 DOI: 10.3389/fpubh.2023.1285453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Schools were uniquely impacted during the COVID-19 (SARS-COV-2) pandemic. We sought to elucidate how parents/guardians of elementary and middle school students in Maryland navigated the return to in-person school following remote instruction. We also sought to understand how they perceived communication about school-based COVID-19 mitigation strategies and their preferences for the content and format of public health communication about COVID-19 mitigation in schools. Methods We engaged a community advisory board comprised of key partners and implemented a survey and focus groups. Results Results indicated that parents/guardians wanted clearer communication about COVID-19 mitigation policies in schools and were experiencing fatigue and confusion. These insights informed the development of a tailorable communication toolkit. The toolkit was designed to (1) inform parents/guardians about the importance and effectiveness of mitigation strategies for preventing viral spread to keep children in school, (2) promote a sense of community and support, and (3) help school communication teams effectively communicate information about mitigation strategies being implemented. Discussion We describe a process for leveraging schools as a trusted messenger, engaging school communities in the development of communication messages, and utilizing a tailorable communication toolkit in the context of shifting public health guidance and local needs. The toolkit development and dissemination process offers a model for targeting public health messaging to parents/guardians in school settings.
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Affiliation(s)
- August Summers
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Gabriela V. Calderon
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Lauren M. Klein
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - June Wang
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Janny Dinh
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina Suliman
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Erin R. Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorece Edwards
- School of Community Health & Policy, Morgan State University, Baltimore, MD, United States
| | - Megan E. Collins
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Wang J, Calderon G, Hager ER, Edwards LV, Berry AA, Liu Y, Dinh J, Summers AC, Connor KA, Collins ME, Prichett L, Marshall BR, Johnson SB. Identifying and preventing fraudulent responses in online public health surveys: Lessons learned during the COVID-19 pandemic. PLOS Glob Public Health 2023; 3:e0001452. [PMID: 37610999 PMCID: PMC10446196 DOI: 10.1371/journal.pgph.0001452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
Web-based survey data collection has become increasingly popular, and limitations on in-person data collection during the COVID-19 pandemic have fueled this growth. However, the anonymity of the online environment increases the risk of fraudulent responses provided by bots or those who complete surveys to receive incentives, a major risk to data integrity. As part of a study of COVID-19 and the return to in-person school, we implemented a web-based survey of parents in Maryland between December 2021 and July 2022. Recruitment relied, in part, on social media advertisements. Despite implementing many existing best practices, we found the survey challenged by sophisticated fraudsters. In response, we iteratively improved survey security. In this paper, we describe efforts to identify and prevent fraudulent online survey responses. Informed by this experience, we provide specific, actionable recommendations for identifying and preventing online survey fraud in future research. Some strategies can be deployed within the data collection platform such as careful crafting of survey links, Internet Protocol address logging to identify duplicate responses, and comparison of client-side and server-side time stamps to identify responses that may have been completed by respondents outside of the survey's target geography. Other strategies can be implemented during the survey design phase. These approaches include the use of a 2-stage design in which respondents must be eligible on a preliminary screener before receiving a personalized link. Other design-based strategies include within-survey and cross-survey validation questions, the addition of "speed bump" questions to thwart careless or computerized responders, and the use of optional open-ended survey questions to identify fraudsters. We describe best practices for ongoing monitoring and post-completion survey data review and verification, including algorithms to expedite some aspects of data review and quality assurance. Such strategies are increasingly critical to safeguarding survey-based public health research.
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Affiliation(s)
- June Wang
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, Maryland, United States of America
| | - Gabriela Calderon
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Erin R. Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lorece V. Edwards
- School of Community Health and Policy, Morgan State University, Baltimore, Maryland, United States of America
| | - Andrea A. Berry
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yisi Liu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Janny Dinh
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - August C. Summers
- Johns Hopkins Center for Communications Programs, Baltimore, Maryland, United States of America
| | - Katherine A. Connor
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Megan E. Collins
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, United States of America
| | - Laura Prichett
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Beth R. Marshall
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Olarte DA, Tsai MM, Chapman L, Hager ER, Cohen JFW. Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review. Nutrients 2023; 15:2951. [PMID: 37447277 DOI: 10.3390/nu15132951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).
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Affiliation(s)
- Deborah A Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Marisa M Tsai
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, USA
| | - Leah Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA
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Kuhn AP, Thompson HR, Webster CA, Burgeson C, Chriqui J, Okutoyi T, Hager ER. Physical Education Teachers' Perceived Effectiveness in Association with Student Attendance, Teacher Adaptability, External Educational Supports, and Teaching Format During the COVID-19 Pandemic. J Healthy Eat Act Living 2022; 2:97-112. [PMID: 37771476 PMCID: PMC10521999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Spring 2020 pandemic-control policies included an abrupt shift to remote teaching, which may have affected physical education (PE) teachers' perceived effectiveness. This study examined K-12 PE teachers' perceived effectiveness in association with student attendance, teacher adaptability, PE supports, teaching format (in-person, remote synchronous, remote asynchronous, etc.), and teacher- and school-level demographics at three time points (pre-pandemic 2019-early 2020, Spring 2020, 2020-2021 school year). An electronic survey was developed by an expert panel and distributed to U.S. public school PE teachers (convenience sampling via school health-related organizations). For analyses, teacher perceived effectiveness was dichotomized (very/extremely effective= "1"; not at all/slightly/moderately effective= "0"). Logistic regression models assessed associations between perceived effectiveness and independent variables (student attendance, teacher adaptability, PE supports, teaching format, and demographic variables) at each time point. Respondents (n=134; M age=46) were mostly female (62%), general PE teachers (82%, versus adapted), had a graduate degree (66%), had >11 years of teaching experience (63%), and from 26 states. Perception of being very/extremely effective was highest pre-pandemic 2019-early 2020 (93%), lowest in Spring 2020 (12%), and recovered somewhat in 2020-2021 (45%). During the 2020-2021 school year, teachers had greater odds of perceiving they were more effective if they reported having higher student attendance (OR 1.06 [CI:1.02-1.09], p>.001) and higher adaptability (OR 1.22 [CI: 1.09-1.37], p>.001), adjusting for gender, education level, years of experience, grade level taught, and Title I status. Professional development opportunities are needed for remote teaching of PE to enhance teachers' adaptability and perceived effectiveness during potential future school closures.
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Affiliation(s)
- Ann Pulling Kuhn
- Department of Pediatrics, University of Maryland School of Medicine,
USA
| | - Hannah R. Thompson
- Community Health Sciences, School of Public Health, University of California Berkeley,
USA
| | - Collin A. Webster
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham Dubai,
UAE
| | | | - Jamie Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago,
USA
| | - Tevin Okutoyi
- Department of Pediatrics, University of Maryland School of Medicine,
USA
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine,
USA
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health,
USA
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11
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McGuirt JT, Lane H, Cooper MC, Sessoms-Parks L, Pulling Kuhn A, Hager ER. Geospatial Reach of the Maryland COVID-19 School Meals Response: Spring 2020. J Nutr Educ Behav 2022; 54:957-963. [PMID: 35987904 PMCID: PMC9385400 DOI: 10.1016/j.jneb.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Examine characteristics of pandemic meal site (n = 602) location and meals served per site in Maryland, Spring 2020, following federal/state waivers for local meal site placement decision-making. METHODS Using geographic information systems, we connected meal sites to census tract-level data and generated service areas from sites and distances from population-weighted census tract centroids to the closest pandemic meal site. Regression analysis determined associations of census tract pandemic meal site count and meals served per site with socioeconomic and demographic variables. RESULTS Census tracts with more meal sites were urban (P < 0.001), food deserts (P < 0.001), and had higher percentages of children in poverty (P < 0.001). Sites serving fewer meals were in food deserts (P < 0.001) and areas with more children in poverty (P < 0.001). CONCLUSIONS AND IMPLICATIONS Waivers allowing local meal site placement decision-making supported meal sites in high-need areas. Geospatial approaches could optimize site locations to ensure maximum reach to populations in need. Additional supports may be needed to ensure children in poverty areas receive meals distributed at these sites.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC.
| | - Hannah Lane
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - M Chela Cooper
- Office of School and Community Nutrition Programs, Maryland State Department of Education, Baltimore, MD
| | - Leslie Sessoms-Parks
- Office of School and Community Nutrition Programs, Maryland State Department of Education, Baltimore, MD
| | - Ann Pulling Kuhn
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD
| | - Erin R Hager
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD
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12
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Trude ACB, Ali SH, Lowery CM, Vedovato GM, Lloyd-Montgomery JM, Hager ER, Black MM. A click too far from fresh foods: A mixed methods comparison of online and in-store grocery behaviors among low-income households. Appetite 2022; 175:106038. [PMID: 35421540 DOI: 10.1016/j.appet.2022.106038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/09/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
A recent policy in the U.S. authorized monthly benefits from a nutrition assistance program - Supplemental Nutrition Assistance Program (SNAP) - to be used online to increase grocery access and promote healthy eating. This study examined online grocery attitudes and purchasing behaviors among low-income SNAP-eligible households with young children with and without online grocery experience. An explanatory sequential mixed methods design was used, including a survey informed by the theory of planned behavior (TPB) and focus groups conducted between November-March 2021. In the quantitative phase, 310 Maryland residents completed an online survey assessing TPB constructs (attitudes, social norms, perceived control), and food purchase frequency online and in-store. Subsequently, 42 participated in the qualitative phase. Differences in TPB constructs and food purchases were compared between families with and without online grocery experience. Online food selection and fees were a common obstacle to online grocery purchasing. Families who had purchased groceries online (57%) had more positive attitudes and perceived fewer barriers to online shopping than those who had not. Self-reported frequency of buying fresh produce (OR = 0.34, p < 0.001), meat and seafood (OR = 0.29, p < 0.001), and sweets (OR = 0.54, p = 0.005) were lower online than in-store. Families discussed mistrust of online hired shoppers and fewer impulse purchases online as reasons for less frequent purchases of produce and sweets, respectively. Successful scale-up of the U.S. policy must address barriers to healthier purchasing behaviors to effectively promote equitable food access, such as decreasing delivery fees and improving the online food selection.
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Affiliation(s)
- Angela C B Trude
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; New York University, Steinhardt School of Culture, Education, and Human Development, Department of Nutrition and Food Studies, 411 Lafayette St, 5th Floor, New York, NY, 10003, USA.
| | - Shahmir H Ali
- New York University, School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Caitlin M Lowery
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Gabriela M Vedovato
- Federal University of Sao Paulo, Institute of Health and Society, 136 Silva Jardim, Santos, SP, 11015-020, Brazil.
| | - Joy M Lloyd-Montgomery
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; American Psychiatric Association Foundation, 800 Maine Avenue, S.W., Suite 900, Washington, DC, 20024, USA.
| | - Erin R Hager
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Baltimore, 737 W. Lombard St., Baltimore, MD, 21201, USA; RTI International, Research Triangle Park, NC, 27709, USA.
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13
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Hecht AA, Dunn CG, Kinsey EW, Read MA, Levi R, Richardson AS, Hager ER, Seligman HK. Estimates of the Nutritional Impact of Non-Participation in the National School Lunch Program during COVID-19 School Closures. Nutrients 2022; 14:1387. [PMID: 35406001 PMCID: PMC9003403 DOI: 10.3390/nu14071387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic resulted in widespread school closures, reducing access to school meals for millions of students previously participating in the US Department of Agriculture (USDA) National School Lunch Program (NSLP). School-prepared meals are, on average, more nutritious than home-prepared meals. In the absence of recent data measuring changes in children's diets during the pandemic, this article aims to provide conservative, back-of-the-envelope estimates of the nutritional impacts of the pandemic for school-aged children in the United States. We used administrative data from the USDA on the number of NSLP lunches served in 2019 and 2020 and nationally representative data from the USDA School Nutrition and Meal Cost Study on the quality of school-prepared and home-prepared lunches. We estimate changes in lunchtime calories and nutrients consumed by NSLP participants from March to November 2020, compared to the same months in 2019. We estimate that an NSLP participant receiving no school meals would increase their caloric consumption by 640 calories per week and reduce their consumption of nutrients such as calcium and vitamin D. Because 27 to 78 million fewer lunches were served per week in March-November 2020 compared to the previous year, nationally, students may have consumed 3 to 10 billion additional calories per week. As students return to school, it is vital to increase school meal participation and update nutrition policies to address potentially widening nutrition disparities.
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Affiliation(s)
- Amelie A. Hecht
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Caroline Glagola Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Eliza W. Kinsey
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | | | - Ronli Levi
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA; (R.L.); (H.K.S.)
| | | | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Hilary K. Seligman
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA; (R.L.); (H.K.S.)
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14
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Wang Y, Zhu E, Hager ER, Black MM. Maternal depressive symptoms, attendance of sessions and reduction of home safety problems in a randomized toddler safety promotion intervention trial: A latent class analysis. PLoS One 2022; 17:e0261934. [PMID: 35045101 PMCID: PMC8769292 DOI: 10.1371/journal.pone.0261934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Little is known about the association between maternal depressive symptoms and attendance at safety promotion interventions. This study used latent class analysis (LCA) to identify the profile of attendance within a toddler safety intervention and assessed its relation with maternal depressive symptoms at baseline and reduction of home safety problems over time, separately. Methods The analytic sample included 91 mothers of toddlers (mean maternal age 28.16 years) who were assigned to the safety promotion intervention group as part of a randomized trial and assessed at baseline, 6-month and 12-month follow-ups. Using LCA, we classified mothers into low and high attendance classes based on their attendance at 8 intervention sessions. We assessed maternal depressive symptoms with the Beck Depression Inventory (BDI) and home safety problems with a 9-item home safety problem observation. Results The mothers were classified into low attendance (45%) and high attendance classes (55%). The posterior probability of attending each session ranged from 0–0.29 for the low attendance class and 0.68–0.92 for the high attendance class. Each one unit increase of BDI sum score at baseline was associated with an 8% reduced odds of being in the high attendance class (aOR = 0.92, 95% CI: 0.86, 1.00, p = 0.037). The home safety problem score reduction was greater among high attendance class participants than low attendance class participants at the 6-month follow-up (b = -1.15, 95% CI:-2.09, -0.20, p = 0.018). Conclusion Maternal depressive symptoms were associated with the reduced probability of maternal attendance at toddler safety promotion sessions; high session attendance was related to greater reduction of toddler home safety problems. Identifying risk factors for maternal low attendance to interventions and developing strategies to promote attendance should lead to reductions in home safety problems and reductions in unintentional injuries among young children.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Eric Zhu
- Centennial High School, Ellicott City, Maryland, United States of America
| | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- RTI International, Research Triangle Park, North Carolina, United States of America
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15
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Kuhn AP, Kowalski AJ, Wang Y, Deitch R, Selam H, Rahmaty Z, Black MM, Hager ER. On the Move or Barely Moving? Age-Related Changes in Physical Activity, Sedentary, and Sleep Behaviors by Weekday/Weekend Following Pandemic Control Policies. Int J Environ Res Public Health 2021; 19:ijerph19010286. [PMID: 35010546 PMCID: PMC8751153 DOI: 10.3390/ijerph19010286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022]
Abstract
This study examined pre-pandemic (2017-early March 2020) to early-pandemic (Spring 2020) changes in moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary behavior/sleep (SS), by weekday/weekend, and age (preschool, elementary, middle school). We re-enrolled children from two pre-pandemic obesity prevention trials and examined differences in accelerometer-measured PA from pre-pandemic to early-pandemic across age groups using linear mixed models. Children (n = 75) were 51% multiple race/ethnicities, 29% preschool, 28% elementary, 43% middle school, 65% suburban, 21% rural, and 13% urban. Pre-pandemic to early-pandemic changes in weekday MVPA (p = 0.006), LPA (p = 0.018), and SS (p = 0.003) differed by age. On weekdays, middle schoolers' MVPA decreased 15.36 min/day (p = 0.002) and SS increased 94.36 min/day (p < 0.001) with non-significant changes among preschoolers and elementary schoolers. Compared to elementary schoolers, middle schoolers' changes in weekday MVPA (b = -16.34, p = 0.036) and SS (b = 63.28, p = 0.039) significantly differed. Declines in weekday MVPA and increases in SS among middle schoolers suggest that, compared with younger children, middle schoolers are dependent on school and recreational facilities for PA, and in their absence engage in more sedentary activities and sleep.
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Affiliation(s)
- Ann Pulling Kuhn
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (A.J.K.); (R.D.); (H.S.); (M.M.B.)
| | - Alysse J. Kowalski
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (A.J.K.); (R.D.); (H.S.); (M.M.B.)
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA;
| | - Rachel Deitch
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (A.J.K.); (R.D.); (H.S.); (M.M.B.)
| | - Helina Selam
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (A.J.K.); (R.D.); (H.S.); (M.M.B.)
| | - Zahra Rahmaty
- Department of Biology and Medicine, Institut Universitaire de Formation et de Recherche en Soins, Lausanne University Hospital, University of Lausanne, IUFRS Bureau 169—SV-A Secteur Vennes—Rte de la Corniche 10, CH-1010 Lausanne, Switzerland;
| | - Maureen M. Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (A.J.K.); (R.D.); (H.S.); (M.M.B.)
- RTI International, Research Triangle Park, Durham, NC 27709, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Erin R. Hager
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (A.J.K.); (R.D.); (H.S.); (M.M.B.)
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Correspondence: ; Tel.: +1-(410)-706-0213
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16
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Kowalski AJ, Kuhn AP, Lane HG, Trude ACB, Selam H, Hager ER, Black MM. Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children. Public Health Nutr 2021; 25:1-23. [PMID: 34889183 PMCID: PMC8943228 DOI: 10.1017/s136898002100481x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). DESIGN We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programs (e.g. CARES stimulus payment, school meals). SETTING Maryland, United States. PARTICIPANTS Economically, geographically, and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n=496). RESULTS Prevalence of risk of FI was unchanged (pre-pandemic: 22%, early-pandemic: 25%, p=0.27). Risk of early-pandemic FI was elevated for non-Hispanic Black (aRR=2.1 [95% CI 1.1, 4.0]) and Other families (aRR=2.6 [1.3, 5.4]) and families earning ≤300% federal poverty level. Among pre-pandemic food secure families, decreased income, job loss, and reduced hours were associated with increased early-pandemic FI risk (aRR=2.1 [1.2, 3.6] to 2.5 [1.5, 4.1]); CARES stimulus payment (aRR=0.5 [0.3, 0.9]) and continued school meal participation (aRR=0.2 [0.1, 0.9]) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net program participation was not associated with early-pandemic FI risk. CONCLUSIONS The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics.
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Affiliation(s)
- Alysse J Kowalski
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Ann Pulling Kuhn
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Hannah G Lane
- Duke University School of Medicine, Department of Population Health Sciences Durham, NC
| | - Angela C B Trude
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Helina Selam
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Erin R Hager
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD
- RTI International, Research Triangle Park, NC
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17
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Cohen JFW, Hecht AA, Hager ER, Turner L, Burkholder K, Schwartz MB. Strategies to Improve School Meal Consumption: A Systematic Review. Nutrients 2021; 13:3520. [PMID: 34684521 PMCID: PMC8538164 DOI: 10.3390/nu13103520] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023] Open
Abstract
School meals can play an integral role in improving children's diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students' access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., "Smarter Lunchroom") techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students' access to flavored milk. Several studies found increases in students' meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).
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Affiliation(s)
- Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
| | - Amelie A. Hecht
- Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA;
| | - Erin R. Hager
- Departments of Pediatrics and Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Kara Burkholder
- College of Liberal Arts and Science, University of Connecticut, Storrs, CT 06269, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
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18
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Pulling Kuhn A, Kim E, Lane HG, Wang Y, Deitch R, Turner L, Hager ER, Parker EA. Associations between elementary and middle school teachers' physical activity promoting practices and teacher- and school-level factors. Int J Behav Nutr Phys Act 2021; 18:66. [PMID: 34011376 PMCID: PMC8135930 DOI: 10.1186/s12966-021-01129-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Few studies have evaluated teacher- and school-level characteristics associated with implementation of recommended physical activity (PA) promoting practices. The purpose of this study is to examine associations between teachers' PA practices and: [1] teacher-level factors, including their own PA, and [2] school-level factors. METHODS This cross-sectional study examined time spent daily in light PA (LPA) and moderate-vigorous PA (MVPA) in association with 7 teacher PA practices among 288 classroom/special area teachers and teaching assistants in 20 urban, suburban and rural schools (recruited through a school wellness trial) in 4 districts. LPA and MVPA was assessed using 24-h ankle accelerometry (up to seven consecutive days). A sum score for teacher PA practices was assessed via survey (7 items; sum score range: 7-35; Cronbach's alpha = 0.73; higher scores indicate more PA promoting practices). Teacher-level factors included gender, race, self-reported height/weight, years teaching, and education. School-level factors included school type, free-and-reduced-price meal eligibility, student racial/ethnic composition, and urbanicity. Analyses included multilevel regression models, accounting for clustering within schools and adjusting for demographic covariates and school district. RESULTS Teachers were 91% female, 63% elementary, 60% white, mean age 43.2 years (SD = 11.3), and 41% obese). Teachers wore accelerometers an average of 5.8 days, spent 399.6 min in LPA (SD = 85.0) per day, 24.1 min in MVPA (SD = 14.4) per day, and the mean teacher PA practices sum score was 22.4 (SD = 5.0). Every 15-min increase in MVPA was related to an increase in teacher PA practices sum score (coeff =1.07; SE = 0.28; p < 0.001). Female gender (versus males; coeff = - 1.95; SE = 0.92, p = 0.034), an obese weight status (versus non-obese; coeff = - 1.38; SE = 0.54, p = 0.010), and teaching in a middle school (versus elementary; coeff = - 3.86; SE = 0.54, p < 0.001) were associated with lower teacher PA practices scores. LPA was not associated with teacher PA promoting practices. CONCLUSIONS Teachers with higher MVPA, but not higher LPA, and those without obesity were more likely to implement PA promoting practices that could positively impact their students' PA. Similar to prior studies, these practices were more commonly implemented in elementary schools and by male teachers. Future studies in schools should explore whether improvement of teacher health behaviors subsequently impacts student health behaviors. TRIAL REGISTRATION Clinical Trials, NCT03432715 ; Registered on 02/2/2018.
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Affiliation(s)
- Ann Pulling Kuhn
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, 737 Lombard St, Baltimore, MD 21201 USA
| | - Edward Kim
- University of Maryland, Baltimore, Baltimore, MD 21201 USA
| | - Hannah G. Lane
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27705 USA
| | - Yan Wang
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, 737 Lombard St, Baltimore, MD 21201 USA
- Department of Prevention and Community Health, George Washington University, 20052 Washington DC, USA
| | - Rachel Deitch
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, 737 Lombard St, Baltimore, MD 21201 USA
| | - Lindsey Turner
- Boise State University, College of Education, Boise, ID 83725 USA
| | - Erin R. Hager
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, 737 Lombard St, Baltimore, MD 21201 USA
| | - Elizabeth A. Parker
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 21201 Baltimore, MD USA
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19
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Pulling Kuhn A, Cockerham A, O’Reilly N, Bustad J, Miranda V, Loboda TV, Black MM, Hager ER. Home and Neighborhood Physical Activity Location Availability among African American Adolescent Girls Living in Low-Income, Urban Communities: Associations with Objectively Measured Physical Activity. Int J Environ Res Public Health 2021; 18:ijerph18095003. [PMID: 34065051 PMCID: PMC8125901 DOI: 10.3390/ijerph18095003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
Based on the ecological model of active living, the neighborhood environment may relate to individual physical activity (PA) behaviors. The purposes of this study were to (1) generate a replicable neighborhood-level physical activity location availability score (PALAS) from data variables associated with physical activity among adolescents and adults, and apply this score to Baltimore City, Maryland, and (2) determine if relationships exist between PA and PA location availability. Geographic information systems (GISs) were used to create the PALAS. Using linear regression models, we examined relations between objectively measured PA among low-income, urban, predominantly African American adolescent girls (n = 555, 2009-2012 data collection), and the PALAS rating of their neighborhood environment (neighborhood PALAS) and their home neighborhood area (PALAS variables/subcomponents within 0.25 miles of the home). A PALAS map of the study area was created, illustrating neighborhoods varying in availability and variety of PA locations. After adjusting for confounders, a higher neighborhood PALAS (β = 0.10, p = 0.041) and the presence of a recreation center in the home neighborhood area (β = 0.46, p = 0.011) were associated with more minutes per day spent in moderate to vigorous PA. Policy makers and stakeholders should consider increasing access to PA locations as a strategy to promote PA among adolescent girls.
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Affiliation(s)
- Ann Pulling Kuhn
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (M.M.B.)
| | - Alexandra Cockerham
- Cartographic Products and Services Branch, U.S. Census Bureau, Suitland, MD 20746, USA;
| | - Nicole O’Reilly
- School of Social Work, Boise State University, Boise, ID 83725, USA;
| | - Jacob Bustad
- Department of Kinesiology, Towson University, Towson, MD 21204, USA;
| | - Victor Miranda
- Baltimore City Department of Recreation and Parks, Baltimore, MD 21217, USA;
| | - Tatiana V. Loboda
- Department of Geographical Sciences, University of Maryland, College Park, MD 21043, USA;
| | - Maureen M. Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (M.M.B.)
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
- RTI International, Research Triangle Park, Durham, NC 27709, USA
| | - Erin R. Hager
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.P.K.); (M.M.B.)
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
- Correspondence: ; Tel.: +1-(410)-706-0213
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20
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Black MM, Hager ER, Wang Y, Hurley KM, Latta LW, Candelaria M, Caulfield LE. Toddler obesity prevention: A two-generation randomized attention-controlled trial. Matern Child Nutr 2021; 17:e13075. [PMID: 32885909 PMCID: PMC7729807 DOI: 10.1111/mcn.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022]
Abstract
Rapid weight gain increases risks of obesity and associated co-morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler-mother physical activity, mealtime interactions and fruit/vegetable intake. The randomized three-arm, eight-session, 4-month trial, conducted 2009-2013, included two intervention arms (responsive parenting and maternal lifestyle) and an attention control (home safety). Baseline and 6- and 12-month follow-up evaluations included weight and length/height, ankle accelerometry, video-recorded mealtime interactions (Emotional Availability Scales) and 24-h diet recalls (Healthy Eating Index-2015 [HEI-2015]). Analyses used linear mixed-effects models with repeated measures comparing intervention versus control changes in BMI z score. We recruited 277 racially mixed (70% African American) toddler-mother dyads (mean ages 20.1 months and 27.3 years) from US WIC and primary care clinics and randomized them into intervention versus control; 31% toddlers and 73% mothers were overweight/obese. At follow-up, changes in the rate of toddler BMI z score and maternal BMI were non-significant. Maternal lifestyle group toddlers and mothers spent 24.43 and 11.01 more minutes in physical activity (95% confidence interval [CI]: 2.55, 46.32, and 95% CI: 1.48, 20.54, respectively). Fruit intake increased in both intervention groups. Hostile mealtime interactions increased in the maternal lifestyle group, and in supplementary analyses, mealtime interactions were significantly higher in the responsive parenting group than in the maternal lifestyles group, suggesting that toddler dietary interventions include responsive parenting. Intervention effects were stronger among older versus younger toddlers. Despite no impact on weight gain, additional research should examine integrated two-generation responsive parenting and maternal lifestyle interventions among toddler-mother dyads.
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Affiliation(s)
- Maureen M. Black
- Department of Pediatrics and Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Erin R. Hager
- Department of Pediatrics and Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Yan Wang
- Department of Pediatrics and Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Kristen M. Hurley
- Center for Human NutritionThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Laura W. Latta
- Institute for Innovation and ImplementationUniversity of Maryland School of Social WorkBaltimoreMarylandUSA
| | - Margo Candelaria
- Institute for Innovation and ImplementationUniversity of Maryland School of Social WorkBaltimoreMarylandUSA
| | - Laura E. Caulfield
- Center for Human NutritionThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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21
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O'Reilly NL, Hager ER, Harrington D, Black MM. Assessment of risk for food insecurity among African American urban households: utilizing cumulative risk indices and latent class analysis to examine accumulation of risk factors. Transl Behav Med 2020; 10:1322-1329. [PMID: 33421086 DOI: 10.1093/tbm/ibaa027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
African American caregivers in low-income, urban communities have high rates of food insecurity. Unemployment, education, smoking, stress, and depressive symptoms are associated with household food insecurity. A cumulative risk model suggests that accumulation of risk may compound food insecurity risk, and certain risk factors are more likely to co-occur. This study utilizes two approaches to examine food insecurity risk among African American caregivers with an adolescent daughter-a cumulative risk index to examine accumulation of risk and food insecurity risk; latent class analysis (LCA) to determine if certain risk profiles exist and their relation to food insecurity risk. Caregivers completed surveys including demographic, psychosocial, and behavioral questions (to create a cumulative risk index) and a validated 2-item food insecurity screen. LCA was used to identify risk profiles. Logistic regression was used to examine relations between cumulative risk, risk profiles, and food insecurity risk. Each additional cumulative risk index factor was associated with a 54% increase in odds of risk of food insecurity. LCA identified three subgroups: high stress/depression (class #1), low education/low stress and depression (class #2), and low risk overall (class #3). Odds of food insecurity risk were 4.7 times higher for class #1, and 1.5 times higher for class #2 compared with class #3. This study contributes to understanding of how food insecurity risk relates to cumulative risk and risk profiles. Findings can be used to improve food insecurity risk screening in clinical settings, enhancing intervention/referral for food security risk and mental health among African American caregivers and their households.
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Affiliation(s)
- Nicole L O'Reilly
- School of Social Work, Boise State University, Boise, ID.,School of Social Work, University of Maryland, Baltimore, Baltimore, MD
| | - Erin R Hager
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.,Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, MD
| | - Donna Harrington
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD
| | - Maureen M Black
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.,Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, MD.,RTI International, Research Triangle Park, NC
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22
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Slaton A, Kowalski AJ, Zemanick A, Pulling Kuhn A, Hager ER, Black MM. Motor Competence and Attainment of Global Physical Activity Guidelines among a Statewide Sample of Preschoolers. Int J Environ Res Public Health 2020; 17:ijerph17228546. [PMID: 33217996 PMCID: PMC7698764 DOI: 10.3390/ijerph17228546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
Global physical activity guidelines for preschoolers include 60 min of moderate-to-vigorous physical activity (MVPA) daily. This study, based on the developmental model of motor skill competence, examines how motor competence relates to preschoolers’ likelihood of meeting global guidelines using ankle accelerometry. We measured physical activity using 24-h ankle-placement accelerometry (Actical) for at least two consecutive days (87% with six-seven days), motor competence using the Test of Gross Motor Development-2 (TGMD-2), and BMI-for-age z-scores (BMIz) using anthropometry and age- and sex-specific CDC norms. Caregivers provided demographic characteristics of children’s age, sex, and race. We used multivariable logistic regression to examine how motor competence, BMIz weight status, and demographic characteristics related to meeting global physical activity guidelines. The sample included 588 preschoolers, age 3–5 years; 55% male; 60% white; and 28% overweight/obese; 75% attained the recommended 60 min of MVPA per day. The odds of meeting MVPA guidelines were associated with higher gross motor quotient, higher object control scores, sex (male), age (older), and race (white), but not with BMIz weight status. Findings support the use of 24-h ankle accelerometry among preschoolers and are consistent with the developmental model of motor competence applied to preschoolers, whereby object control competence relates positively to attaining global physical activity guidelines.
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Affiliation(s)
- Anthony Slaton
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY 11549, USA
| | - Alysse J. Kowalski
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
| | - Amy Zemanick
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
| | - Ann Pulling Kuhn
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
| | - Erin R. Hager
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Maureen M. Black
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.S.); (A.J.K.); (A.Z.); (A.P.K.); (E.R.H.)
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
- RTI International, Research Triangle Park, Durham, NC 27709, USA
- Correspondence:
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23
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Kinsey EW, Hecht AA, Dunn CG, Levi R, Read MA, Smith C, Niesen P, Seligman HK, Hager ER. School Closures During COVID-19: Opportunities for Innovation in Meal Service. Am J Public Health 2020; 110:1635-1643. [PMID: 32941069 PMCID: PMC7542295 DOI: 10.2105/ajph.2020.305875] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/04/2022]
Abstract
In 2019, the National School Lunch Program and School Breakfast Program served approximately 15 million breakfasts and 30 million lunches daily at low or no cost to students.Access to these meals has been disrupted as a result of long-term school closures related to the COVID-19 pandemic, potentially decreasing both student nutrient intake and household food security. By the week of March 23, 2020, all states had mandated statewide school closures as a result of the pandemic, and the number of weekly missed breakfasts and lunches served at school reached a peak of approximately 169.6 million; this weekly estimate remained steady through the final week of April.We highlight strategies that states and school districts are using to replace these missed meals, including a case study from Maryland and the US Department of Agriculture waivers that, in many cases, have introduced flexibility to allow for innovation. Also, we explore lessons learned from the pandemic with the goal of informing and strengthening future school nutrition policies for out-of-school time, such as over the summer.
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Affiliation(s)
- Eliza W Kinsey
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Amelie A Hecht
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Caroline Glagola Dunn
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Ronli Levi
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Margaret A Read
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Courtney Smith
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Pamela Niesen
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Hilary K Seligman
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Erin R Hager
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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24
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Lane HG, Turner L, Dunn CG, Hager ER, Fleischhacker S. Leveraging Implementation Science in the Public Health Response to COVID-19 : Child Food Insecurity and Federal Nutrition Assistance Programs. Public Health Rep 2020; 135:728-736. [PMID: 33031712 PMCID: PMC7649993 DOI: 10.1177/0033354920959285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Hannah G. Lane
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lindsey Turner
- College of Education, Boise State University, Boise, ID, USA
| | - Caroline Glagola Dunn
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Erin R. Hager
- Division of Growth and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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25
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Parker EA, Feinberg TM, Lane HG, Deitch R, Zemanick A, Saksvig BI, Turner L, Hager ER. Diet quality of elementary and middle school teachers is associated with healthier nutrition-related classroom practices. Prev Med Rep 2020; 18:101087. [PMID: 32309116 PMCID: PMC7155219 DOI: 10.1016/j.pmedr.2020.101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022] Open
Abstract
Many schools have implemented policies and programs to address childhood obesity. However, few have evaluated obesity-related health behaviors among teachers, or how these behaviors may be associated with teachers' nutrition-related practices in the classroom setting. This cross-sectional study utilized data from teachers employed in 20 schools representing three public school districts in a mid-Atlantic state from 2017 to 2019 to examine associations between teachers' diet quality and their nutrition-related classroom practices (e.g. rewarding students with food; modeling healthy diet behaviors). Measures included: one 24-h dietary recall summarized via healthy eating index (HEI-2015; higher scores indicate better diet quality; Range: 0-100); demographics, self-reported height/weight (BMI; ≥25 kg/m2 = overweight/obese), and nutrition-related classroom practices (10 item survey; sum score range: 0-40; alpha = 0.65; higher score = more health-promoting practices). Associations between HEI and nutrition-related classroom practices were assessed in multilevel models, adjusting for covariates (gender, race/ethnicity, age, income, BMI, years teaching) and controlling for within-school effects. Of 331 teachers recruited, 116 (35.0%) completed both the optional dietary recall and incentivized survey (analytic sample: 89% female; 45% black; 79% overweight/obese; BMI = 30.5 ± 7.1; aged 41.1 ± 11.8 years). Means and standard deviations were calculated for HEI (52.2 ± 12.2) and nutrition-related classroom practices sum score (25.4 ± 5.9). For every one-unit increase in HEI, there was a 0.20 increase in nutrition-related classroom practices score (SE = 0.05; p < 0.001), which remained significant in the adjusted model. To better inform obesity prevention efforts, future studies should collect data among both students and teachers and explore the mechanisms through which teacher health behaviors may impact student health behaviors.
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Affiliation(s)
- Elizabeth A. Parker
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Termeh M. Feinberg
- Veterans Affairs Healthcare Connecticut/Yale University School of Medicine, New Haven, CT, USA
| | - Hannah G. Lane
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rachel Deitch
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Amy Zemanick
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Brit I. Saksvig
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Lindsey Turner
- College of Education, Boise State University, Boise, ID, USA
| | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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26
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Schuler BR, Fowler B, Rubio D, Kilby S, Wang Y, Hager ER, Black MM. Building Blocks for Healthy Children: Evaluation of a Child Care Center-Based Obesity Prevention Pilot Among Low-Income Children. J Nutr Educ Behav 2019; 51:958-966. [PMID: 31229396 PMCID: PMC6736706 DOI: 10.1016/j.jneb.2019.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children. DESIGN A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted. SETTING A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children). PARTICIPANTS Children aged 18-71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff). INTERVENTION(S) A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers. MAIN OUTCOME MEASURE(S) Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns. ANALYSIS Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers. RESULTS Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures. CONCLUSIONS AND IMPLICATIONS Curriculum-driven training and implementation support improved nutritional policies and practices and staff-child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.
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Affiliation(s)
- Brittany R Schuler
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA.
| | - Baylie Fowler
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Diana Rubio
- University of Minnesota Medical School, Twin Cities Campus, Twin Cities, MN
| | - Sarah Kilby
- Maryland State Department of Education, Baltimore, MD
| | - Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; Distinguished Fellow, RTI International, Research Triangle Park, NC
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Armstrong B, Covington LB, Hager ER, Black MM. Objective sleep and physical activity using 24-hour ankle-worn accelerometry among toddlers from low-income families. Sleep Health 2019; 5:459-465. [PMID: 31171491 DOI: 10.1016/j.sleh.2019.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Poverty is a risk for short sleep duration and limited physical activity. This study describes sleep, physical activity, and sedentary behavior of Women, Infants, and Children-eligible toddlers and the proportion of toddlers meeting recommendations for sleep and physical activity, and examines associations with body mass index z scores and poverty. PARTICIPANTS/MEASUREMENTS A total of 101 toddlers (12-32 months) from low-income families (62% African American) wore 24-hour ankle accelerometers over 3-7 consecutive days. Concurrent validity for daytime napping was assessed using parent-reported toddler wake/sleep between 08:00 and 20:00 collected using Ecological Momentary Assessment. Logistic regressions predicted odds of meeting guidelines. RESULTS Toddlers averaged 10.56 hours of sleep in 24 hours. All toddlers averaged ≥180 minutes of total activity per day, 38% had ≥60 minutes of moderate/vigorous physical activity per day, 32% of toddlers slept between 11 and 14 hours over 24 hours, and 26% had a bedtime before 9:00 pm. Body mass index z score was not associated with meeting guidelines. Poverty was associated with less than 60 minutes of moderate/vigorous physical activity. CONCLUSIONS Most toddlers were not meeting sleep guidelines. This study provides objective data on sleep and activity among a diverse sample of low-income toddlers. Objective measures of sleep and physical activity facilitate surveillance of children meeting guidelines for sleep and physical activity. Such norms are needed to examine disparities among children from varying racial and economic backgrounds. Future research should examine if meeting guidelines is related to other health indicators.
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Affiliation(s)
- Bridget Armstrong
- University of Maryland School of Medicine 737 W Lombard St, Baltimore, MD 21201.
| | - Lauren B Covington
- University of Delaware School of Nursing, The Tower at STAR, 5th floor 100 Discovery Blvd, Newark, DE 19713.
| | - Erin R Hager
- University of Maryland School of Medicine 737 W Lombard St, Baltimore, MD 21201.
| | - Maureen M Black
- University of Maryland School of Medicine 737 W Lombard St, Baltimore, MD 21201; RTI International 3040 E Cornwallis Rd, PO Box 12194 Research Triangle Park, NC, United States 27709.
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McIlree CD, Lane HG, Wang Y, Hager ER. Wellness Committee Status and Local Wellness Policy Implementation Over Time. Am J Prev Med 2019; 56:e75-e83. [PMID: 30777166 DOI: 10.1016/j.amepre.2018.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Local Wellness Policies are school-district documents containing guidelines for schools to promote nutrition/physical activity. In cross-sectional studies, schools with wellness committees are more likely to implement Local Wellness Policies. This prospective cohort study examines associations between wellness committee status over time and change in Local Wellness Policy implementation using a biennial, statewide survey. METHODS School administrators completed surveys following the 2012-2013 (Wave I) and 2014-2015 (Wave II) school years, including a 17-item Local Wellness Policy implementation scale. Four wellness committee status categories included established (both Waves, 35%); new (Wave II only, 22%); discontinued (Wave I only, 13%); and never (neither Wave, 30%). Linear mixed models conducted in 2017-2018 compared LWP implementation change across status groups, accounting for clustering and school characteristics. RESULTS Of 1,333 schools, 701 had Wave I data (53%); 748 Wave II (56%); and 441 both (33%). Schools were 69% elementary, 56% suburban, and 35% and 28% had majority (≥75%) African American/Hispanic or low-income student body, respectively. At Wave I, schools with wellness committees (established/discontinued groups) had higher Local Wellness Policy implementation (mean=32.0, SD=11.5, and mean=28.3, SD=11.4, respectively) compared with schools without committees (never/new: mean=15.4, SD=10.7 and mean=17.6, SD=11.4, respectively, F=64.9, p≤0.001). Over time, never and established groups maintained low and high Local Wellness Policy implementation, respectively. Compared with never, new committees increased implementation by 9.9 points (SE=1.8, p<0.001), and discontinued committees decreased by 11.2 (SE=2.1, p<0.001). CONCLUSIONS Forming and maintaining wellness committees encourages Local Wellness Policy implementation and should be a recommended strategy for school wellness promotion.
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Affiliation(s)
- Carolyn D McIlree
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hannah G Lane
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Yan Wang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Erin R Hager
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
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Wang Y, Hager ER, Magder LS, Arbaiza R, Wilkes S, Black MM. A Dyadic Analysis on Source Discrepancy and a Mediation Analysis via Self-Efficacy in the Parental Support and Physical Activity Relationship among Black Girls. Child Obes 2019; 15:123-130. [PMID: 30653347 PMCID: PMC6386074 DOI: 10.1089/chi.2018.0123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Physical activity (PA) declines in adolescence among black girls. This study assesses how moderate/vigorous physical activity (MVPA) relates to caregiver- vs. adolescent-reported parental support and whether the relationship is mediated by self-efficacy. METHODS MVPA was assessed through accelerometry. Parental support and encouragement on adolescents' PA were reported by caregivers and adolescents with a 10-item Social Support and Exercise Survey. Adolescent-reported self-efficacy related to PA was assessed with an 8-item scale. Structural equation modeling assessed source variation (caregiver vs. adolescent report) in the relationship between parental support and MVPA and mediation through adolescent self-efficacy. RESULTS The sample includes black adolescent girls (n = 272), with mean age of 11.6 years (standard deviation = 0.7), and average MVPA/day of 40.6 minutes. Caregiver/adolescent agreement on parental support was low (weighted Kappa <0.20). There was significant source variation in the parental support-MVPA relationship (Wald χ2 = 4.18, df = 1, p = 0.041); adolescent-reported support was related to MVPA (b = 0.40, standard error = 0.14, p = 0.003) and mediated through self-efficacy (95% bootstrapped confidence interval: 0.05-0.29). Caregiver-reported support or BMI z-score was not related to MVPA. CONCLUSIONS The association between MVPA and adolescent-reported parental support among black adolescent girls is explained by positive self-efficacy. Findings suggest that effective adolescent/caregiver communication around parental support on PA relates to high adolescent self-efficacy and supports objectively measured PA. Additional research is merited to examine longitudinal patterns. Furthermore, although 51.5% of girls in the sample were overweight or obese, the lack of association between MVPA and body composition minimizes its implication for mitigating obesity among overweight/obese black adolescent girls.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.,Address correspondence to: Yan Wang, MD, DrPH, Department of Pediatrics, University of Maryland School of Medicine, 737 W. Lombard Street, Room 167, Baltimore, MD 21201
| | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Laurence S. Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Raquel Arbaiza
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Samantha Wilkes
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.,RTI International, Durham, NC
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Lane HG, Deitch R, Wang Y, Black MM, Dunton GF, Aldoory L, Turner L, Parker EA, Henley SC, Saksvig B, Song HJ, Hager ER. "Wellness Champions for Change," a multi-level intervention to improve school-level implementation of local wellness policies: Study protocol for a cluster randomized trial. Contemp Clin Trials 2018; 75:29-39. [PMID: 30342257 PMCID: PMC6594543 DOI: 10.1016/j.cct.2018.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 12/01/2022]
Abstract
Schools are a recommended place for childhood obesity prevention. Local Wellness Policies (LWPs) establish guidelines for schools to provide opportunities for students to access nutritious foods and be physically active. Little is known about the impact of LWPs, when implemented, on students' behavior and body mass index (BMI). The Wellness Champions for Change trial assesses the student-level impact of providing theory-based training and technical assistance to help schools implement LWPs. This 3-arm, cluster randomized controlled trial will take place in 30 low- or middle-income schools (15 elementary and 15 middle) in five Maryland school districts. Ten schools will receive both Wellness Champions for Change (WCC), which involves training teacher-led wellness teams, and Wellness Champions for Change-Student (WCC-S), which engages students as wellness team members. Ten schools will receive WCC only, and ten control schools will receive a delayed intervention. The RE-AIM framework will guide evaluation. Student Effectiveness measures will include BMI z-scores, self-reported diet patterns, and objectively-measured physical activity. The sample size (1080 students across 30 schools, followed for 2.5 years) will enable power (>0.8) to detect BMI z-score differences. A three-level linear mixed model that accounts for clustering will be used to assess Effectiveness. A mixed methods approach will assess school- and district-level Reach, Adoption, and Implementation. If effective, this approach will represent a sustainable, multi-level, school-based strategy to prevent childhood obesity. The evaluation framework will allow for the description of factors necessary to broadly disseminate this approach for obesity prevention on a large scale.
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Affiliation(s)
- Hannah G Lane
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Rachel Deitch
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Yan Wang
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Epidemiology and Public Health, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Epidemiology and Public Health, 737 West Lombard Street, Baltimore, MD 21201, USA; RTI International, Research Triangle Park, NC 27709, USA.
| | - Genevieve F Dunton
- University of Southern California, Departments of Preventive Medicine and Psychology, 2001 N. Soto St., Los Angeles, CA 90032, USA.
| | - Linda Aldoory
- University of Maryland College Park, Department of Communication, College of Arts and Humanities, College Park, MD 20742, USA.
| | - Lindsey Turner
- Boise State University, College of Education, 1910 University Drive, #1740, Boise, ID 83725, USA.
| | - Elizabeth A Parker
- University of Maryland School of Medicine, Department of Family and Community Medicine, Center for Integrative Medicine, 520 W. Lombard Street, East Hall, Baltimore, MD 21201, USA.
| | - Shauna C Henley
- University of Maryland Extension, Department of Agriculture and Natural Resources, 1114 Shawan Road, Cockeysville, MD 21030, USA.
| | - Brit Saksvig
- University of Maryland College Park, Department of Epidemiology and Biostatistics, School of Public Health, College Park, MD 20742, USA.
| | - Hee-Jung Song
- University of Maryland College Park, Department of Nutrition and Food Science, College of Agriculture and Natural Resources, College Park, MD 20742, USA.
| | - Erin R Hager
- University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Epidemiology and Public Health, 737 West Lombard Street, Baltimore, MD 21201, USA.
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Schuler BR, Saksvig BI, Nduka J, Beckerman S, Jaspers L, Black MM, Hager ER. Barriers and Enablers to the Implementation of School Wellness Policies: An Economic Perspective. Health Promot Pract 2018; 19:873-883. [PMID: 29347840 PMCID: PMC6095820 DOI: 10.1177/1524839917752109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Local wellness policies (LWPs) are mandated among school systems to enhance nutrition/physical activity opportunities in schools. Prior research notes disparities in LWP implementation. This study uses mixed methods to examine barriers/enablers to LWP implementation, comparing responses by student body income. METHOD Schools ( n = 744, 24 systems) completed an LWP implementation barriers/enablers survey. Semistructured interviews ( n = 20 random subsample) described barriers/enablers. Responses were compared by majority of lower (≥50% free/reduced-price meals; lower income [LI]) versus higher income (HI) student body. RESULTS In surveys, LI and HI schools identified common barriers (parents/families, federal/state regulations, students, time, funding) and enablers (school system, teachers, food service, physical education curriculum/resources, and staff). Interviews further elucidated how staffing and funding served as enablers for all schools, and provide context for how and why barriers differed by income: time, food service (HI schools), and parents/families (LI schools). CONCLUSIONS Findings support commonalities in barriers and enablers among all schools, suggesting that regardless of economic context, schools would benefit from additional supports, such as physical education and nutrition education resources integrated into existing curricula, additional funding, and personnel time dedicated to wellness programming. LI schools may benefit from additional funding to support parent and community involvement.
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Affiliation(s)
| | - Brit I. Saksvig
- University of Maryland School of Public Health, College Park, MD, USA
| | - Joy Nduka
- Howard University College of Medicine, Washington, DC, USA
| | | | - Lea Jaspers
- Maryland State Department of Education, Baltimore, MD, USA
| | | | - Erin R. Hager
- University of Maryland School of Medicine, Baltimore, MD, USA
- RTI International, Research Triangle Park, NC, USA
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Bussell K, Francis L, Armstrong B, Kilby S, Black MM, Hager ER. Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers. Child Obes 2018; 14:403-411. [PMID: 30199291 PMCID: PMC6150935 DOI: 10.1089/chi.2018.0085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers. METHODS A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores. RESULTS Response rate was 40% (n = 610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B = 0.26, p < 0.001; B = 0.26, p = 0.001, respectively); policies with foods served (B = 0.22, p = 0.002); and policies, provider training, and feeding environment with physical activity (B = 0.19, p = 0.001; B = 0.24, p = 0.010; B = 0.38, p < 0.001). CONCLUSIONS Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.
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Affiliation(s)
- Kristin Bussell
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD
| | | | - Bridget Armstrong
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Sarah Kilby
- Maryland State Department of Education, Baltimore, MD
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.,RTI International, Research Triangle Park, NC
| | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.,Address correspondence to:Erin R. Hager, PhDDepartment of PediatricsUniversity of Maryland School of Medicine737 West Lombard Street, Room 163Baltimore, MD 21201
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Hager ER, Song HJ, Lane HG, Guo HH, Jaspers LH, Lopes MA. Pilot-Testing an Intervention to Enhance Wellness Policy Implementation in Schools: Wellness Champions for Change. J Nutr Educ Behav 2018; 50:765-775. [PMID: 30196883 PMCID: PMC7717577 DOI: 10.1016/j.jneb.2018.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To develop and pilot-test Wellness Champions for Change (WCC) to enhance local wellness policy (LWP) implementation by forming wellness teams. DESIGN Randomized, controlled school-level pilot study. SETTING Five Maryland school districts. PARTICIPANTS A total of 63 elementary, middle, or high schools. INTERVENTION(S) Developed from stakeholder interviews, focus groups, and existing programs. Schools were randomized within district to (1) WCC training (6-hour, single-day teacher training), (2) WCC training plus technical assistance (TA), or (3) delayed training (control). MAIN OUTCOME MEASURE(S) Online teacher/administrator survey pre-post (spring, 1 year apart) that examined the direct effect of the intervention on active wellness team formation (postintervention, 8-item sum score) and LWP implementation (29 items, not implemented to fully implemented)/indirect effect of intervention on LWP implementation via active wellness team formation. ANALYSIS Adjusted linear or logistic regression and mediation modeling. RESULTS Postintervention, WCC plus TA and WCC had more active wellness teams (vs control, β = 1.49, P = .02 and β = 1.42, P = .03, respectively). No direct effect of intervention on LWP implementation was found. Formation of active wellness teams mediated the association between both WCC plus TA and WCC and LWP implementation (WCC plus TA confidence interval [CI], 1.22-16.25; WCC CI, 10.98-15.61 [CI was significant without 0]). CONCLUSIONS AND IMPLICATIONS The WCC intervention approaches indirectly affected LWP implementation through the formation of active wellness teams. These results support building and school-level wellness teams.
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Affiliation(s)
- Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
| | - Hee-Jung Song
- Department of Nutrition and Food Science, University of Maryland, College Park, MD
| | - Hannah G Lane
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Hallene H Guo
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Lea H Jaspers
- Maryland State Department of Education, Baltimore, MD
| | - Megan A Lopes
- Maryland State Department of Education, Baltimore, MD
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Lane HG, Driessen R, Campbell K, Deitch R, Turner L, Parker EA, Hager ER. Development of the PEA-PODS (Perceptions of the Environment and Patterns of Diet at School) Survey for Students. Prev Chronic Dis 2018; 15:E88. [PMID: 29969093 PMCID: PMC6040598 DOI: 10.5888/pcd15.170561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Few instruments assess key outcomes of school-based obesity interventions, including student perceptions of school environments and school-specific dietary intake patterns. This study describes development of PEA-PODS (Perceptions of the Environment and Patterns of Diet at School), a 2-part survey to measure these outcomes. METHODS Part 1 (PEA) assessed student perceptions of policies, physical environment, and practices related to healthy eating and physical activity at school. Part 2 (PODS) assessed usual intake (ie, frequency, location obtained, and foods consumed) of breakfast and lunch. Foods consumed were presented by MyPlate categories (eg, Fruits, Grains). Students in grades 3, 6, and 9 participated in 2 phases: cognitive pre-testing (n = 10) and reliability/validation testing (n = 58). Both surveys were administered 1 week apart to assess test-retest reliability and 5-day food records validated PODS. Analyses included percent agreement (70% = acceptable), Pearson correlations, and Cronbach α. RESULTS Cognitive pre-testing provided feedback on content, length, and age-appropriateness. Percent agreements were acceptable for test-retest reliability of PEA (71%-96%). The final version included 34 items with Likert-type responses in 4 subscales (α ≥0.78). For PODS, agreement for breakfast and lunch location was ≥75% for both reliability and validation. For foods consumed at breakfast, reliability agreement ranged from 74% to 93%, and validation agreement from 68% to 91%. For foods consumed at lunch, agreement ranges were 76% to 95% and 73% to 88%, respectively. CONCLUSION Both parts of the instrument demonstrate acceptable reliability, and PODS demonstrates acceptable validity. This demonstrates appropriateness for assessing perceptions of the environment and usual dietary intake patterns for school-based obesity prevention initiatives.
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Affiliation(s)
- Hannah G Lane
- University of Maryland School of Medicine, Department of Pediatrics, Division of Growth and Nutrition, 737 W Lombard St, Room 169C, Baltimore, MD 21201.
| | | | - Katherine Campbell
- University of Maryland School of Medicine, Department of Pediatrics, Division of Growth and Nutrition
| | - Rachel Deitch
- University of Maryland School of Medicine, Department of Pediatrics, Division of Growth and Nutrition
| | - Lindsey Turner
- Boise State University, Initiative for Healthy Schools, College of Education
| | - Elizabeth A Parker
- University of Maryland School of Medicine, Department of Family and Community Medicine, Center for Integrative Medicine
| | - Erin R Hager
- University of Maryland School of Medicine, Department of Pediatrics, Division of Growth and Nutrition
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Gutermuth LK, Hager ER, Pollack Porter K. Using the CDC's Worksite Health ScoreCard as a Framework to Examine Worksite Health Promotion and Physical Activity. Prev Chronic Dis 2018; 15:E84. [PMID: 29935077 PMCID: PMC6016402 DOI: 10.5888/pcd15.170463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Worksite health promotion programs are emerging as an effective approach for addressing the adult obesity epidemic and improving the overall health of employees. Methods We conducted a scoping review to identify articles that described a physical activity component (eg, promoted increased physical or reduced sitting time) of a worksite health promotion intervention. Our search specified full-length articles published in English from January 2000 through July 2015. We used the Centers for Disease Control and Prevention’s Worksite Health ScoreCard, a validated tool, as a framework to summarize information on organizational supports strategies (18 questions) and physical activity strategies (9 questions) implemented by worksite health promotion programs. We also determined whether or not the included studies reported significant (P < .05) improvements in physical activity. Results We identified 18 worksite health promotion programs; 11 produced significant improvements in physical activity. Incentives, health risk assessments, health promotion committees, leadership support, marketing, and subsidies or discounts for use of exercise facilities were the most effective organizational supports strategies cited, and physical activity seminars, classes, and workshops were the most effective physical activity strategies cited. Conclusion The use of the Health ScoreCard allowed for a practical interpretation of our findings, which can inform next steps for the field. Future research should explore the relationships between components of worksite health promotion programs and their outcomes to further develop best practices that can improve worker health and promote physical activity.
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Affiliation(s)
- Leah K Gutermuth
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 W. Lombard St, 163, Baltimore, MD 21201.
| | - Erin R Hager
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, Maryland
| | - Keshia Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Yimgang DP, Wang Y, Paik G, Hager ER, Black MM. Civil Unrest in the Context of Chronic Community Violence: Impact on Maternal Depressive Symptoms. Am J Public Health 2017; 107:1455-1462. [PMID: 28727535 DOI: 10.2105/ajph.2017.303876] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine changes in maternal-child health surrounding the April 2015 civil unrest in Baltimore, Maryland, following Freddie Gray's death while in police custody. METHODS We conducted cross-sectional Children's HealthWatch surveys January 2014 through December 2015 in pediatric emergency departments and primary care clinics on maternal-child health and June 2015 through October 2015 on daily and community routines. We used trend analysis and piecewise logistic regression to examine effects of time, residential proximity moderation, and mediation analysis to assess proximity and maternal-child health relations via maternal concerns. RESULTS Participants comprised 1095 mothers, 93% of whom were African American and 100% of whom had public or no insurance; 73% of participants' children were younger than 24 months. Following the unrest, prevalence of maternal depressive symptoms increased significantly in proximal, but not distal, neighborhoods (b = 0.41; 95% confidence interval [CI] = 0.03, 0.79; P = .03). Maternal concerns were elevated in proximal neighborhoods and associated with depressive symptoms; mediation through maternal concern was not significant. Five months after the unrest, depressive symptoms returned to previous levels. CONCLUSIONS Civil unrest has an acute effect on maternal depressive symptoms in neighborhoods proximal to unrest. Public Health Implications. To mitigate depressive symptoms associated with civil unrest, maintain stability of community routines, screen for maternal depressive symptoms, and provide parent-child nurturing programs.
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Affiliation(s)
- Doris P Yimgang
- Doris P. Yimgang, Yan Wang, Grace Paik, Erin R. Hager, and Maureen M. Black are with the Departments of Pediatrics, and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Maureen M. Black is also with RTI International, Research Triangle Park, NC
| | - Yan Wang
- Doris P. Yimgang, Yan Wang, Grace Paik, Erin R. Hager, and Maureen M. Black are with the Departments of Pediatrics, and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Maureen M. Black is also with RTI International, Research Triangle Park, NC
| | - Grace Paik
- Doris P. Yimgang, Yan Wang, Grace Paik, Erin R. Hager, and Maureen M. Black are with the Departments of Pediatrics, and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Maureen M. Black is also with RTI International, Research Triangle Park, NC
| | - Erin R Hager
- Doris P. Yimgang, Yan Wang, Grace Paik, Erin R. Hager, and Maureen M. Black are with the Departments of Pediatrics, and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Maureen M. Black is also with RTI International, Research Triangle Park, NC
| | - Maureen M Black
- Doris P. Yimgang, Yan Wang, Grace Paik, Erin R. Hager, and Maureen M. Black are with the Departments of Pediatrics, and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. Maureen M. Black is also with RTI International, Research Triangle Park, NC
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Wang Y, Gielen AC, Magder LS, Hager ER, Black MM. A randomised safety promotion intervention trial among low-income families with toddlers. Inj Prev 2017; 24:41-47. [PMID: 28385953 DOI: 10.1136/injuryprev-2016-042178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Toddler-aged children are vulnerable to unintentional injuries, especially those in low-income families. OBJECTIVE To examine the effectiveness of an intervention grounded in social cognitive theory (SCT) on the reduction of home safety problems among low-income families with toddlers. METHODS 277 low-income mother-toddler dyads were randomised into a safety promotion intervention (n=91) or an attention-control group (n=186). Mothers in the safety promotion intervention group received an eight-session, group-delivered safety intervention targeting fire prevention, fall prevention, poison control and car seat use, through health education, goal-setting and social support. Data collectors observed participants' homes and completed a nine-item checklist of home safety problems at study enrolment (baseline), 6 and 12 months after baseline. A total score was summed, with high scores indicating more problems. Linear mixed models compared the changes over time in home safety problems between intervention and control groups. RESULTS The intent-to-treat analysis indicated that the safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the 12-month follow-up (between-group difference in change over time β=-0.54, 95% CI -0.05 to -1.03, p=0.035), with no significant differences at the 6-month follow-up. CONCLUSIONS A safety promotion intervention built on principles of SCT has the potential to promote toddlers' home safety environment. Future studies should examine additional strategies to determine whether better penetration/compliance can produce more clinically important improvement in home safety practices. TRIAL REGISTRATION NUMBER NCT02615158; post-results.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea C Gielen
- The Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,RTI International, Research Triangle Park, North Carolina, USA
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Hager ER, Tilton NA, Wang Y, Kapur NC, Arbaiza R, Merry BC, Black MM. The home environment and toddler physical activity: an ecological momentary assessment study. Pediatr Obes 2017; 12:1-9. [PMID: 26696192 PMCID: PMC5544349 DOI: 10.1111/ijpo.12098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Physical activity (PA) promotion/obesity prevention in toddlerhood should include home environments. OBJECTIVE The aim of the study was to determine social/physical home environment factors associated with toddler PA using ecological momentary assessment (EMA, real-time data collection). METHODS Low-income mother-toddler dyads were recruited and given a handheld EMA device (53 random beeps followed by social/physical environment survey over 8 d). Simultaneously, PA was assessed via accelerometry (data extracted 15 min before/after response, average activity counts per minute). Linear mixed-effects models were used, adjusting for toddler age, urban/suburban residence and time of day; covariate moderating effects were examined; within-subjects and between-subjects findings were reported. PA was hypothesized to be greater when toddlers are outside (vs. inside), children are nearby (vs. alone), toddlers are interacting with their mothers (vs. not) and TV is off (vs. on). RESULTS The final count was 2454 EMA/PA responses for 160 toddlers (mean age 20 months, range 12-31; 55% male, 66% Black and 54% urban). Associations with PA include (within subjects) the following: outside location (212 additional counts min-1 ), children nearby (153 additional counts min-1 ) and interacting with mother (321 additional counts min-1 ), compared with alternatives. Age was moderated by outside location/PA association (within subjects), with 90 additional counts min-1 per 3-month age group outside vs. inside. No between-subjects or television/PA associations were found. CONCLUSIONS Home environment factors were associated with PA, including outside location, children nearby and mother interaction. EMA is a novel method, allowing identification of contextual factors associated with behaviours in natural environments.
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Affiliation(s)
- E R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - N A Tilton
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Y Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - N C Kapur
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | - R Arbaiza
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - B C Merry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - M M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Hager ER, Rubio DS, Eidel GS, Penniston ES, Lopes M, Saksvig BI, Fox RE, Black MM. Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities. J Sch Health 2016; 86:742-750. [PMID: 27619765 DOI: 10.1111/josh.12430] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). METHODS Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. RESULTS Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). CONCLUSIONS Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.
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Affiliation(s)
- Erin R Hager
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Department of Pediatrics, Growth and Nutrition Division, 737 West Lombard Street, Room 163, Baltimore, MD 21201.
| | - Diana S Rubio
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 West Lombard Street, Room 163, Baltimore, MD 21201.
| | - G Stewart Eidel
- Professional Development and Technical Assistance, Maryland State Department of Education, Office of School & Community Nutrition Programs, Baltimore, MD 21201.
| | - Erin S Penniston
- Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201.
| | - Megan Lopes
- Maryland State Department of Education, Professional Development and Technical Assistance Section, Office of School and Community Nutrition Programs/Office for School Effectiveness, Baltimore, MD 21201.
| | - Brit I Saksvig
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742.
| | - Renee E Fox
- Division of Quality & Health Outcomes (DQHO), Center for Medicare and Medicaid Services, CMCS/CAHPG, 7500 Security Blvd, Baltimore, MD 21244.
| | - Maureen M Black
- Division of Growth and Nutrition, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 737 West Lombard Street, Room 161, Baltimore, MD 21201.
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Hager ER, Calamaro CJ, Bentley LM, Hurley KM, Wang Y, Black MM. Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting. Child Obes 2016; 12:392-400. [PMID: 27447782 PMCID: PMC5041548 DOI: 10.1089/chi.2015.0252] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Shortened sleep duration is associated with poor health and obesity among young children. Little is known about relationships among nighttime sleep duration, sleep behaviors, and obesogenic behaviors/obesity among toddlers. This study characterizes sleep behaviors/duration and examines relationships with obesogenic behaviors/obesity among toddlers from low-income families. METHODS Mothers of toddlers (age 12-32 months) were recruited from urban/suburban sites serving low-income families. Mothers provided demographic information and completed the Brief Infant Sleep Questionnaire (BISQ); a 6-item Toddler Sleep Behavior Scale was derived (TSBS-BISQ, higher score reflects more recommended behaviors). Toddler weight/length were measured; obesity defined as ≥95th percentile weight-for-length. Measures of obesogenic behaviors: physical activity [accelerometry, minutes/day in Moderate-to-Vigorous Physical Activity (MVPA)] and diet quality [24-hour recall, Healthy Eating Index 2005 (HEI-2005)]. Bivariate and adjusted multivariable models examined associations between nighttime sleep behaviors/duration and obesogenic behaviors/obesity. RESULTS Sample included 240 toddlers (mean age = 20.2 months), 55% male, 69% black, 59% urban. Toddlers spent 55.4 minutes/day in MVPA, mean HEI-2005 score was 55.4, 13% were obese. Mean sleep duration was 9.1 hours, with 35% endorsing 5-6 recommended sleep behaviors (TSBS-BISQ). In multivariable models, MVPA was positively related to sleep duration; obese toddlers had a shorter nighttime sleep duration than healthy weight toddlers [odds ratio = 0.69, p = 0.014]. Nighttime sleep duration was associated with high TSBS-BISQ scores, F = 6.1, p = 0.003. CONCLUSIONS Toddlers with a shorter nighttime sleep duration are at higher risk for obesity and inactivity. Interventions to promote healthy sleep behaviors among toddlers from low-income families may improve nighttime sleep duration and reduce obesogenic behaviors/obesity.
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Affiliation(s)
- Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | | | | | - Kristen M. Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
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Hager ER, Gormley CE, Latta LW, Treuth MS, Caulfield LE, Black MM. Toddler physical activity study: laboratory and community studies to evaluate accelerometer validity and correlates. BMC Public Health 2016; 16:936. [PMID: 27600404 PMCID: PMC5011903 DOI: 10.1186/s12889-016-3569-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 08/20/2016] [Indexed: 11/30/2022] Open
Abstract
Background Toddlerhood is an important age for physical activity (PA) promotion to prevent obesity and support a physically active lifestyle throughout childhood. Accurate assessment of PA is needed to determine trends/correlates of PA, time spent in sedentary, light, or moderate-vigorous PA (MVPA), and the effectiveness of PA promotion programs. Due to the limited availability of objective measures that have been validated and evaluated for feasibility in community studies, it is unclear which subgroups of toddlers are at the highest risk for inactivity. Using Actical ankle accelerometry, the objectives of this study are to develop valid thresholds, examine feasibility, and examine demographic/ anthropometric PA correlates of MVPA among toddlers from low-income families. Methods Two studies were conducted with toddlers (12–36 months). Laboratory Study (n = 24)- Two Actical accelerometers were placed on the ankle. PA was observed using the Child Activity Rating Scale (CARS, prescribed activities). Analyses included device equivalence reliability (correlation: activity counts of two Acticals), criterion-related validity (correlation: activity counts and CARS ratings), and sensitivity/specificity for thresholds. Community Study (n = 277, low-income mother-toddler dyads recruited)- An Actical was worn on the ankle for > 7 days (goal >5, 24-h days). Height/weight was measured. Mothers reported demographics. Analyses included frequencies (feasibility) and stepwise multiple linear regression (sMLR). Results Laboratory Study- Acticals demonstrated reliability (r = 0.980) and validity (r = 0.75). Thresholds demonstrated sensitivity (86 %) and specificity (88 %). Community Study- 86 % wore accelerometer, 69 % had valid data (mean = 5.2 days). Primary reasons for missing/invalid data: refusal (14 %) and wear-time ≤2 days (11 %). The MVPA threshold (>2200 cpm) yielded 54 min/day. In sMLR, MVPA was associated with age (older > younger, β = 32.8, p < 0.001), gender (boys > girls, β = −11.21, p = 0.032), maternal MVPA (β = 0.44, p = 0.002) and recruitment location (suburban > urban, β = 19.6, p < 0.001), or race (non-Black > Black, β = 18.5, p = 0.001). No association with toddler weight status. Conclusions Ankle accelerometry is a valid, reliable, and feasible method of assessing PA in community studies of toddlers from low-income families. Sub-populations of toddlers may be at increased risk for inactivity, including toddlers that are younger, female, Black, those with less active mothers, and those living in an urban location.
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Affiliation(s)
- Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Candice E Gormley
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura W Latta
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,Family League of Baltimore, Baltimore, MD, USA
| | - Margarita S Treuth
- Department of Kinesiology, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Laura E Caulfield
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Devonshire AL, Hager ER, Black MM, Diener-West M, Tilton N, Snitker S. Elevated blood pressure in adolescent girls: correlation to body size and composition. BMC Public Health 2016; 16:78. [PMID: 26812968 PMCID: PMC4729122 DOI: 10.1186/s12889-016-2717-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background To improve understanding of the pathophysiology of hypertension in adolescents and pave the way for risk stratification, studies have sought to determine the correlates of blood pressure (BP). Inconsistencies in dependent and independent variables have resulted in an elusive consensus. The aim of this report is to examine an inclusive array of correlates of BP, as a continuous (systolic and diastolic BP) and a dichotomous variable. Methods Subjects were a school-based sample of 730 urban, mostly African American, non-referred 6th and 7th grade girls. To find independent correlates of SBP/DBP, we used a stepwise model selection method based on the Schwarz Bayesian Information Criterion, enabling selection of a parsimonious model among highly correlated covariates. Candidate variables were: age, stature, heart rate, pubertal development, BMI, BMI z-score, waist circumference, waist-to-height ratio (WHtR), body surface area, fat mass (by bioelectrical impedance analysis), fat-free mass (FFM), percentage of body fat, and presence of overweight/obesity. Results The best-fitting models for DBP and SBP (considered separately) included fat-free mass, heart rate and, in the case of SBP, stature. The best-fitting model for high-normal/elevated blood pressure (H-N/EBP) included WHtR with no independent relation of any other variable. The prevalence of H-N/EBP tripled between a WHtR of 0.5 and 0.7. Conclusions The easily obtained and calculated WHtR is the strongest correlate of elevated blood pressure among available variables and is a prime candidate for longitudinal studies of predictors of the development of hypertension. Trial registration ClinicalTrials.gov Identifier, NCT00746083
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Affiliation(s)
- Ashley L Devonshire
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas Tilton
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Soren Snitker
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA. .,Department of Medicine, University of Maryland School of Medicine, 660 West Lombard Street, Rm. 598-B, 21201, Baltimore, Maryland, USA.
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Affiliation(s)
- Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Lindsey Turner
- College of Education, Boise State University, Boise, Idaho
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Hager ER, Treuth MS, Gormely C, Epps L, Snitker S, Black MM. Ankle Accelerometry for Assessing Physical Activity Among Adolescent Girls: Threshold Determination, Validity, Reliability, and Feasibility. Res Q Exerc Sport 2015; 86:397-405. [PMID: 26288333 PMCID: PMC4775231 DOI: 10.1080/02701367.2015.1063574] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Ankle accelerometry allows for 24-hr data collection and improves data volume/integrity versus hip accelerometry. Using Actical ankle accelerometry, the purpose of this study was to (a) develop sensitive/specific thresholds, (b) examine validity/reliability, (c) compare new thresholds with those of the manufacturer, and (d) examine feasibility in a community sample (low-income, urban adolescent girls). METHOD Two studies were conducted with 6th- through 7th-grade girls (aged 10-14 years old): First was a laboratory study (n = 24), in which 2 Actical accelerometers were placed on the ankle and worn while measuring energy expenditure (Cosmed K4b2, metabolic equivalents [METs]) during 10 prescribed activities. Analyses included device equivalence reliability (intraclass correlation coefficient [ICC], activity counts of 2 Acticals), criterion-related validity (correlation, activity counts and METs), and calculations of sensitivity, specificity, kappa, and receiver-operating characteristic curves for thresholds. The second was a free-living study (n = 459), in which an Actical was worn for more than 7 days on the ankle (full 24-hr days retained). Analyses included feasibility (frequencies, missing data) and paired t tests (new thresholds vs. those of the manufacturer). RESULTS In the laboratory study, the Actical demonstrated reliability (ICC = .92) and validity (r = .81). Thresholds demonstrated sensitivity (91%), specificity (84%), kappa = .73 (p = .043), area under curve range = .81-.97. In the free-living study, 99.6% of participants wore the accelerometer; 84.1% had complete/valid data (mean = 5.7 days). Primary reasons for missing/invalid data included: improper programming/documentation (5.2%), failure to return device (5.0%), and wear-time ≤ 2 days (2.8%). The moderate-to-vigorous physical activity threshold (> 3,200 counts/minute) yielded 37.2 min/day, 2 to 4.5 times lower than that of the manufacturer's software (effect size = 0.74-4.05). CONCLUSIONS Validity, reliability, and feasibility evidences support Actical ankle accelerometry to assess physical activity in community studies of adolescent girls. When comparing manufacturers' software versus new thresholds, a major difference was observed.
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Affiliation(s)
- Erin R. Hager
- University of Maryland School of Medicine, Department of Pediatrics
- University of Maryland School of Medicine, Department of Epidemiology and Public Health
| | - Margarita S. Treuth
- University of Maryland Eastern Shore, Departments of Physical Therapy and Exercise Science
| | - Candice Gormely
- University of Maryland School of Medicine, Department of Pediatrics
| | - LaShawna Epps
- University of Maryland School of Medicine, Department of Pediatrics
| | - Soren Snitker
- University of Maryland School of Medicine, Department of Pediatrics
- University of Maryland School of Medicine, Department of Medicine
| | - Maureen M. Black
- University of Maryland School of Medicine, Department of Pediatrics
- University of Maryland School of Medicine, Department of Epidemiology and Public Health
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Abstract
Medical management of critically ill patients often incorporates prolonged bed rest, which, in combination with the underlying illness, results in global muscle weakness and atrophy. Recent evidence has demonstrated improvements in clinical and functional outcomes when exercise and physical activity are incorporated early in the management of ICU patients. Accurate monitoring of ICU patients' physical activity is essential for proper prescription and escalation of activity levels. Accelerometry is a technique used to measure physical activity and has been validated in several ambulatory populations. However, its use in critically ill, hospitalized patients with poor functional mobility is limited. In this review, we focus on the few studies assessing the use of accelerometry to measure physical activity in the care of mechanically ventilated adult ICU patients. The selected literature demonstrates that accelerometry correlates well with direct observation in reporting frequency and duration of various types of physical activity (rolling, sitting up, transferring, walking), but cannot differentiate various intensities of activity or whether movements are voluntary or involuntary with respect to effort. Thus, although accelerometry may serve as a useful adjunct in reporting temporality of physical activity in critically ill patients, other objective information may be needed to accurately record frequency, duration, and intensity of activity in this population.
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Affiliation(s)
| | - Erin R Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Pollack KM, González ER, Hager ER, Sallis JF. The Active Living Research 2014 Conference: "niche to norm". Prev Med 2014; 69 Suppl 1:S1-4. [PMID: 25450491 DOI: 10.1016/j.ypmed.2014.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Keshia M Pollack
- Department of Health Policy and Management, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Erualdo R González
- Department of Chicana and Chicano Studies, California State University, Fullerton, 800 N. State College Blvd., Fullerton, CA 92832, USA.
| | - Erin R Hager
- University of Maryland School of Medicine, Departments of Pediatrics and Epidemiology and Public Health, 737 West Lombard Street, Room 163, Baltimore, MD 21201, USA.
| | - James F Sallis
- University of California, San Diego, Mail Code 0824, 3900 Fifth Avenue, Suite 310, San Diego, CA 92103, USA.
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Abstract
OBJECTIVES Pediatric obesity is a major public health problem that undermines the physical and mental health of children and increases their risk for adult obesity and other chronic illnesses. Although health care providers, including pediatric psychologists, have implemented prevention programs, effects have been minimal, with no solid evidence of sustainable programs. METHODS A systems science framework that incorporates the multiple interacting factors that influence pediatric obesity may be useful in guiding prevention. RESULTS The National Prevention Strategy provides recommendations that can be incorporated into systems science designs, including (1) Healthy and Safe Environments, (2) Clinical and Community Preventive Services, (3) Empowering People, and (4) Elimination of Health Disparities. In addition, our recommendation is that future obesity prevention programs target early in life (pre-pregnancy through toddlerhood) and use multilevel multidisciplinary designs. CONCLUSIONS The benefits of preventing pediatric obesity extend from the health and well-being of individual children to the economic security of the nation.
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Hager ER, Witherspoon DO, Gormley C, Latta LW, Pepper MR, Black MM. The perceived and built environment surrounding urban schools and physical activity among adolescent girls. Ann Behav Med 2014; 45 Suppl 1:S68-75. [PMID: 23334761 DOI: 10.1007/s12160-012-9430-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Neighborhood perceived/built environment and physical activity (PA) associations have been examined for adolescents around homes, but not surrounding schools. PURPOSE The purpose of this paper is to examine if positive perceptions/built environment in neighborhoods surrounding schools predict PA among low-income, urban adolescent girls. METHODS Measures include: minutes in moderate-vigorous PA (MVPA, ankle accelerometry), perceptions of the school environment (questionnaire), built environment (neighborhood audit). Analyses include multi-level models. RESULTS Two hundred twenty-four sixth and seventh grade girls [mean(sd) age = 12.1(0.7) years] from 12 schools serving low-income, primarily African American communities; mean MVPA 35.4 min (mean days assessed = 5.8). Girls in schools with more positive perceptions of the neighborhood environment surrounding the school were less active (β = 7.2, p = 0.043). Having "places to go within walking distance" (perceptions) and number of food stores near school (built environment) positively relate to MVPA (β = 5.5, p = 0.042 and β = 0.59, p = 0.047). CONCLUSIONS Among neighborhoods surrounding urban schools, positive perceptions do not predict PA; accessibility, via both perceived and built environment, support PA.
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Affiliation(s)
- Erin R Hager
- Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD 21201, USA.
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Hurley KM, Pepper MR, Candelaria M, Wang Y, Caulfield LE, Latta L, Hager ER, Black MM. Systematic development and validation of a theory-based questionnaire to assess toddler feeding. J Nutr 2013; 143:2044-9. [PMID: 24068792 PMCID: PMC3827642 DOI: 10.3945/jn.113.179846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper describes the development and validation of a 27-item caregiver-reported questionnaire on toddler feeding. The development of the Toddler Feeding Behavior Questionnaire was based on a theory of interactive feeding that incorporates caregivers' responses to concerns about their children's dietary intake, appetite, size, and behaviors rather than relying exclusively on caregiver actions. Content validity included review by an expert panel (n = 7) and testing in a pilot sample (n = 105) of low-income mothers of toddlers. Construct validity and reliability were assessed among a second sample of low-income mothers of predominately African-American (70%) toddlers aged 12-32 mo (n = 297) participating in the baseline evaluation of a toddler overweight prevention study. Internal consistency (Cronbach's α: 0.64-0.87) and test-retest (0.57-0.88) reliability were acceptable for most constructs. Exploratory and confirmatory factor analyses revealed 5 theoretically derived constructs of feeding: responsive, forceful/pressuring, restrictive, indulgent, and uninvolved (root mean square error of approximation = 0.047, comparative fit index = 0.90, standardized root mean square residual = 0.06). Statistically significant (P < 0.05) convergent validity results further validated the scale, confirming established relations between feeding behaviors, toddler overweight status, perceived toddler fussiness, and maternal mental health. The Toddler Feeding Behavior Questionnaire adds to the field by providing a brief instrument that can be administered in 5 min to examine how caregiver-reported feeding behaviors relate to toddler health and behavior.
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Affiliation(s)
- Kristen M. Hurley
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD,Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,To whom correspondence should be addressed: E-mail:
| | - M. Reese Pepper
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD,Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC
| | - Margo Candelaria
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Laura E. Caulfield
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Laura Latta
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
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Hager ER, Candelaria M, Latta LW, Hurley KM, Wang Y, Caulfield LE, Black MM. Maternal perceptions of toddler body size: accuracy and satisfaction differ by toddler weight status. ACTA ACUST UNITED AC 2012; 166:417-22. [PMID: 22566540 DOI: 10.1001/archpediatrics.2011.1900] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To examine (1) accuracy of maternal perceptions of toddler body size; (2) factors associated with accuracy of toddler body size; and (3) how maternal satisfaction relates to accuracy/toddler body size. DESIGN Cross-sectional. SETTING Low-income community sample from suburban Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)/urban pediatric clinics. PARTICIPANTS Two hundred eighty-one mother-toddler dyads (toddlers: 54.1% male; mean age, 20.2 months; 70.8% African American; 8.5% underweight [<15th weight-for-length percentile]; and 29.2% overweight [≥85th weight-for-length percentile]). MAIN EXPOSURE Measured anthropometry (mother/toddler) and demographics. OUTCOME MEASURE Validated toddler silhouette scale (accuracy and satisfaction). RESULTS Nearly 70% of mothers were inaccurate in assessing their toddler's body size. Compared with mothers of healthy-weight toddlers, mothers of underweight toddlers were 9.13 times more likely to be accurate (95% CI, 2.94-28.36) and mothers of overweight toddlers were 87% less likely to be accurate (95% CI, 0.05-0.33); accuracy did not differ by toddler age, sex, or race or mother's education or weight status. More than 70% of all mothers and 81.7% of mothers of overweight toddlers were satisfied with their toddler's body size. Accurate mothers of underweight toddlers were less likely to be satisfied than accurate mothers of healthy-weight toddlers (30.0% vs 76.8%; P < .001). CONCLUSIONS Mothers of overweight toddlers had inaccurate perceptions of their toddler's body size and were highly satisfied, suggesting a view of heavy toddlers as normative. Mothers of underweight toddlers had accurate perceptions yet were dissatisfied, suggesting recognition of their child as outside the norm. Because inaccurate perceptions begin early in toddlerhood, pediatric providers should help improve families' understanding of healthy body size. Future studies should examine how satisfaction and accuracy relate to parenting behaviors.
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Affiliation(s)
- Erin R Hager
- Division of Growth and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
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