Development, scoring, and reliability for the Microscale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) instrument

BACKGROUND

Active commuting to school can be a meaningful contributor to overall physical activity in children. To inform better micro-level urban design near schools that can support active commuting to school, there is a need for measures that capture these elements. This paper describes the adaptation of an observational instrument for use in assessing micro-scale environments around urban elementary schools in the United States.

METHODS

The Micro-scale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) was developed from existing audit instruments not designed for school travel environments and modifications for the MAPS-SRTS instrument include the structure of the audit tool sections, the content, the observation route, and addition of new subscales. Subscales were analyzed for inter-rater reliability in a sample of 36 schools in Austin, TX. To assess reliability for each subscale, one-way random effects single-measure intraclass correlation coefficients (ICC) were used.

RESULTS

Compared to the 30 original subscales, the adapted MAPS-SRTS included 26 (86.6%) subscales with revised scoring algorithms. Most MAPS-SRTS subscales had acceptable inter-rater reliability, with an ICC of 0.97 for the revised audit tool.

CONCLUSIONS

The MAPS-SRTS audit tool is a reliable instrument for measuring the school travel environment for research and evaluation purposes, such as assessing human-scale determinants of active commuting to school behavior and documenting built environment changes from infrastructure interventions.

Association Between Sleep Time and Pro- and Anti-Inflammatory Biomarkers Is Mediated by Abdominal Obesity Among Adolescents

OBJECTIVES

Movement behaviors and abdominal obesity are associated with higher inflammatory biomarkers. However, the role of waist circumference as a mediating factor is still unknown. Thus, our aims were to (1) test the associations between 24-hour movement behavior variables (physical activity, sedentary behavior, and sleep), abdominal obesity, and pro- and anti-inflammatory biomarkers; and (2) investigate whether abdominal obesity had a mediating effect between the investigated associations.

METHODS

This multicenter cross-sectional study included 3591 adolescents (aged 12-17 y) from 4 Brazilian cities. Waist circumference (in centimeters; at half the distance between the iliac crest and at the lower costal margin), 24-hour movement behaviors (validated questionnaire), high-sensitive C-reactive protein, and adiponectin (serum plasma) were evaluated. We used multiple mediation regression models (95% confidence interval) to determine if waist circumference mediated the association between 24-hour movement behaviors and pro- and anti-inflammatory biomarkers.

RESULTS

The results revealed that screen time and moderate to vigorous physical activity were not associated with pro- or anti-inflammatory biomarkers. However, sleep duration (in hours per day) was negatively associated with pro- (C-reactive protein, β = -0.08; 95% confidence interval, -0.38 to -0.02) and anti- (adiponectin, β = -0.31; 95% confidence interval, -2.13 to -0.12) inflammatory biomarkers. Our results also showed that waist circumference mediated the association between sleep duration and high-sensitive C-reactive protein (2.7%), and adiponectin (2.8%).

CONCLUSION

Sleep duration was inversely associated with pro- and anti-inflammatory biomarkers, and these relations were mediated by abdominal obesity. Therefore, adolescents having healthy sleep can have implications for reducing waist circumference and inflammatory indicators.

Association of Walking and Biking to School Policies and Active Commuting to School in Children

BACKGROUND

Active commuting to school (ACS) can be an important source of physical activity for children. Schools are an important setting for policy-related ACS promotion. The purpose of this study was to examine the association between school policies and ACS, and to assess whether this relation varied by grade.

METHODS

This cross-sectional study used data from schools recruited to the Safe Travel Environment Evaluation in Texas School study (n = 94). The percent of trips made by active travel modes was measured through tallies among third to fifth grade classrooms from 5 school districts in Central Texas in 2018-2019. School ACS policies and practices were measured through 8 survey items aggregated into a score. Linear mixed effects models were used to assess the association between policies and ACS.

RESULTS

School health policy surveys and ACS data were collected from 69 elementary schools. An average of 14.6% of trips to/from school was made using active travel modes. Schools with higher numbers of policies had significantly higher percentages of students using active travel modes (P = .03), and for each additional policy, the predicted percentage of trips made by active travel modes was 1.46% higher. There was a significant interaction effect between school policy and grade, with stronger correlations among higher grades (P = .002).

CONCLUSIONS

Results from this study demonstrate a correlation between the school policies designed to support walking and biking and ACS. Results from this study can be used to justify the use of school-based policy interventions to promote ACS.

Children's Enjoyment, Perceived Competency, and Vigorous Physical Activity During High-Intensity Interval Training in Physical Education

Purpose: Little is known about children's experience with high-intensity interval training (HIIT) during elementary school. Perceptions of enjoyment, perceived competence, and motivation are likely to drive long-term adherence and are, therefore, critical to understanding how HIIT might be implemented in this setting. The purpose of this study was to describe children's vigorous physical activity (VPA), enjoyment, and perceived competency of HIIT activities within a Self-Determination Theory framework (autonomy) in elementary school physical education (PE) classes. Methods: Participants were 402 children from a single, diverse elementary school (49.4% female, 59.6% Non-Hispanic white). Student enjoyment and perceived competency were collected following teacher- (non-autonomous) and student-led (autonomous) conditions. A sub-set of 201 children wore accelerometers to measure percent of time in VPA during HIIT conditions. This mixed factorial design was assessed through a series of repeated measures ANOVAs. Results: While children reported generally positive enjoyment and perceived competence in both conditions (rating over 4.0 on a 5-point scale), children significantly enjoyed (d = 0.44) and felt more competent (d = 0.11) during the autonomous HIIT condition compared to the nonautonomous HIIT condition. In contrast, the percent of time in VPA (d = 0.94) was significantly lower in the autonomous condition. Conclusions: These data illustrate a challenging trade-off with the design of HIIT trials. Increasing autonomy through the inclusion of student choice increased enjoyment and perceived competence of HIIT, which are likely to improve adherence, but lowered VPA, which is likely to reduce cardiometabolic impact.Abbreviations: U.S.: United States; PA: Physical activity; MVPA; Moderate-to-vigorous physical activity; PE: Physical education; CDC: Centers for Disease Control and Prevention; Randomized control trial, RCT; SDT: Self-Determination Theory; HIIT: High-intensity interval training; RCT: Randomized control trial; VPA: Vigorous physical activity; IRB; Institutional Review Board; HFZ: Healthy Fitness Zone; PACES: Physical Activity Enjoyment Scale; M: Mean; SD: Standard deviation.

Individual- and Environmental- Level Predictors of Recess Activity and Sedentary Behavior: Findings from the I-CAN! study

Introduction/Purpose

Recess represents a prime opportunity for physical activity during the school day. However, evidence is mixed with regard to factors associated with activity during recess.

Methods

Data were collected as a part of the Texas Initiative for Children's Activity and Nutrition (I-CAN!) program from 14 elementary schools and 1,049 4th-grade students. Percent of time in moderate-to-vigorous physical activity (MVPA) and sedentary behavior during recess was measured using GT3X+ accelerometers. Students' demographics, aerobic fitness, and body mass index (BMI) were collected from school records and FITNESSGRAM® data. Aspects of the playground environment supporting activity (e.g. soccer goals) or sedentary behavior (e.g. benches) were calculated following the procedures of the System for Observing Play and Leisure Activity in Youth (SOPLAY), with recess spatial area calculated via the polygon measurement tool in Google™ Earth Pro software. Recess time was collected from school data. Weather during recess was determined using time-stamped archived weather data from Weather Underground. Two-level, linear mixed model regression examined associations between individual- and school-level characteristics and percent time in MVPA.

Results

At the student-level, boys were more active than girls (effect size (ES)=0.50) and percent time in MVPA was directly associated with aerobic fitness (ES=0.35). At the school-level, recess infrastructure was associated with percent time in MVPA (ES=1.45), except for factors related to sedentary behavior, which were indirectly associated with percent time in MVPA (ES=-1.98). Patterns for sedentary behavior mirrored these effects.

Conclusions

This is one of the few studies to test the associations of fitness and sedentary upgrades to play areas with MVPA and sedentary behavior. The results suggest that recess is most likely to support MVPA in boys and those who are already most fit (i.e., those who would not be the target of intervention). This is not surprising because the focus of recess is on free choice of play, and thus recess might be supported more for social and emotional benefits than the impact on physical activity.

Longitudinal changes in objectively-measured physical activity and sedentary time among school-age children in Central Texas, US during the COVID-19 pandemic

Background

Most available evidence on the effects of the COVID-19 pandemic on child movement behaviors is from cross-sectional studies using self-report measures. This study aimed to identify change trajectories and their associated factors for objectively-assessed physical activity and sedentary time among an ethnically and socioeconomically diverse sample of school-age children from Central Texas, U.S.A., during COVID-19.

Methods

Pre- (Sept. 2019 – Feb. 2020) and during- (Oct. 2020 – March 2021) COVID-19 physical activity and sedentary behavior data were collected for school-age children (8–11 years) enrolled in the Safe Travel Environment Evaluation in Texas Schools (STREETS) cohort study. Daily time spent in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time were assessed using GT3X-wBT Actigraph accelerometers. Parent surveys were used to assess socio-ecological factors. Latent class linear mixed models were used to identify change trajectories of MVPA and sedentary time. Logistic regression models were used to assess the association between socio-ecological characteristics with physical activity and sedentary time change trajectory groups.

Results

There was a significant decrease in mean daily MVPA (− 9.4 mins, SD = 18.54) and an increase in sedentary behavior (0.83 hrs, SD = 1.18). Two trajectory groups were identified for MVPA (‘decrease MPVA’ and ‘maintain high MVPA’), with the majority (82.1%) being in the ‘decrease MVPA’ group. Three trajectory groups were identified for sedentary behavior (‘moderate increase sedentary, ‘steep increase sedentary,’ and ‘decrease sedentary’), with most children (78.5%) being in the ‘moderate increase’ group. Girls had significantly lower odds of being in the ‘maintain high MVPA’ group than boys (OR = 0.27, 95% CI = 0.11, 0.61). Children living in neighborhoods with higher perceived social cohesion had significantly higher odds of being in the ‘maintain high MVPA’ group (OR = 1.22, 95% CI = 1.06, 1.41), while those in neighborhoods with higher social cohesion had lower odds of being in the ‘decrease sedentary’ group (OR = 0.86, 95% CI = 0.74, 0.99).

Conclusions

Declines in physical activity and increases in sedentary time among most school-age children during COVID-19 in a socioeconomically and ethnically diverse U.S. sample, were observed in our study, especially among girls. These findings highlight the need to counteract the short-term negative changes in movement behaviors in response to COVID-19 among children.

School-Level Economic Disparities in Police-Reported Crimes and Active Commuting to School

Perceived safety remains one of the main barriers for children to participate in active commuting to school (ACS). This ecological study examined the associations between the number of police-reported crimes in school neighborhoods and ACS. The percentage of active travel trips was assessed from a teacher tally survey collected from students across 63 elementary schools that were primarily classified as high-poverty (n = 27). Geographic Information System (GIS) was used to create a detailed measure of police-reported crimes during 2018 and neighborhood covariates that occurred within a one-mile Euclidean buffer of the schools. Statistical analyses included linear fixed effects regressions and negative binomial regressions. In fully-adjusted models, reported crime did not exhibit significant associations with ACS. Medium-poverty schools were indirectly associated with ACS when compared to high- and low-poverty schools in all models (p < 0.05). Connectivity and vehicle ownership were also directly associated with ACS (p < 0.05). Low- and medium-poverty schools were indirectly associated with all types of reported crime when compared to high-poverty schools (p < 0.05). Although reported crime was not associated with school-level ACS, differences in ACS and reported crime do exist across school poverty levels, suggesting a need to develop and promote safe and equitable ACS interventions.

"I shy away from them because they are very identifiable": A qualitative study exploring user and non-user's perceptions of wearable activity trackers

OBJECTIVE

Wearable activity trackers hold potential as a research tool to increase physical activity. However, long-term wearable adherence is low among users, which may be due to the limited understanding of the factors related to use and relation to health behavior theory. The purpose of this study was to qualitatively explore the perceptions of wearables among active adult users and non-users. Findings will inform potential barriers and facilitators for the adherence and adoption of wearables through the application of the Self-Determination Theory.

METHODS

Six focus groups were conducted and equally stratified to wearable users (n = 10) and non-users (n = 10). Data were audio recorded, transcribed, and analyzed using an iterative approach creating first-level codes. This was followed by developing second-level codes that allowed for generating themes.

RESULTS

For users, the wearables' feedback provided them with validation, a sense of achievement, and other-determined motivation. Users appreciated the functionality of wearables, particularly with simpler and newer models. They also reported improvements in health behaviors. While both users and non-users had a general positive feeling towards wearables, they held similar concerns about cost, guilt, dependency, and accuracy. Non-users were unique in their concerns for materialism and functionality (i.e. ease of use and charge) associated with wearables. They also seemed to be more intrinsically motivated to be physically active by relying less on external sources of motivation as potentially provided by wearables.

CONCLUSIONS

Findings show that while both adult users and non-users held positive perceptions of wearables and concerns for feelings of guilt and dependency, widespread adoption and adherence may be prevented by differences in motivation for physical activity and concerns for cost, materialism, and functionality.

Health Behavior Changes During COVID-19 Pandemic and Subsequent "Stay-at-Home" Orders

The COVID-19 pandemic, and resultant "Stay-at-Home" orders, may have impacted adults' positive health behaviors (sleep, physical activity) and negative health behaviors (alcohol consumption, drug use, and tobacco use). The purpose of this study was to investigate how these health behaviors changed (increased/improved or decreased/worsened) at the early stages of the pandemic, what participant characteristics were associated with health behavior changes, and why these behavioral changes may have occurred. A convenience sample of 1809 adults residing in the United States completed a 15-min self-report questionnaire in April and May 2020. Multinomial logistic regressions and descriptive statistics were used to evaluate how, for whom, and why these health behaviors changed. Participants were primarily female (67.4%), aged 35-49 years (39.8%), college graduates (83.3%), non-tobacco users (74.7%), and had previously used marijuana (48.6%). Overall, participants primarily reported a decrease in physical activity, while sleep and all of the negative health behaviors remained the same. Changes in negative health behaviors were related (p < 0.05) to sex, age, parental status, educational status, job status, BMI, and depression scores. Changes in positive health behaviors were related (p < 0.05) to sex, parental status, job status, and depression scores. Having more time available during the pandemic was the most commonly cited reason for changing health behaviors (negative and positive). Public health efforts should address the potential for long-term health consequences due to behavior change during COVID-19.

The erosive potential of the alcoholic lemonade Hooch

The aim of this in vitro study was to assess the erosive potential of four flavours of the alcoholic lemonade Hooch. This study measured the pH on opening, the volume of 0.1M sodium hydroxide required to raise the pH of 20 mls of the lemonade to neutrality and the fluoride content. The amount of surface enamel lost following immersion for one hour was also assessed compared to water as a control. The pH on opening ranged from 2.57-2.86 and the volume of 0.1M sodium hydroxide required to neutralise 50 mls of the lemonade ranged from 15.4-23.1 mls. The fluoride content of the drinks ranged from 0.36-0.45 p.p.m. The amount of surface enamel lost over one hour ranged from 1.80-3.28 microns. This study suggests that the alcoholic lemonade Hooch has considerable erosive potential and seems likely to be as erosive as orange juice.

A one-year review of maxillofacial sports injuries treated at an accident and emergency department

To assess the aetiology and demand for oral and maxillofacial surgery services associated with sports injuries, a prospective study was undertaken. Data were collected from consecutive patients (with maxillofacial injuries associated with sports) attending the accident and emergency department at the Cardiff Royal Infirmary in the UK during a 12-month period and analysed. Data relating to demography, aetiology, site and extent of injury, treatment and outcome were collected. There were 790 attendances (695M:85F) arising principally from injuries related to rugby (n = 206), cycling (n = 189) and football (n = 109) but few from recognized contact sports (n = 26). The principal causes of these injuries were direct bodily contact (n = 260) and falls (n = 219). The commonest injury was soft-tissue laceration (n = 604); 80 patients had dentoalveolar fractures and 64 patients had fractures of the facial skeleton. Injuries were located in the upper- (n = 257), middle- (n = 201) and lower third of the face (n = 124) with 188 lip/intraoral injuries. Repair of lacerations (n = 600) was the commonest treatment; only 46 fractures required interventive treatment. Follow-up was performed for most of these patients at the Department of Oral and Maxillofacial Surgery at the Dental Hospital (n = 404) and general medical/dental practitioners (n = 258). These data highlight the importance of oral and maxillofacial surgery staff in the management of sports injuries in accident and emergency departments. Moreover, they suggest the need for prioritization of rule and legislation changes and the continuing need to improve safety standards to prevent maxillofacial injuries.

Health care's future: the impact of women

More than 100 female executives gathered in New Orleans, LA on May 7-8, to attend the Second Annual National Women's Conference of the American College of Healthcare Executives. This two-way conference was designed to examine issues critical to professional development and offered a forum to develop a better understanding of the effect that women, as executives and consumers, have on health care.