Physical Activity, Sleep, and Screen Time in Children and Adolescents Before and During the COVID-19 Pandemic: An Analysis of the 2019-2020 National Survey of Children's Health.

PURPOSE: The purpose of this study was to examine whether engagement in health behaviors changed from pre-pandemic (2019) to during the pandemic (2020). METHODS: The combined 2019-2020 National Survey of Children's Health (NSCH) was used to inform this study. The NSCH is an annual survey designed to provide national estimates of key indicators of childhood health and well-being. Physical activity (number of days/week with >60 min of activity), screen-time (hours/day of TV viewing and computer use), and sleep (hours/day) were assessed by parental report. Adjusted binomial and multinomial logistic regression models were used to determine the association between survey year and health behaviors. RESULTS: Children and adolescents were 36% more likely to be physically inactive in 2020 compared to 2019. Additionally, children and adolescents were 14% more likely to meet sleep guidelines and 39% less likely to meet screen-time guidelines in 2020 compared to 2019, independent of age, sex, race/ethnicity, and poverty level. Children (6-13 year) and adolescents (14-17 years) were 10% and 15% less likely to get below the recommended amount of sleep in 2020 compared to 2019, respectively. CONCLUSION: Prevalence of meeting sleep guidelines increased among children and adolescents in 2020 but decreased for physical activity and screen-time. Initiatives targeting activity and screen-time may be urgently needed. Whether rates of these health behaviors return to pre-pandemic levels over the next few years should be closely assessed.

Understanding Health Behaviors, Weight Perceptions, and Body Appreciation of Young Adult Women Engaged in the Body Positivity Movement.

BACKGROUND: The body positivity movement on social media is thought to foster body appreciation, but pervasive societal concern persists about the body positivity movement and the body image, health behaviors, and "normalization of obesity" of young adult women. PURPOSE: This study explored the relationship between engagement in the body positivity movement on social media and weight status, body appreciation, body dissatisfaction, and the health behaviors of intuitive eating and physical activity in young adult women (18-35 years). METHODS: Participants (N = 521; ∼64% engaged in body positivity content on social media) were recruited using Qualtrics online panels for this cross-sectional survey during February 2021. Outcomes included weight status, weight consideration, weight perception, body appreciation, body dissatisfaction, physical activity, and intuitive eating. Logistic and linear regression models adjusted for age, race, ethnicity, education level, and household income were used to assess the association between engagement in the body positivity movement and specified outcomes. RESULTS: Engagement with body positivity content was associated with greater body dissatisfaction (ß = 2.33, t(519) = 2.90 p = .017), body appreciation (ß = 0.26, t(519) = 2.90 p = .004), and greater likelihood of reporting high amounts of physical activity (odds ratio = 2.28; p < .05) relative to nonengaged peers; these associations remained significant after further adjustment for weight status. Body positivity engagement was not associated with weight status, weight perception, or intuitive eating. CONCLUSIONS: Engagement in the body positivity movement is associated with higher body dissatisfaction and body appreciation in young adult women, which suggests they may be drawn to and engage in the body positivity movement as a protective or coping mechanism for body dissatisfaction.

Physical Activity, Sports Participation, and Psychosocial Health in Adolescents With Hearing Loss.

PURPOSE: This study examined the association between hearing status (i.e., adolescents with and without hearing loss) and physical activity and sports participation. Secondarily, we explored the association between physical activity and sports participation and psychosocial outcomes among adolescents with hearing loss. METHODS: Analyses included 29,034 adolescents (52.1% male, 13.8 ± 2.3 (M ± SD) years) from the combined 2018-2019 National Survey of Children's Health. Adolescents were grouped by hearing status. Adjusted logistic regression models assessed physical activity level (i.e., 0, 1-3, 4-6, and 7 days/week) and sports participation (i.e., participation in sports within the past 12 months) by hearing status. Secondary analyses examined associations between physical activity and sports participation with psychosocial outcomes among adolescents with hearing loss adjusting for relevant confounders. RESULTS: Relative to their hearing peers, adolescents with hearing loss (n = 359) were 40% [adjusted odds ratio (AOR), 0.60; 95% confidence interval (CI), 0.44, 0.81], 43% [AOR, 0.57; 95% CI, 0.41, 0.80], and 33% [AOR, 0.67; 95% CI, 0.47, 0.95] less likely to engage in 1-3 days/week of physical activity, 4-6 days/week of physical activity, and meet physical activity guidelines, respectively. Further, adolescents with hearing loss were 31% [AOR, 0.69; 95% CI, 0.55, 0.85] less likely to participate in sports. Sports participation, but not physical activity, was associated with a significant reduction in the likelihood of experiencing adverse psychosocial outcomes among adolescents with hearing loss (p's < .05). DISCUSSION: Sports participation, but not physical activity, was associated with attenuated likelihood of experiencing adverse psychosocial outcomes in adolescents with hearing loss, suggesting unique characteristics of sports participation confer protection of psychosocial health. Increasing access to and reducing barriers to engagement in sports should be prioritized to improve psychosocial health in adolescents with hearing loss.

Changes in Health Behaviors Associated With Weight Gain by Weight Classification During the COVID-19 Pandemic.

PURPOSE: To determine whether perceived changes (i.e. perception of engagement during the pandemic relative to pre-pandemic) in specific health behaviors differ by weight status (i.e. healthy weight, overweight, obese). DESIGN: Cross-sectional. Recruitment took place between June-August 2020, via social media posts and Qualtrics online panels. SETTING: Participants completed the survey online through the Qualtrics platform. SAMPLE: Analyses included N = 502 participants (≥18 years); 45.2% healthy weight (n = 227), 28.5% overweight (n = 143), and 26.3% obese (n = 132). MEASURES: Study-specific survey items included questions about demographics and perceived changes in health behaviors. ANALYSIS: Logistic regression models, adjusted for age, race, ethnicity, gender, education, and COVID-19 diagnosis, assessed the odds of perceiving changes in health behaviors considered a risk for weight gain. RESULTS: Participants with obesity, but not overweight, were significantly more likely to report deleterious changes to health behaviors compared to healthy weight peers, including: (1) decreased fruit/vegetable consumption [adjusted odds ratio (AOR) = 1.92; 95% confidence interval (CI): (1.13, 3.26)]; (2) increased processed food consumption [AOR = 1.85; 95%CI: (1.15, 3.00)]; (3) increased caloric intake [AOR = 1.66; 95% CI: (1.06, 2.61)]; (4) decreased physical activity [AOR = 2.07; 95%CI: (1.31, 3.28)]; and (5) deterioration in sleep quality [AOR = 2.07; 95%CI: (1.32, 3.25)]. CONCLUSION: Our findings suggest that adults with obesity may be at greater risk for unhealthy behaviors during a period of prolonged social distancing, potentially exacerbating the obesity epidemic.

Differences in health behaviors related to overweight/obesity by race/ethnicity in a diverse urban commuter college.

Objective: To examine health behaviors associated with overweight/obesity by race/ethnicity at a diverse urban college. Participants: 270 undergraduates (77.0% female; 26.7% non-Hispanic white) and median body mass index (BMI) of 23.1 kg/m2. Methods: A questionnaire about health-related behaviors as part of the "Get Fruved" project was used to measure health behaviors (sugar sweetened beverage (SSB), fruit and vegetable consumption, physical activity, stress, and sleep) by race/ethnicity. Multivariable logistic regression was used to assess the adjusted odds of engaging in positive health-related behaviors. Results: Non-Hispanic black and Hispanic students were 64% and 59% less likely to consume lower amounts of SSB. Hispanic students were 83% and 81% less likely to meet vegetable and fruit recommendations. Non-Hispanic black and other (including biracial) had reduced odds of meeting vegetable recommendations (AOR = 0.18 and 0.28). Conclusions: Disparities in SSB, fruit, and vegetable consumption represent potential intervention targets to improve health behaviors among racial/ethnic minorities.

Perception of moderate-intensity physical activity by onset of obesity: A randomized crossover trial.

Moderate-intensity physical activity is recommended for inactive adults with overweight/obesity (OW/OB). The objective of this study is to determine if differences exist in the selection of moderate intensity between inactive adults with juvenile-onset (JO) and adult-onset (AO) OW/OB. Participants (JO = 18, AO = 20) were stratified by onset and completed two separate 20-minute moderate-intensity exercise sessions on a treadmill and cycle ergometer (randomized order). Multiple linear regression was used to determine whether exercise intensity (average METS, % age-predicted HRmax ), self-reported pleasure or exertion differed by onset, controlling for age and gender. On the treadmill, JO and AO participants selected an average intensity of (mean [SD]) 3.5 (0.9) and 3.7 (0.9) METS, and 64.0 (7.7) and 64.9 (7.5) % of age-predicted HRmax , respectively. On the cycle, JO and AO participants selected an average intensity of 3.3 (0.9) and 3.3 (1.0) METS, and 65.2 (8.8) and 60.7 (7.2) % of age-predicted HRmax . After adjustment, participant intensity selection did not significantly differ by obesity onset when walking or cycling. There were no significant differences in pleasure or perceived exertion by onset, however, perception of exertion was on the high-end of moderate for both the cycle (13.0, 12.5) and treadmill (12.0, 12.1), in JO and AO participants, respectively. Perception of moderate intensity did not differ by obesity onset. Self-selected intensity was at the low end of moderate for walking and cycling.

Physical activity participation, flourishing and academic engagement in adolescents with obesity.

BACKGROUND: Adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers. However, it is unknown how participation in physical activity influences flourishing and academic engagement in adolescents with obesity. The current study examined engagement in varying levels of physical activity and the likelihood of flourishing and academic engagement in adolescents with obesity. METHODS: Analyses included 26 764 adolescents, ages 10-17 years, from the parent-reported, combined 2016-2017 National Survey of Children's Health. Participants were grouped by physical activity levels (none, low, moderate, daily). Outcome variables included flourishing (finishing tasks, staying calm when faced with a challenge and showing interest in new things) and academic engagement (completing all required homework and caring about doing well in school). Logistic regression models, adjusted for age, sex, race, household income, highest level of education in the household, behavioural conduct problems and depression assessed the likelihood of each outcome comparing physical activity levels among adolescents with obesity. RESULTS: Adolescents with obesity who participated in any amount of physical activity (low, moderate and daily) or sports had significantly greater likelihood of flourishing and academic engagement compared those that did not engage in any physical activity (p's < 0.05). CONCLUSIONS: Participation in even low amounts of physical activity or participation in sports increases the likelihood of flourishing and academic engagement in adolescents with obesity, which expands on previous findings that adolescents with obesity are less likely to flourish and be academically engaged in comparison to their healthy weight peers.

Household Support for Physical Activity in Adolescent Girls Living in Primarily Low Socioeconomic Status Neighborhoods.

The purpose of this study was to examine the association between perception of household support and physical activity levels of adolescent girls living in primarily low socioeconomic status (SES) neighborhoods. The sample consisted of thirty-six adolescent girls (N=36; 60% non-Hispanic Black; mean age of 14.6 ± 1.3 [mean ± sd]; median body mass index (BMI) percentile of 90.5 [58.5, 97.0]) living in primarily low socioeconomic status (SES) neighborhoods. Trained researchers measured participants' height and weight, and administered questionnaires to assess perception of household support for physical activity and minutes per day participating in moderate-to-vigorous physical activity (MVPA) (3-Day Physical Activity Recall). Pearson's correlation, controlling for race, age, and BMI, was used to evaluate the association between perception of household support and adolescents' MVPA levels. There were no significant associations between measures of the perception of household support for physical activity and adolescents' MVPA levels. There were significant negative associations between total adult household support for physical activity (r=-0.51; p<.01) with BMI and the support provided by the closest adult in the household (r=-0.55; p<.01) with BMI. These data suggest that support for physical activity in the household for adolescents with higher BMI's may be warranted.

Bullying Perpetration and Victimization among Adolescents with Overweight and Obesity in a Nationally Representative Sample.

Background: Adolescents with obesity are more likely to experience bullying in comparison to their healthy weight peers. However, it is unclear whether adolescents with obesity are more likely to perpetuate bullying or be both, a bully perpetrator and a bully victim. The purpose of this analysis was to examine differences in bully perpetration, victimization, and both (perpetration and victimization) by BMI classification in a nationally representative sample of adolescents. Methods: Analyses included 31,770 adolescents, ages 10-17, from the combined 2016-2017 National Survey of Children's Health. Adolescents were grouped by BMI classification; outcome variables included bullying, difficulty making new friends, excessive arguing, depression, and behavioral conduct problems. Logistic regression models, adjusted for age, sex, race, household income, highest level of education in the household, and attention-deficit/hyperactivity disorder assessed the odds of each outcome comparing healthy weight to adolescents with overweight and obesity. Results: Adolescents with overweight and obesity had greater odds of experiencing bullying behaviors: bully victim [odds ratio (OR) = 1.34 and 2.03] and both bully perpetrator and victim (OR = 1.37 and 2.01) (p's < 0.05), respectively, in comparison to healthy weight peers. Adolescents with overweight or obesity involved in bullying behaviors had significantly higher odds of behavioral conduct problems, depression, arguing excessively, and having difficulty making friends compared to adolescents with overweight or obesity who were neither a bully perpetrator nor victim (p's < 0.05). Conclusions: To promote overall health and well-being among adolescents with overweight and obesity, effort should be made to mitigate engagement in and/or victimization from bullying and associated behavioral or depressive symptoms.

Flourishing and academic engagement among adolescents with overweight and obesity.

BACKGROUND: Overweight and obesity in adolescence are associated with several negative health indicators; the association with flourishing, an indicator of overall well-being, is less clear. OBJECTIVES: To examine associations between weight status and indicators of flourishing and academic engagement in adolescents. SUBJECTS: Analyses included 22,078 adolescents (10-17 years) from the 2016 National Survey of Children's Health. METHODS: Adolescents were grouped according to body mass index (BMI) classification; outcomes included indicators of flourishing and academic engagement. Logistic regression models assessed the odds of each outcome comparing adolescents with overweight and adolescents with obesity to healthy weight adolescents. RESULTS: For flourishing, adolescents with overweight and adolescents with obesity were less likely to stay calm during a challenge (17% and 30%, respectively; p < 0.01); adolescents with obesity were 30% less likely to finish a task they started (p < 0.001), and 34% less likely to show interest in new things (p < 0.001) in comparison to healthy weight peers. Adolescents with obesity were 26% less likely to care about doing well in school (p < 0.001), and adolescents with overweight and adolescents with obesity were significantly less likely to complete all required homework (19% and 34%, respectively) (p < 0.001), in comparison to healthy weight peers. CONCLUSIONS: A comprehensive approach to addressing overweight and obesity in adolescence should target improving academic engagement and flourishing to promote overall well-being.

Reducing Sedentary Behavior Versus Increasing Moderate-to-Vigorous Intensity Physical Activity in Older Adults.

OBJECTIVE: To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity (MVPA) in older adults. METHOD: Inactive older adults ( N = 38, 68 ± 7 years old, 71% female) were randomized to 12-week interventions targeting decreased sedentary behavior ( Sit Less) or increased MVPA ( Get Active). The SenseWear armband was used to objectively assess activity in real time. Assessments included a blinded armband, the Community Health Activites Model Program for Senior (CHAMPS) questionnaire, 400-meter walk, and the Short Physical Performance Battery (SPPB). RESULTS: Objectively measured MVPA increased in Get Active (75 ± 22 min/week, p < .001); self-reported MVPA increased in both groups ( p < .05). Sedentary behavior did not change in either group (all p > .05). Only the Sit Less group improved the SPPB score (0.5 ± 0.3, p = .046). DISCUSSION: Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks. Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed.