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McNeely A, Borchers L, Szeszulski J, Eicher-Miller HA, Seguin-Fowler RA, MacMillan Uribe A. The role of the community café in addressing food security: Perceptions of managers and directors. Appetite 2024; 196:107274. [PMID: 38364971 DOI: 10.1016/j.appet.2024.107274] [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] [Received: 10/11/2023] [Revised: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
In the United States, the pay-what-you-can restaurant model (community cafes) is an increasingly popular approach to addressing food insecurity in local communities. We conducted semi-structured interviews (n = 13) with community café executive managers and directors to assess their perceptions of the role that their cafes play in addressing food security (FS). Analysis of interviews revealed two major areas of emphasis by participants. Filling an unoccupied space in the food security landscape. Interviewees regularly cited the goal of making meals available through a dependable schedule, convenient location, and welcoming atmosphere for guests to promote regular visits to the café, and they did so with an awareness of how their practices were shaped by perceived shortcomings in comparable services. In addition, guest agency and social aspects of the café as components of utilization, was another major area. Interviewees often regarded the opportunity of the food insecure guest to choose healthy options (i.e., nutritionally dense) over less healthful ones (i.e., calorically dense) from the menu as a critical component of their service. The social component of the café (e.g., community atmosphere, 'dining-out' experience) was another aspect of the café's function that promoted dignity for the guest which can lead to greater likelihood of return visits. Perceptions shared by participants of the café's role in addressing food security suggest that rather than simply adding to the available options of hunger relief services, the café model attempts to address many areas of concern, such as structural and cultural barriers, found in the traditional forms of charitable food provision.
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Affiliation(s)
- Andrew McNeely
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Dallas Research Center, 17360 Coit Rd., Dallas, TX, 75252, USA
| | - Lori Borchers
- Texas Christian University Harris College of Nursing & Health Sciences, Annie Richardson Bass Building 2101, 2800 W Bowie St, Fort Worth, TX, 76109, USA
| | - Jacob Szeszulski
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Dallas Research Center, 17360 Coit Rd., Dallas, TX, 75252, USA
| | - Heather A Eicher-Miller
- Purdue University, Department of Nutrition Science, 700 West State Street, West Lafayette, IN, 47907, USA
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health through Agriculture, Texas A&M University, 500 Research Parkway Centeq Building B, Suite 270, College Station, TX, 77845, USA
| | - Alexandra MacMillan Uribe
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Dallas Research Center, 17360 Coit Rd., Dallas, TX, 75252, USA.
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Githinji P, Uribe ALM, Seguin-Fowler RA, Ayine P, On A, Villarreal DL, McNeely A, Szeszulski J, Rethorst CD. A qualitative exploration of the health needs and goals of urban women to inform the tailoring and adaptation of Strong Hearts Healthy Communities: a community-based cardiovascular disease prevention intervention. BMC Public Health 2024; 24:296. [PMID: 38273284 PMCID: PMC10811835 DOI: 10.1186/s12889-024-17818-1] [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: 08/31/2023] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND In the United States, cardiovascular diseases (CVD) are the leading cause of death and disability in women. CVD-modifiable risk factors, including poor diet quality and inadequate physical activity, can be addressed through evidence-based interventions (EBIs). Strong Hearts Healthy Communities (SHHC) is an EBI that has demonstrated effectiveness in reducing CVD risk and improving health outcomes among rural white women. The aims of this study were to understand the general health, diet, and physical activity-related needs and goals of women living in an urban community, to inform the tailoring and adaptation of the SHHC EBI to an urban setting and more diverse population. METHODS Focus groups (FGs) were conducted with African American/Black and Hispanic/Latinx women in the Dallas metropolitan area who had a BMI ≥ 25 kg/m2 and engaged in ≤ 150 min per week of moderate physical activity. The data were coded using a team-based, deductive, and thematic analysis approach, that included multiple coders and in-depth discussions. RESULTS Four FGs with a total of 18 participants (79% Black and 21% Latinx) were conducted, and three themes were developed: (1) participants had adequate knowledge and positive attitudes towards healthy living but faced many barriers to practicing healthy behaviors; (2) culturally-based beliefs and community practices exerted a strong influence on behaviors related to food and stress, revealing barriers to healthy eating and generational differences in stress and stress management; (3) participants desired a more individualized approach to nutrition and physical activity interventions that included familiar and enjoyable activities and social support centered around shared health goals. CONCLUSIONS The SHHC intervention and similar health programs for Black/African American and Hispanic/Latinx women in urban settings should emphasize individualized nutrition and practical skills for healthy eating with accessible, familiar, and enjoyable exercises. Additionally, stress management strategies should be culturally and generationally sensitive and social support, whether through family, friends, or other program participants, should be based on shared health goals.
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Affiliation(s)
- Phrashiah Githinji
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA.
| | | | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
| | - Priscilla Ayine
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
| | - Anita On
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
| | - Deyaun L Villarreal
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
| | - Andrew McNeely
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
| | - Jacob Szeszulski
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
| | - Chad D Rethorst
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Dallas, TX, USA
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Onadeko K, Walker TJ, Craig DW, Szeszulski J, Pavlovic A, DeFina LF, Kohl HW. Comparing the Use and Effectiveness of In-Person and Remote Physical Education Delivery During the COVID-19 Pandemic. Am J Health Educ 2024; 55:24-32. [PMID: 38264143 PMCID: PMC10803051 DOI: 10.1080/19325037.2023.2277945] [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: 06/07/2023] [Accepted: 07/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Physical Education is a key component to improve youth health, but there is limited information on Physical Education delivery in different formats. PURPOSE We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio. METHODS We distributed questionnaires (2020-2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n=216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables. RESULTS Among 165 schools, 10% (n=17) offered in-person instruction, 31% (n=51) offered remote instruction, and 59% offered both (n=97). Results revealed higher in-person PE minutes (77.2±7.3) compared to remote minutes (67.1±14.6), but results were not significantly different (p=0.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p<0.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p<0.001). DISCUSSION Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE. TRANSLATION to HEALTH EDUCATION PRACTICE Efforts are needed to improve remote PE to reinforce high-quality PE in the future.
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Affiliation(s)
- Kempson Onadeko
- The University of Texas Health Science Center at Houston School of Public Health
| | - Timothy J Walker
- The University of Texas Health Science Center at Houston School of Public Health
| | - Derek W Craig
- The University of Texas Health Science Center at Houston School of Public Health
| | | | | | | | - Harold W Kohl
- The University of Texas Health Science Center at Houston School of Public Health
- The University of Texas at Austin
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Szeszulski J, Faro JM, Joseph RP, Lanza K, Lévesque L, Monroe CM, Pérez-Paredes EA, Soltero EG, Lee RE. How Societal Forces of Change Are Transforming Youth Physical Activity Promotion in North America. J Phys Act Health 2023; 20:1069-1077. [PMID: 37917976 DOI: 10.1123/jpah.2023-0167] [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: 04/17/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic are large-scale, societal events (ie, forces of change) that affect the timing, settings, and modes of youth physical activity. Despite the impact that forces of change have on youth physical activity and physical activity environments, few studies consider how they affect physical activity promotion. METHODS The authors use 2 established frameworks, the ecological model of physical activity and the youth physical activity timing, how, and setting framework, to highlight changes in physical activity patterns of youth in North America that have resulted from contemporary forces of change. RESULTS North American countries-Canada, Mexico, and the United States-have faced similar but contextually different challenges for promoting physical activity in response to climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic. Innovative applications of implementation science, digital health technologies, and community-based participatory research methodologies may be practical for increasing and sustaining youth physical activity in response to these forces of change. CONCLUSIONS Thoughtful synthesis of existing physical activity frameworks can help to guide the design and evaluation of new and existing physical activity initiatives. Researchers, practitioners, and policymakers are encouraged to carefully consider the intended and unintended consequences of actions designed to respond to forces of change.
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Affiliation(s)
- Jacob Szeszulski
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, USA
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Kevin Lanza
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Lucie Lévesque
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Courtney M Monroe
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Elsa A Pérez-Paredes
- Forest Research Institute (Instituto de Investigaciones Forestales), Universidad Veracruzana, Xalapa, México
| | - Erica G Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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MacMillan Uribe AL, Demment M, Graham ML, Szeszulski J, Rethorst CD, Githinji P, Nelson ME, Strogatz D, Folta SC, Bailey RL, Davis JN, Seguin-Fowler RA. Improvements in dietary intake, behaviors, and psychosocial measures in a community-randomized cardiovascular disease risk reduction intervention: Strong Hearts, Healthy Communities 2.0. Am J Clin Nutr 2023; 118:1055-1066. [PMID: 37717638 PMCID: PMC10636233 DOI: 10.1016/j.ajcnut.2023.09.003] [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: 11/02/2022] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) prevalence has disproportionately risen among midlife and older female adults of rural communities, partly due to poor diet and diet-related behaviors and psychosocial factors that impede healthy eating. OBJECTIVES This study aimed to evaluate the impact of Strong Hearts Healthy Communities 2.0 (SHHC-2.0) on secondary diet-related outcomes between intervention and control participants that align with the dietary goal and behavioral aims of the SHHC-2.0, a CVD risk reduction program. METHODS A community-randomized controlled trial was conducted in rural, medically underserved communities. Participants were female adults ≥40 y who were classified as obese or both overweight and sedentary. Communities were randomized to SHHC-2.0 intervention (n = 5 communities; n = 87 participants) or control (with delayed intervention) (n = 6 communities; n = 95 participants). SHHC-2.0 consisted of 24 wk of twice-weekly experiential nutrition education and group-based physical activity classes led by local health educators. Changes between baseline and end point (24 wk) in dietary intake (24-h recalls), dietary behaviors (e.g., Rapid Eating Assessment for Participants-Short Version [REAP-S] scores) and diet-related psychosocial measures (e.g., Three Factor Eating questionnaire) between groups were analyzed using linear mixed-effects multilevel models. RESULTS At 24 wk, participants from the 5 intervention communities, compared with controls, consumed fewer calories (mean difference [MD]= -211 kcal, 95% CI: -412, -110, P = 0.039), improved overall dietary patterns measured by REAP-S scores (MD: 3.9; 95% CI: 2.26, 5.6; P < 0.001), and improved psychosocial measures (healthy eating attitudes, uncontrolled eating, cognitive restraint, and emotional eating). CONCLUSIONS SHHC-2.0 has strong potential to improve diet patterns and diet-related psychosocial wellbeing consistent with improved cardiovascular health. This trial was registered at www. CLINICALTRIALS gov as NCT03059472.
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Affiliation(s)
| | - Margaret Demment
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Meredith L Graham
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Jacob Szeszulski
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Chad D Rethorst
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Phrashiah Githinji
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Miriam E Nelson
- Tufts University, Friedman School of Nutrition, Boston, MA, United States
| | - David Strogatz
- Bassett Research Institute, Cooperstown, NY, United States
| | - Sara C Folta
- Tufts University, Friedman School of Nutrition, Boston, MA, United States
| | - Regan L Bailey
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Jaimie N Davis
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, United States
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Dias EM, Walker TJ, Craig DW, Gibson R, Szeszulski J, Brandt HM, Johnson H, Lamont A, Wandersman A, Fernandez ME. Examining readiness for implementing practice changes in federally qualified health centers: A rapid qualitative study. J Community Psychol 2023; 51:2724-2740. [PMID: 37021464 PMCID: PMC10523852 DOI: 10.1002/jcop.23041] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Implementing evidence-based interventions remains slow in federally qualified health centers (FQHCs). The purpose of this study is to qualitatively examine the R = MC2 (Readiness = motivation × innovation specific capacity × general capacity) heuristic subcomponents in the context of implementing general and colorectal cancer screening (CRCS)-related practice changes in FQHCs. We conducted 17 interviews with FQHC employees to examine (1) experiences with successful or unsuccessful practice change efforts, (2) using approaches to promote CRCS, and (3) opinions about R = MC2 subcomponents. We conducted a rapid qualitative analysis to examine the frequency, depth, and spontaneity of subcomponents. Priority, compatibility, observability (motivation), intra- and interorganizational relationships (innovation-specific capacity), and organizational structure and resource utilization (general capacity) emerged as highly relevant. For example, organizational structure was described as related to an organization's open communication during meetings to help with scheduling procedures. The results contribute to understanding organizational readiness in the FQHC setting and can be helpful when identifying and prioritizing barriers and facilitators that affect implementation.
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Affiliation(s)
- Emanuelle M Dias
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Timothy J Walker
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Derek W Craig
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Robert Gibson
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jacob Szeszulski
- Texas A&M AgriLife Research and Extension Center at Dallas, Dallas, Texas, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital, St. Jude Comprehensive Cancer Center, Memphis, Tennessee, USA
| | | | | | | | - Maria E Fernandez
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
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Rethorst CD, Githinji P, Seguin-Fowler RA, MacMillan Uribe AL, Szeszulski J, Liao Y. Real-time Assessment of the Bidirectional Relationship Between Affective States and Glucose: Protocol for a 14-Day Observational Study. JMIR Res Protoc 2023; 12:e45104. [PMID: 36947140 PMCID: PMC10132050 DOI: 10.2196/45104] [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] [Received: 01/06/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Glucose variability increases cardiometabolic disease risk. While many factors can influence glucose levels, postprandial glucose response is the primary driver of glucose variability. Furthermore, affect may directly and indirectly impact glucose variability through its effect on eating behavior. Continuous glucose monitors (CGMs) facilitate the real-time evaluation of blood glucose, and ecological momentary assessment (EMA) can be used to assess affect in real time. Together, data collected from these sources provide the opportunity to further understand the role of affect in glucose levels. OBJECTIVE This paper presents the protocol for a study that aims to (1) evaluate the feasibility and acceptability of using CGMs along with EMA in nondiabetic populations and (2) examine the bidirectional relationship between affect and glucose in nondiabetic adults with overweight or obesity using a CGM and EMA. METHODS Eligibility criteria for the study include participants (1) aged 18 to 65 years old, (2) with a BMI of ≥25 kg/m2, (3) who are able to read and write in English, and (4) who own a smartphone. Individuals will be excluded if they (1) have type 1 or 2 diabetes or have any other condition that requires glucose monitoring, (2) are pregnant, (3) use any medications that have the potential to alter blood glucose levels or interfere with the glucose sensing process, or (4) have a diagnosed gastrointestinal condition or eating disorder. In a 14-day observational study, participants will wear a FreeStyle Libre Pro CGM sensor (Abbott) and will receive mobile phone-based EMA prompts 6 times per day (randomly within six 2-hour windows between 8 AM and 8 PM) to assess positive and negative affect. Participants will also wear a Fitbit Inspire 2 (Fitbit) to continuously monitor physical activity and sleep, which will be included as covariates in the analysis. Multilevel linear regression models will be used to evaluate the acute relationship between glucose level and affect. RESULTS Recruitment started in October 2022 and is expected to be completed in March 2023. We will aim to recruit 100 participants. As of December 12, 2022, a total of 39 participants have been enrolled. CONCLUSIONS The results of this study will further elucidate the role of affect in glucose variability. By identifying affective states that may lead to glucose excursions, our findings could inform just-in-time behavioral interventions by indicating opportunities for intervention delivery. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45104.
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Affiliation(s)
- Chad D Rethorst
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research, Dallas, TX, United States
| | - Phrashiah Githinji
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research, Dallas, TX, United States
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research, College Station, TX, United States
| | | | - Jacob Szeszulski
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research, Dallas, TX, United States
| | - Yue Liao
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, United States
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Walker TJ, Foster M, Szeszulski J, Craig DW, Mullen PD, Fernández ME. Evidence-Based Intervention (EBI) Mapping: a systematic approach to understanding the components and logic of EBIs. BMC Public Health 2022; 22:1300. [PMID: 35794615 PMCID: PMC9261043 DOI: 10.1186/s12889-022-13692-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. To improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice. METHODS We describe EBI Mapping tasks and provide an example of the process. EBI Mapping uses principles from Intervention Mapping, a systematic framework for planning multilevel health promotion interventions. EBI Mapping applies the Intervention Mapping steps retrospectively to help planners understand an existing EBI (rather than plan a new one). We explain each EBI Mapping task and demonstrate the process using the VERB Summer Scorecard (VSS), a multi-level community-based intervention to improve youth physical activity. RESULTS EBI Mapping tasks are: 1) document EBI materials and activities, and their audiences, 2) identify the EBI goals, content, and mechanisms of action, 3) identify the theoretical change methods and practical applications of those methods, 4) describe design features and delivery channels, and 5) describe the implementers and their tasks, implementation strategies, and needed resources. By applying the EBI Mapping tasks, we created a logic model for the VSS intervention. The VSS logic model specifies the links between behavior change methods, practical applications, and determinants for both the at-risk population and environmental change agents. The logic model also links the respective determinants to the desired outcomes including the health behavior and environmental conditions to improve the health outcome in the at-risk population. CONCLUSIONS EBI Mapping helps program planners understand the components and logic of an EBI. This information is important for selecting, adapting, and scaling-up EBIs. Accelerating and improving the use of existing EBIs can reduce the research-to-practice gap and improve population health.
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Affiliation(s)
- Timothy J Walker
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, 7000 Fannin St., TX, 77030, USA.
| | - Maya Foster
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, 7000 Fannin St., TX, 77030, USA
| | - Jacob Szeszulski
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX, 77030, USA
| | - Derek W Craig
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, 7000 Fannin St., TX, 77030, USA
| | - Patricia Dolan Mullen
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, 7000 Fannin St., TX, 77030, USA
| | - Maria E Fernández
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, 7000 Fannin St., TX, 77030, USA
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Walker TJ, Szeszulski J, Robertson MC, Cuccaro PM, Fernandez ME. Understanding implementation strategies to support classroom-based physical activity approaches in elementary schools: A qualitative study. Eval Program Plann 2022; 92:102051. [PMID: 35240403 PMCID: PMC9177707 DOI: 10.1016/j.evalprogplan.2022.102051] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2021] [Accepted: 02/11/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Classroom-based physical activity approaches can improve children's physical activity levels during school. However, the implementation of these approaches remains a challenge. The purpose of this study was to examine implementation strategies to support the delivery of classroom-based physical activity approaches from the perspectives of elementary school staff. METHODS We conducted individual interviews with elementary school staff from a mid-sized school district in Texas. Interviews lasted approximately 60 min and were audio recorded and transcribed for analyses. We used directed content analysis and an iterative categorization approach to identify emerging themes related to implementation strategies. RESULTS We interviewed 15 participants (4 classroom teachers, 4 physical education teachers, 3 assistant principals, and 4 principals) about implementation strategies supporting classroom-based physical activity approaches. Four prominent themes related to implementation strategies emerged: 1) the role of program champions, 2) the use and function of staff training, 3) the importance of strategic planning, and 4) the use of positive reinforcements to support implementation. CONCLUSIONS Results highlight the need for multiple implementation strategies to support the delivery of classroom-based physical activity approaches. Results also highlight potential mechanisms through which the implementation strategies operate. This information is valuable to future planning efforts for classroom-based physical activity approaches.
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Affiliation(s)
- Timothy J Walker
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St., Houston, TX 77030, USA.
| | - Jacob Szeszulski
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St., Houston, TX 77030, USA.
| | - Michael C Robertson
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St., Houston, TX 77030, USA; MD Anderson Cancer Center, Center for Energy Balance, Department of Behavioral Science, Houston, TX 77030, USA.
| | - Paula M Cuccaro
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St., Houston, TX 77030, USA.
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St., Houston, TX 77030, USA.
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Lee RE, Szeszulski J, Lorenzo E, Arriola A, Bruening M, Estabrooks PA, Hill JL, O’Connor TM, Shaibi GQ, Soltero EG, Todd M. Sustainability via Active Garden Education: The Sustainability Action Plan Model and Process. Int J Environ Res Public Health 2022; 19:5511. [PMID: 35564909 PMCID: PMC9102810 DOI: 10.3390/ijerph19095511] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023]
Abstract
Sustainability of intervention programming is challenging to achieve under real world conditions, since few models exist and many studies do not plan far beyond the funding period. Programming content in early care and education centers (ECECs) is often driven by guidelines. However, implementation is very sensitive to contextual factors, such as the setting and implementer (teacher) characteristics. This paper presents the model, definitions, and methodology used for the sustainability action plan capitalizing on a community-based participatory research (CBPR) approach, developed for a multi-site, multi-level garden-based childhood obesity prevention study, Sustainability via Active Garden Education (SAGE). The Ecologic Model of Obesity is applied to develop a sustainability action plan (SAP) and accompanying measures to link early care and education (ECE) environment, the community, policies, and classroom practices to an early childhood obesity prevention program. The SAGE SAP provides an example of how to iteratively evaluate and refine sustainability processes for an obesity prevention intervention utilizing CBPR approaches and will be applied to assess the sustainability of SAGE in a cluster randomized controlled trial. This SAP model can also help inform intervention delivery and scalability within ECECs.
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Affiliation(s)
- Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Jacob Szeszulski
- Institute for Advancing Health through Agriculture (IHA), Texas A&M AgriLife Research, 17360 Coit Rd., Dallas, TX 75252, USA;
| | - Elizabeth Lorenzo
- School of Nursing, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Anel Arriola
- City of Phoenix Office of Arts and Culture, 200 W. Washington St., 10th Floor, Phoenix, AZ 85003, USA;
| | - Meg Bruening
- College of Health Solutions, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Paul A. Estabrooks
- College of Health, University of Utah, 260 1850 E, Salt Lake City, UT 84112, USA;
| | - Jennie L. Hill
- Population Health Sciences, University of Utah, 295 S Chipeta Way, Salt Lake City, UT 84108, USA;
| | - Teresia M. O’Connor
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (T.M.O.); (E.G.S.)
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Erica G. Soltero
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (T.M.O.); (E.G.S.)
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
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11
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Classen S, Szeszulski J, Ranjit N, Rivas-Ponce G, Hoelscher DM. Coordinated Health in Texas Elementary Schools' Campus Improvement Plans: Analysis of Regional Differences and Trends between 2016 and 2020. Int J Environ Res Public Health 2022; 19:ijerph19094979. [PMID: 35564373 PMCID: PMC9102063 DOI: 10.3390/ijerph19094979] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022]
Abstract
Schools signal health priorities through policies. Using a repeated cross-sectional study design, we compare the presence and strength of policies related to four topics—physical activity, nutrition, mental health, and bullying—described in elementary school Campus Improvement Plans (CIPs; also called school improvement plans) within Texas, across four Texas Public Health Regions (PHRs), and between 2016 and 2020. CIPs were collected using a multi-stage probability-based survey approach, scored using an adapted WellSAT tool, and analyzed to determine associations between PHR or year and health topic. Across 170 CIPs, bullying was the most frequently addressed topic, followed by mental health, physical activity, and nutrition. On average, schools addressed 2.7 ± 1.3 topics within their CIP; 38.2% of schools addressed all four, 26.5% addressed three, 12.4% addressed two, 15.3% addressed one, and 7.6% addressed none. CIPs in the same district had high levels of clustering (ICCs = 0.28–0.55). The mostly rural Panhandle PHR included the fewest topics in their CIPs and used the weakest policy language. Between 2016 and 2020, there was a decrease in the proportion of CIPs that addressed nutrition; the strength of language for mental health and bullying also decreased. Regional and time trends reveal opportunities for more robust school health policy interventions.
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Affiliation(s)
- Sarah Classen
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (S.C.); (J.S.); (N.R.); (G.R.-P.)
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jacob Szeszulski
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (S.C.); (J.S.); (N.R.); (G.R.-P.)
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research Center, Dallas, TX 75252, USA
| | - Nalini Ranjit
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (S.C.); (J.S.); (N.R.); (G.R.-P.)
| | - Genesis Rivas-Ponce
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (S.C.); (J.S.); (N.R.); (G.R.-P.)
| | - Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX 78701, USA; (S.C.); (J.S.); (N.R.); (G.R.-P.)
- Correspondence:
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12
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Szeszulski J, Lorenzo E, Todd M, O’Connor TM, Hill J, Shaibi GQ, Vega-López S, Buman MP, Hooker SP, Lee RE. Early Care and Education Center Environmental Factors Associated with Product- and Process-Based Locomotor Outcomes in Preschool-Age Children. Int J Environ Res Public Health 2022; 19:ijerph19042208. [PMID: 35206392 PMCID: PMC8871663 DOI: 10.3390/ijerph19042208] [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] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
Environmental characteristics of early care and education centers (ECECs) are an important context for preschool-aged children’s development, but few studies have examined their relationship with children’s locomotor skills. We examined the association between characteristics of the ECEC environment with quantitatively (i.e., product-based) and qualitatively (i.e., process-based) measured locomotor skills, using the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the locomotor portion of the Children’s Activity and Movement in Preschool Study (CHAMPS) motor skills protocol (CMSP), respectively. ECEC characteristics included outdoor and indoor play environment quality, outdoor and indoor play equipment, screen-time environment quality, and policy environment quality. Mean (SD) scores for the PACER (n = 142) and CSMP (n = 91) were 3.7 ± 2.3 laps and 19.0 ± 5.5 criteria, respectively, which were moderately correlated with each other (Pearson r = 0.5; p < 0.001). Linear regression models revelated that a better policy environment score was associated with fewer PACER laps. Better outdoor play and screen-time environment quality scores and more outdoor play equipment were positively associated with higher CMSP scores. ECEC environments that reflect best practice guidelines may be opportunities for locomotor skills development in preschool-aged children. ClinicalTrials.gov Identifier: NCT03261492 (8/25/17).
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Affiliation(s)
- Jacob Szeszulski
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Research, 17360 Coit Rd., Dallas, TX 75252, USA
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA; (E.L.); (G.Q.S.)
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
- Correspondence:
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA; (E.L.); (G.Q.S.)
- School of Nursing, University of Texas Medical Branch, 1114 Mechanic St., Galveston, TX 77555, USA
| | - Michael Todd
- College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA;
| | - Teresia M. O’Connor
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave., Houston, TX 77030, USA;
| | - Jennie Hill
- Department of Population Health Sciences, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112, USA;
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA; (E.L.); (G.Q.S.)
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
- Southwestern Interdisciplinary Research Center, Arizona State University, 400 E. Van Buren St., Suite 800 Phoenix, Phoenix, AZ 85004, USA
| | - Matthew P. Buman
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
| | - Steven P. Hooker
- College of Health and Human Services, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA;
| | - Rebecca E. Lee
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
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Szeszulski J, Lorenzo E, Arriola A, Lee RE. Community-Based Measurement of Body Composition in Hispanic Women: Concurrent Validity of Dual- and Single-Frequency Bioelectrical Impedance. J Strength Cond Res 2022; 36:577-584. [PMID: 31929352 PMCID: PMC7347434 DOI: 10.1519/jsc.0000000000003483] [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: 02/03/2023]
Abstract
ABSTRACT Szeszulski, J, Lorenzo, E, Arriola, A, and Lee, RE. Community-based measurement of body composition in hispanic women: concurrent validity of dual- and single-frequency bioelectrical impedance. J Strength Cond Res 36(2): 577-584, 2022-We examined the concurrent validity of single-frequency (SF) and dual-frequency (DF) bioelectrical impedance (BIA) scales among Hispanic women participating in a community-based health promotion program in Arizona. Hispanic women (N = 14), age 31.9 ± 6.5 years old, with a mean body mass index (BMI) of 31.1 ± 8.1 kg·m-2, were measured using SF BIA, DF BIA, BMI, and skinfold calipers in 2017. Intrarater reliability and concurrent validity were calculated. Bland-Altman plots examined agreement of each BIA measure within measurement tools, between tools, and with skinfold calipers. Scatter plots were used to examine agreement between BIAs and BMI. Short-term intrarater reliability was perfect within measurements for SF and DF BIAs (α = 1.0). The coefficient of variation within a measurement tool (CV%) was slightly smaller for DF BIA (0.2%; n = 13) than for SF BIA (0.3%; n = 14). Concurrent validity measures revealed that DF (M = 39.3 ± 7.3% fat; within sample CV% = 18.6; n = 14) and SF (M = 39.4 ± 7.5% body fat; within sample CV% = 19.0; n = 14) BIAs were highly correlated (Pearson r = 0.885; p < 0.001; n = 14) and had an absolute mean difference of -0.2 ± 3.5% fat (range 0.7-6.0% fat; n = 14). The CV% between BIA measures was 5.4%. Dual-frequency and SF BIAs were both strongly correlated with BMI and skinfolds. There was evidence of bias between skinfolds and both BIA measures. Strength and conditioning practitioners should feel confident in using either SF or DF BIA measures with Hispanic women who participate in training interventions in community-based settings, because they offer similar measurement value.
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Affiliation(s)
- Jacob Szeszulski
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas,Michael Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, Texas
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Anel Arriola
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona,Herberger Institute for Design and the Arts, Arizona State University, Tempe, Arizona
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
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14
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Szeszulski J, Helal Salsa G, Cuccaro P, Markham CM, Martin M, Savas LS, Valerio-Shewmaker M, Walker TJ, Springer AE. Using Community-Academic Partnerships and a Creative Expression Contest to Engage Youth in the Development of Communication Materials for Promoting Behaviors That Prevent COVID-19. Health Promot Pract 2022; 23:609-618. [PMID: 35043711 DOI: 10.1177/15248399211070547] [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: 11/17/2022]
Abstract
Youth can transmit COVID-19 to adults, but few communication materials exist for engaging youth in COVID-19 prevention behaviors. We describe the process of leveraging a community-academic partnership in a rapid response initiative to engage youth in a contest (i.e., Youth-Led Creative Expression Contest to Prevent COVID-19 across Texas) to develop creative public health messaging centered on the prevention of COVID-19 transmission and infection for their peers. Core activities included developing a request for applications that solicited submission of creative expression materials promoting the use of COVID-19 prevention behaviors (mask-wearing, social distancing, handwashing, not touching the face) from Texas youth in elementary, middle, and/or high school; sending the request for applications to 48 organizations in Austin, Brownsville, Dallas, El Paso, Houston, and San Antonio in summer 2020; and recruiting a youth advisory board to score submissions and award prizes. We report on youth engagement in the COVID communication contest across Texas and use statistics (chi-square and t-tests) to characterize and compare youth participants and their creative expression artwork. The contest resulted in 3,003 website views and 34 submissions eligible for scoring. Each submission averaged >2 prevention behaviors. On average, winning submissions included a higher number of prevention behaviors than nonwinning submissions. The prevention behavior "not touching the face" was included more often in winning submissions than nonwinning submissions. Elementary school children were less likely to include a mask in their submission compared with older youth. Existing community-academic networks can engage youth in the development of geographically and age-tailored communication materials.
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Affiliation(s)
- Jacob Szeszulski
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, USA.,The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
| | - Ghadir Helal Salsa
- The University of Texas Health Science Center at Houston, School of Public Health in Brownsville, Brownsville, TX, USA
| | - Paula Cuccaro
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Christine M Markham
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Mary Martin
- The University of Texas Health Science Center at Houston, School of Public Health in San Antonio, San Antonio, TX, USA
| | - Lara S Savas
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Melissa Valerio-Shewmaker
- The University of Texas Health Science Center at Houston, School of Public Health in Brownsville, Brownsville, TX, USA
| | - Timothy J Walker
- The University of Texas Health Science Center at Houston, School of Public Health in Houston, Houston, TX, USA
| | - Andrew E Springer
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, USA
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15
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Szeszulski J, Craig DW, Walker TJ, Foster M, Mullen PD, Fernandez ME. Applying evidence-based intervention (EBI) mapping to identify the components and logic of colorectal cancer screening interventions. Transl Behav Med 2021; 12:304-323. [PMID: 34730181 DOI: 10.1093/tbm/ibab140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Implementation of evidence-based interventions (EBIs) can help to increase colorectal cancer screening (CRCS). Potential users of CRCS EBIs are often unclear about the specific features, logic, and core elements of existing EBIs, making it challenging to use or adapt them. We used EBI Mapping, a systematic process developed from Intervention Mapping that identifies an EBI's components and logic, to characterize existing CRCS EBIs from the National Cancer Institute's Evidence-Based Cancer Control Programs website. The resulting information can facilitate intervention adoption, adaptation, and/or implementation. Two trained coders independently coded intervention materials to describe intervention components and logic (n = 20). We display CRCS EBI components (potential mechanism of change) using evidence tables and heat maps. All EBIs addressed completion of at least one CRCS behavior (stool-based test, n = 9; stool-based test or another CRCS test, n = 8; colonoscopy, n = 3; colonoscopy or sigmoidoscopy, n = 1). The psychosocial determinants most frequently addressed by these interventions were knowledge (n = 19), attitudes (n = 17), risk perception/perceived susceptibility (n = 16), skills (n = 15), and overcoming barriers (n = 15). Multi-level EBIs (n = 9) attempted to change an average of 2.1 ± 1.1 conditions in the patients' environment (e.g., accessibility of CRCS); only four EBIs used environmental change agents (e.g., providers, nurses). From the heat maps of EBIs, we describe common theoretical change methods' (e.g., facilitation) used for addressing determinants (e.g., overcoming barriers). EBI Mapping can help users identify important components of a CRCS EBI's logic; these proposed mechanisms of action can inform adoption, adaptation, and implementation in new settings, and facilitate scale up of EBIs.
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Affiliation(s)
- Jacob Szeszulski
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA.,Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health, Austin, TX 78701, USA
| | - Derek W Craig
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
| | - Timothy J Walker
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
| | - Maya Foster
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
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16
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Walker TJ, Craig DW, Pavlovic A, Thiele S, Natale B, Szeszulski J, DeFina LF, Kohl HW. Physical Activity and Healthy Eating Programming in Schools to Support Student's Health-Related Fitness: An Observational Study. Int J Environ Res Public Health 2021; 18:ijerph182111069. [PMID: 34769588 PMCID: PMC8583401 DOI: 10.3390/ijerph182111069] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
Centers for Disease Control (CDC) guidelines recommend schools use a coordinated health approach to support healthy eating and physical activity. This study examines whether the number of healthy eating and physical activity programs and activities used by schools and their perceived success relate to students’ health-related fitness. This observational study used data from the Healthy Zone Schools Program. Data (collected in 2017–2019) were integrated from three sources: (1) school surveys, (2) FitnessGram®, and (3) the Texas Education Agency. Independent variables were the number of health promotion programs and activities and their perceived success; dependent variables were meeting Healthy Fitness Zone Standards (HFZ) for aerobic capacity and body mass index (BMI). We used mixed-effects logistic regression models. Fifty-six schools were in the analytic sample (n = 15,096 students with aerobic capacity data and n = 19,969 with BMI data). Results indicated the perceived success of physical activity programs/activities was significantly associated with students meeting HFZ standards for aerobic capacity (OR = 1.32, CI = 1.06–1.63). There was a significant direct association between the number of physical activity and healthy eating activities implemented (OR = 1.04, CI = 1.01–1.06) and students meeting HFZ for BMI. Schools using multiple health programs and activities need to balance the number provided with their capacity to maintain success.
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Affiliation(s)
- Timothy J. Walker
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030, USA; (D.W.C.); (J.S.)
- Correspondence:
| | - Derek W. Craig
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030, USA; (D.W.C.); (J.S.)
| | - Andjelka Pavlovic
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Shelby Thiele
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Breanna Natale
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Jacob Szeszulski
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030, USA; (D.W.C.); (J.S.)
| | - Laura F. DeFina
- Division of Youth Education, The Cooper Institute, 12330 Preston Road, Dallas, TX 75230, USA; (A.P.); (S.T.); (B.N.); (L.F.D.)
| | - Harold W. Kohl
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX 78701, USA;
- Department of Kinesiology and Health Education, The University of Texas at Austin, 1616 Guadalupe, Austin, TX 78701, USA
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Walker TJ, Craig DW, Szeszulski J, Fernandez ME. Examining the Validity and Reliability of Measures for Individual-Level Constructs related to Implementation of School-Based Physical Activity Approaches. J Healthy Eat Act Living 2021; 1:117-126. [PMID: 36313519 PMCID: PMC9615476 DOI: 10.51250/jheal.v1i3.18] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Valid and reliable measures are important to understanding the implementation of physical activity approaches in schools. The study purpose is to examine the psychometric properties of measures of individual-level constructs (knowledge, attitudes, outcome expectations, self-efficacy, innovativeness, and support) in the context of implementing school-based physical activity approaches. We collected data from a sample of elementary school employees (administrators, classroom teachers, physical educators, and support staff) from an urban school district in southeast Texas. Confirmatory factor analysis (CFA) models were used to examine structural validity. We also examined correlations between constructs to assess discriminant and convergent validity. Last, we used a CFA-based approach to examine scale reliability. The analytic sample consisted of 205 employees. CFA results for each individual measure revealed good-fitting models for most measures (χ2(df)>0.05, RMSEA<0.08, CFI>0.90, TLI>0.90, SRMR≤0.07). A combined model that included all the measures also indicated good fit across indices: χ2(306)=485, p<0.001; RMSEA=0.05, CFI=0.93, TLI=0.92, SRMR=0.07. All correlations between constructs were <0.70, and all but one construct (innovativeness) demonstrated moderate correlations with support for classroom-based physical activity approaches (>0.30). In addition, reliability point estimates were all >0.70. The measures tested in this study were found to have good reliability, as well as good structural, discriminant, and convergent validity. These measures are useful in efforts to better understand how individual-level constructs relate to implementation behaviors for physical activity approaches in schools.
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Affiliation(s)
- Timothy J Walker
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research
| | - Derek W Craig
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research
| | - Jacob Szeszulski
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research
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18
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Walker TJ, Craig DW, Szeszulski J, Fernández ME. Examining the Validity and Reliability of Measures for Individual-Level Constructs Related to Implementation of School-Based Physical Activity Approaches. J Healthy Eat Act Living 2021; 1:128-137. [PMID: 37799196 PMCID: PMC10550035] [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] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Valid and reliable measures are important to understanding the implementation of physical activity approaches in schools. The study purpose is to examine the psychometric properties of measures of individual-level constructs (knowledge, attitudes, outcome expectations, self-efficacy, innovativeness, and support) in the context of implementing school-based physical activity approaches. We collected data from a sample of elementary school employees (administrators, classroom teachers, physical educators, and support staff) from an urban school district in southeast Texas. Confirmatory factor analysis (CFA) models were used to examine structural validity. We also examined correlations between constructs to assess discriminant and convergent validity. Last, we used a CFA-based approach to examine scale reliability. The analytic sample consisted of 205 employees. CFA results for each individual measure revealed good-fitting models for most measures (χ2 (df) >0.05, RMSEA <0.08, CFI >0.90, TLI >0.90, SRMR≤0.07). A combined model that included all the measures also indicated good fit across indices: χ2(306) = 485, p <0.001; RMSEA = 0.05, CFI = 0.93, TLI = 0.92, SRMR = 0.07. All correlations between constructs were <0.70, and all but one construct (innovativeness) demonstrated moderate correlations with support for classroom-based physical activity approaches (>0.30). In addition, reliability point estimates were all >0.70. The measures tested in this study were found to have good reliability, as well as good structural, discriminant, and convergent validity. These measures are useful in efforts to better understand how individual-level constructs relate to implementation behaviors for physical activity approaches in schools.
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Affiliation(s)
- Timothy J Walker
- University of Texas Health Science Center at Houston School of Public Health
| | - Derek W Craig
- University of Texas Health Science Center at Houston School of Public Health
| | - Jacob Szeszulski
- University of Texas Health Science Center at Houston School of Public Health
| | - Maria E Fernández
- University of Texas Health Science Center at Houston School of Public Health
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19
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Szeszulski J, Walker TJ, Robertson MC, Fernandez ME. Differences in psychosocial constructs among elementary school staff that implement physical activity programs: a step in designing implementation strategies. Transl Behav Med 2021; 12:237-242. [PMID: 34423841 DOI: 10.1093/tbm/ibab120] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Multiple types of school staff members (e.g., classroom teachers, principals) are involved in implementing physical activity programs (e.g., classroom-based, gym), but factors specific to their job responsibilities may inhibit their ability to implement programming effectively. Thus, implementation strategies tailored by job type may be needed. We compare perceptions of behavioral constructs related to implementation of school-based physical activity programs, by job type, among school staff. School staff (n = 139), including principals/assistant principals (n = 21), physical education teachers (n = 41), and classroom teachers (n = 77), from elementary schools (n = 25), completed a cross-sectional survey measuring perceptions of attitudes, barriers, knowledge, and outcome expectations related to the implementation of physical activity programs. We compared constructs between job types using complex samples general linear models. Classroom teachers reported more perceived implementation barriers, lower physical activity knowledge, and lower outcome expectations than physical education teachers. Principals reported more perceived implementation barriers than physical education teachers. Classroom teachers reported lower physical activity knowledge than principals. Attitudes towards physical activity were not different by job type. Each job type has a unique constellation of factors affecting their capacity to implement physical activity programs. Understanding these differences enables tailoring of implementation strategies by job type.
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Affiliation(s)
- Jacob Szeszulski
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,The University of Texas Health Science Center at Houston School of Public Health, Austin Campus, Michael Susan Dell Center for Healthy Living, Austin, TX, USA
| | - Timothy J Walker
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,The University of Texas Health Science Center at Houston School of Public Health, Austin Campus, Michael Susan Dell Center for Healthy Living, Austin, TX, USA
| | - Michael C Robertson
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA.,MD Anderson Cancer Center, Cancer Prevention Building, Center for Energy Balance, Department of Behavioral Science, Houston, TX, USA
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX, USA
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20
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Walker TJ, Craig DW, Robertson MC, Szeszulski J, Fernandez ME. The relation between individual-level factors and the implementation of classroom-based physical activity approaches among elementary school teachers. Transl Behav Med 2021; 11:745-753. [PMID: 33598700 DOI: 10.1093/tbm/ibaa133] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Classroom-based physical activity approaches can improve students' physical activity; however, their implementation remains a challenge. This study examined teacher-level factors associated with implementing two classroom-based physical activity approaches (active learning and physical activity breaks). We collected cross-sectional survey data from classroom teachers (n = 133) from 20 elementary schools in an urban Texas school district. Surveys included questions about theoretical constructs (e.g., knowledge, self-efficacy), personal characteristics (e.g., age, gender), and the implementation of active learning and physical activity breaks. We used linear regression models to assess associations between independent variables and implementation outcomes. We also assessed variable importance by examining the unique variance explained. Knowledge (b = .31, p = .001), outcome expectations (b = .18, p = .015), self-efficacy (b = .40, p ≤ .001), and support (b = .22, p = .028) were directly associated with active learning implementation. Teacher physical activity level (b = .29, p = .004) and grade level (third to fifth had lower levels than kindergarten to second grade, b = -.45, p = .022) were also associated with active learning implementation. In fully adjusted models, self-efficacy explained the most variance (≈5%) in active learning implementation compared to other variables. Knowledge (b = .18, p = 0.026), attitudes (b = .18, p = .019), self-efficacy (b = .15, p = .036), and teacher grade level (third to fifth had lower levels than kindergarten to second grade, b = -.80, p < .001) were associated with activity break implementation. In fully adjusted models, teacher grade level explained the most variance (≈13%) in activity break implementation compared to other variables. Results suggest multiple theoretical constructs and personal characteristics are important to target/consider when developing implementation strategies for classroom-based physical activity approaches. Additionally, self-efficacy and teacher grade level are two factors to prioritize.
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Affiliation(s)
- Timothy J Walker
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Derek W Craig
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michael C Robertson
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jacob Szeszulski
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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21
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Lee RE, Joseph RP, Blackman Carr LT, Strayhorn SM, Faro JM, Lane H, Monroe C, Pekmezi D, Szeszulski J. Still striding toward social justice? Redirecting physical activity research in a post-COVID-19 world. Transl Behav Med 2021; 11:1205-1215. [PMID: 33822205 PMCID: PMC8083595 DOI: 10.1093/tbm/ibab026] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 crisis and parallel Black Lives Matter movement have amplified longstanding systemic injustices among people of color (POC). POC have been differentially affected by COVID-19, reflecting the disproportionate burden of ongoing chronic health challenges associated with socioeconomic inequalities and unhealthy behaviors, including a lack of physical activity. Clear and well-established benefits link daily physical activity to health and well-being—physical, mental, and existential. Despite these benefits, POC face additional barriers to participation. Thus, increasing physical activity among POC requires additional considerations so that POC can receive the same opportunities to safely participate in physical activity as Americans who are White. Framed within the Ecologic Model of Physical Activity, this commentary briefly describes health disparities in COVID-19, physical activity, and chronic disease experienced by POC; outlines underlying putative mechanisms that connect these disparities; and offers potential solutions to reduce these disparities. As behavioral medicine leaders, we advocate that solutions must redirect the focus of behavioral research toward community-informed and systems solutions.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Loneke T Blackman Carr
- Department of Nutritional Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA
| | - Shaila Marie Strayhorn
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hannah Lane
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Courtney Monroe
- Department of Health Promotion, Education, and Behavior, Technology Center to Promote Healthy Lifestyles, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dorothy Pekmezi
- School of Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Szeszulski
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, Michael & Susan Dell Center for Healthy Living, Houston, TX, USA
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22
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Szeszulski J, Walker TJ, McCurdy SA, Hoelscher DM. Use of School Wellness Policy Templates in One Texas Public Health Region: A Mixed-Methods Analysis. J Sch Health 2021; 91:562-573. [PMID: 33954996 PMCID: PMC8192465 DOI: 10.1111/josh.13032] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Federal law requires most school districts to develop school wellness policies (SWPs), which state agencies assist in by providing templates. Templates provide standard language, which districts may edit for numerous reasons. We aimed to identify the frequency/consistency of template usage and identify the types of edits districts make when using SWP templates. METHODS We identified SWPs (N = 117) and templates (N = 2) from districts in 1 Texas public health region. We developed template specific coding guides, which allowed us to examine the frequency SWPs used template text within multiple areas (eg, nutrition goals, reporting). We also collected/categorized SWP edits from the template text and conducted a thematic analysis of locally developed SWPs and SWP templates. RESULTS Of 117 SWPs, 81.2% used a 2020 template, 13.7% used a 2005 template, and 5.1% created their own SWP. Across template-based SWPs, 44 content edits (0.4 per policy) occurred in 9 categories. Thematic analysis revealed: (1) locally developed SWPs created an informed mission statement linked to their goals; (2) Locally developed SWPs provided details that the current template includes in wellness plans. CONCLUSIONS Most districts used exact template language when writing their SWP. Adding spaces where districts can specify details could improve SWP content.
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Affiliation(s)
- Jacob Szeszulski
- The University of Texas Health Science Center at Houston,
Center for Health Promotion and Prevention Research and the Michael & Susan Dell
Center for Healthy Living, 7000 Fannin St #2528, Houston, TX, 77030
| | - Timothy J. Walker
- The University of Texas Health Science Center at Houston,
Center for Health Promotion and Prevention Research, 7000 Fannin St #2630, Houston,
TX, 77030
| | - Sheryl A. McCurdy
- The University of Texas Health Science Center at Houston,
Center for Health Promotion and Prevention Research, 7000 Fannin St #2572, Houston,
Texas, 77030
| | - Deanna M. Hoelscher
- The University of Texas Health Science Center at Houston
(UTHealth) School of Public Health, Austin Campus, Michael & Susan Dell Center
for Healthy Living, 1616 Guadalupe St., Suite 6.300, Austin, TX, 78701
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23
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Szeszulski J, Lanza K, Dooley EE, Johnson AM, Knell G, Walker TJ, Craig DW, Robertson MC, Salvo D, Kohl HW. Y-PATHS: A Conceptual Framework for Classifying the Timing, How, and Setting of Youth Physical Activity. J Phys Act Health 2021; 18:310-317. [PMID: 33581685 PMCID: PMC8035289 DOI: 10.1123/jpah.2020-0603] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity. METHODS The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children's and adolescents' physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation. RESULTS The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure. CONCLUSIONS The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming.
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24
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Szeszulski J, Lorenzo E, O'Connor T, Hill JL, Shaibi GQ, Buman MP, Vega-López S, Hooker SP, Lee RE. Exploring Correlates of Preschool-Aged Children's Locomotor Skills: Individual and Parent Demographics and Home Environment. Percept Mot Skills 2020; 128:649-671. [PMID: 33342342 DOI: 10.1177/0031512520980938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
We examined individual and parental demographics and home environment factors associated with locomotor skills in predominantly Hispanic preschool-aged children. We used questionnaires to survey parents, included inquiries regarding parenting practices, parents' physical activity levels, and home-based physical activity resources; and we administered the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the CHAMPS Motor Skills Protocol (CMSP) to children to measure the quantity and quality of their locomotor skills. Participants were 144 parents and their children (78.9% Hispanic, 49.3% girls) recruited from urban, community-based childcare and education centers. We examined the relationship between survey measures and PACER and CMSP scores with forward-selection stepwise linear regression models. Overall, 142 children completed the PACER, and 91 completed the CMSP. At the individual level, a child's age was positively associated with both PACER and CMSP scores, and girls had lower PACER scores than boys. In the home environment, parental promotion of more screen time was associated with a higher children's PACER score. In addition, higher parent concern for children's safety was associated with a lower PACER score. We identified several physical activity promoting parent practices as new home environment factors related to the preschool-aged children's locomotor development. Additional studies are needed to test new hypotheses generated from these data. ClinicalTrials.gov Identifier: NCT03261492 (date of registration 8/25/17).
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Affiliation(s)
- Jacob Szeszulski
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, United States.,Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, Austin Campus, United States.,Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Jennie L Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, United States
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, United States.,Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, United States
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, United States
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
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25
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Lorenzo E, Szeszulski J, Shin CN, Todd M, Lee RE. Relationship between walking for active transportation and cardiometabolic health among adults: A systematic review. J Transp Health 2020; 19:100927. [PMID: 34676154 PMCID: PMC8525782 DOI: 10.1016/j.jth.2020.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3 St., Phoenix, Arizona, 85004, United States
| | - Jacob Szeszulski
- Center for Health Promotion and Prevention Research, Michael Susan Dell Center for Healthy Living, University of Texas Health Science Center at 7000 Fannin St. #2528 Houston, Texas, United States
| | - Cha-Nam Shin
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3 St., Phoenix, Arizona, 85004, United States
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3 St., Phoenix, Arizona, 85004, United States
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3 St., Phoenix, Arizona, 85004, United States
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26
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Szeszulski J, Walker T, Robertson M, Cuccaro P, Fernandez ME. School Staff's Perspectives on the Adoption of Elementary-School Physical Activity Approaches: A Qualitative Study. Am J Health Educ 2020; 51:395-405. [PMID: 33763162 DOI: 10.1080/19325037.2020.1822241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background There is a need to understand how schools adopt physical activity approaches (curricula, programs and practices), but few studies report on this process. Purpose To obtain elementary school staff's perspectives regarding how their schools are currently adopting physical activity approaches. Methods We recruited 15 participants from four job types in an urban Texas school district to participate in semi-structured interviews. We coded and analyzed interviews using directed content analysis and iterative categorization. Results We identified four themes pertaining to how the district, schools, and teachers contribute to the adoption of approaches. Themes included: (1) Staff identify new approaches through numerous channels; (2) Adoption occurs at multiple organizational levels; (3) District staff fulfilled a supporting role in the adoption process; and (4) School staff's perceptions of approach characteristics influence adoption. Discussion We found that schools adopt physical activity approaches at both the district- and school-level. Additionally, multiple stakeholders played a role in the adoption process and those roles varied across approaches. Translation to Health Education Practice Time, money, space, staff, competing priorities, limited information, the school's mission, and the benefits an approach provides to children are factors that researches and practitioners should consider when starting a new physical activity approach.
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Affiliation(s)
- Jacob Szeszulski
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030.,The University of Texas Health Science Center at Houston School of Public Health, Austin Campus, Michael Susan Dell Center for Healthy Living, 1616 Guadalupe St Suite 6.300, Austin, TX, USA 78701
| | - Tim Walker
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030
| | - Michael Robertson
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030.,MD Anderson Cancer Center, Cancer Prevention Building, Center for Energy Balance, Department of Behavioral Science, Unit 1330, 1155 Pressler St, Houston, TX USA 77030
| | - Paula Cuccaro
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St. Houston, TX, USA 77030
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27
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Szeszulski J, Vega-López S, Todd M, Ray F, Behar A, Campbell M, Chavez A, Eckert R, Lorenzo-Quintero A, Hartmann Manrique L, Crespo NC. Athletes for life: Rationale and methodology of a community- and family-based randomized controlled trial to promote cardiovascular fitness among primarily Latino families. Contemp Clin Trials 2020; 91:105956. [PMID: 32061969 PMCID: PMC7294588 DOI: 10.1016/j.cct.2020.105956] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/27/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Community-based programs have had modest success in combating obesity in Latino populations. Latino families' norms and beliefs about weight often hold larger body sizes to be normal, leading to lower engagement in weight-focused programs. Because improvements in cardiorespiratory fitness confer health benefits, regardless of weight, they offer an alternative to obesity-focused approaches. We describe the rationale and design of Athletes for Life (AFL), a community- and family-based intervention for Latino families. METHODS/DESIGN This two-group randomized controlled trial will test the efficacy of AFL for improving cardiorespiratory fitness and diet in 6- to 11-year-old children (N = 160) and their parents, relative to a wait-list control group. Children will participate in 12 weeks of semiweekly sports skill programing and nutrition sessions. Concurrently, parents will participate in sports-focused activity and behavior change sessions that focus on nutrition, chronic disease prevention, and healthy eating. Cardiovascular fitness will be measured by the 1-mile run and 3-min step-test for both parents and children. Secondary outcomes include changes in objectively measured physical activity, dietary measures, body composition, and cardiometabolic risk (waist circumference, blood pressure, blood lipids, glucose, insulin, and C-reactive protein). DISCUSSION AFL, implemented with a strong community partnership, will provide a test of the efficacy of culturally tailored intervention programming to promote positive health behaviors and improve health outcomes in Latino families. Intervention content, structure, and messaging will provide guidance for future methods to engage Latino families in health promotion programs that highlight their cultural norms, and beliefs. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03761589 (12/3/2018).
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Affiliation(s)
- Jacob Szeszulski
- Arizona State University, College of Health Solutions, 550 North 3rd Street, Phoenix, AZ 85004, USA; The University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, 7000 Fannin Street, #1200, Houston, TX 77030, USA; The University of Texas Health Science Center at Houston, Austin Campus, Michael Susan Dell Center for Healthy Living, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Sonia Vega-López
- Arizona State University, College of Health Solutions, 550 North 3rd Street, Phoenix, AZ 85004, USA; Arizona State University, Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service & Community Solutions, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, USA
| | - Michael Todd
- Arizona State University, Edson College of Nursing and Health Innovation, 550 North 3rd Street, Suite 301, Phoenix, AZ 85004, USA
| | - Frank Ray
- City of Phoenix Parks and Recreation, 212 East Alta Vista Rd, Phoenix, AZ 85042, USA
| | - Alma Behar
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Maria Campbell
- Arizona State University, College of Health Solutions, 550 North 3rd Street, Phoenix, AZ 85004, USA
| | - Adrian Chavez
- Arizona State University, College of Health Solutions, 550 North 3rd Street, Phoenix, AZ 85004, USA
| | - Ryan Eckert
- Arizona State University, College of Health Solutions, 550 North 3rd Street, Phoenix, AZ 85004, USA; Mays Cancer Center at UT Health San Antonio MD Anderson, 7979 Wurzbach Rd, San Antonio, TX 78229, USA
| | - Anabell Lorenzo-Quintero
- Arizona State University, College of Health Solutions, 550 North 3rd Street, Phoenix, AZ 85004, USA
| | | | - Noe C Crespo
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA 92182, USA.
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28
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Lorenzo E, Szeszulski J, Todd M, Mama SK, Lee RE. Health Is Power: Active Transportation, Physical Activity, and Cardiometabolic Health Among Ethnic Minority Women. J Phys Act Health 2020; 17:323-330. [PMID: 32035414 PMCID: PMC7307006 DOI: 10.1123/jpah.2019-0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/27/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Active transportation (AT) increases physical activity, reducing cardiometabolic risk among non-Hispanic white adults; however, research on these linkages in racial/ethnic minority women is sparse. This study explored these associations in 327 African American and Hispanic/Latina women. METHODS This analysis used sociodemographics, self-reported AT via the International Physical Activity Questionnaire, accelerometer-measured moderate to vigorous physical activity (MVPA), body mass index, systolic and diastolic blood pressures, resting heart rate, and body fat percentage (BF). Unadjusted bivariate associations and associations adjusted for sociodemographic factors were examined. RESULTS AT users had higher levels of objective MVPA, but this was not statistically significant. AT was not associated with cardiometabolic risk factors in adjusted models (Ps > .05); however, systolic blood pressure was lower for AT users. MVPA was negatively associated with diastolic blood pressure and BF overall, body mass index and BF in African American women, and BF in Hispanic/Latina women (Ps <.05). CONCLUSIONS MVPA was associated with improvements in body mass index, diastolic blood pressure, and BF among minority women, and these relationships may vary by race/ethnicity. Practitioners should recommend increased participation in MVPA. Future research, using longitudinal designs should investigate AT's potential for increasing MVPA and improving cardiometabolic health along with the role of race/ethnicity in these associations.
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Lee RE, Lorenzo E, Szeszulski J, Arriola A, Bruening M, Estabrooks PA, Hill J, Marsiglia FF, O'Connor T, Pollins KS, Shaibi GQ, Soltero E, Todd M. Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE). Contemp Clin Trials 2019; 77:8-18. [PMID: 30550775 PMCID: PMC6464371 DOI: 10.1016/j.cct.2018.12.003] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3-5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States.
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Jacob Szeszulski
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Anel Arriola
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Meg Bruening
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Paul A Estabrooks
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jennie Hill
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Flavio F Marsiglia
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, United States
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Kim Sellers Pollins
- Booker T. Washington Early Childhood Learning Center, Phoenix, AZ, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Erica Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Michael Todd
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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Szeszulski J, Vega-López S, Crespo NC. Children’s Cardiovascular Fitness, Rather Than Weight Status, Is Associated With Cardiovascular Disease Risk. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485722.71022.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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