Associations between dietary habits, socio-demographics and gut microbial composition in adolescents.

The relationship between dietary habits and microbiota composition during adolescence has not been well examined. This is a crucial knowledge gap to fill considering that diet-microbiota interactions influence neurodevelopment, immune system maturation and metabolic regulation. This study examined the associations between diet and the gut microbiota in a school-based sample of 136 adolescents (Mage = 12·1 years; age range 11-13 years; 48 % female; 47 % Black, 38 % non-Hispanic White, 15 % Hispanic or other minorities) from urban, suburban and rural areas in the Southeast USA. Adolescents completed the Rapid Eating Assessment for Participants and provided stool samples for 16S ribosomal RNA gene sequencing. Parents reported their child and family socio-demographic characteristics. The associations between diet and socio-demographics with gut microbiota diversity and abundance were analysed using multivariable regression models. Child race and ethnicity, sex, socio-economic status and geographic locale contributed to variation within microbiota composition (ß-diversity). Greater consumption of processed meat was associated with a lower microbial α-diversity after adjusting for socio-demographic variables. Multi-adjusted models showed that frequent consumption of nutrient-poor, energy-dense foods (e.g. sugar-sweetened beverages, fried foods, sweets) was negatively associated with abundances of genera in the family Lachnospiraceae (Anaerostipes, Fusicatenibacter and Roseburia), which are thought to play a beneficial role in host health through their production of short-chain fatty acids (SCFAs). These results provide new insights into the complex relationships among socio-demographic factors, diet and gut microbiota during adolescence. Adolescence may represent a critical window of opportunity to promote healthy eating practices that shape a homoeostatic gut microbiota with life-long benefits.

Associations of Household Food Insecurity With Academic Outcomes in Early Adolescents.

BACKGROUND: Food insecurity is characterized by limited access to adequate food due to a lack of money or resources (eg, lack of transportation to obtain food). School aged children who are experiencing food insecurity are at greater risk for poor academic outcomes, but previous studies have not examined the effects of food insecurity on specific academic outcomes over time. METHOD: This study examined food insecurity as a risk factor for subsequent academic skills, enablers, and achievement. As part of a larger longitudinal study, middle school students (N = 112; meanage = 12.14, SD = 0.41; 50% female; 68% black/African American, 14% white, 13% Hispanic or Latino, 5% other) reported on food insecurity at baseline, while teachers reported on students' academic skills and enablers at both baseline and 12 months later at 1 year follow up. Math and English/Language Arts grades were obtained from the schools at each wave. FINDINGS: Food insecurity predicted lower academic skills over time but was unrelated to academic enablers and grades. IMPLICATIONS: Considering a whole school, whole community, whole child (WSCC) framework, this study will also discuss the important role schools and communities have in reducing food insecurity in middle school students. CONCLUSIONS: These results support negative long-term effects of food insecurity on academic skills in early adolescents.

Beliefs and Intentions of Anesthesia Physicians Toward Providing Culturally Competent Care to Transgender Patients.

Purpose: Anesthesiologists have limited relationships with their patients before delivering care and have little time for patient interactions. Yet, they should possess the knowledge and skills to treat all patients in an equitable, culturally competent manner, including transgender patients. The study's purpose was to determine behavioral factors influencing culturally competent care by anesthesia physicians with transgender patients. Methods: A two-phase design was utilized in 2020 to examine the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. Phase 1 allowed exploration of themes related to facilitators and barriers of the provision of culturally competent care to transgender patients. Phase 2 involved the creation and deployment of a 51-question survey informed by phase 1 to 100 anesthesia physicians at a single academic medical center in the southeastern United States. Results: Thematic analysis was performed on results from the phase 1 elicitation survey, which informed the creation of the survey for phase 2. One hundred phase 2 surveys were distributed, with a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool. Conclusion: Attitude followed by subjective norms were positive influencers of intent, while lack of knowledge was a negative influencer. Strengthening attitudes and subjective norms, while implementing programs to increase knowledge, competence, and humility, would be goals for future studies and actions toward improving healthcare of transgender individuals.

The Potential for Teacher-Student Relationships and the Whole School, Whole Community, Whole Child Model to Mitigate Adverse Childhood Experiences.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with poorer health and educational outcomes. With over 20% of children experiencing multiple ACEs, interventions must target protective factors to improve outcomes among these students. Teacher-student relationships (TSRs) integrated with the Whole School, Whole Community, Whole Child (WSCC) are one promising approach to building resilience to overcome ACEs. METHODS: A narrative literature review was conducted on ACEs, resilience, TSRs, and the WSCC model to explore the evidence and potential of TSR interventions integrated within the WSCC model to build resilience in students experiencing ACEs. RESULTS: Supportive adult relationships are one of the strongest protective factors against ACEs. TSR interventions have improved student and relationship outcomes. Few studies have explored the relationship between TSRs and ACEs or TSR ACEs interventions. The WSCC model provides opportunities to integrate TSRs and other protective factors into a schoolwide health model to build resilience. CONCLUSIONS: TSRs and the WSCC model are promising approaches to target protective factors to mitigate ACEs. Research is needed to further establish TSRs as a protective factor, explore TSR ACEs interventions, and determine best practices for integrating TSRs and resilience in the WSCC model.

Exploring the Relationship Between Modifiable Protective Factors and Mental Health Issues Among Children Experiencing Adverse Childhood Experiences Using a Resilience Framework.

The purpose of this study was to examine whether the National Scientific Council on the Developing Child (NSCDC) resilience framework statistically predicted whether a child with 4 or more adverse childhood experiences (ACEs) ever had a mental health issue. The study also explored which NSCDC modifiable resilience factors had the strongest relationship with mental health issues among children with 4 or more ACEs. Utilizing the 2019 National Survey of Children's Health, secondary data analysis was conducted using a sample of 1,225 children between 6 and 17 years old that had experienced 4 or more ACEs. Logistic regression examined whether the NSCDC framework was associated with a lower likelihood of mental health issues in school-aged children. Analysis found that the NSCDC framework predicted whether children with 4 or more ACEs ever had a mental health issue. Self-regulation had the strongest relationship with whether a child with 4 or more ACEs ever had a mental health issue. A supportive parent/caregiver relationship was also associated with a lower likelihood of ever having a mental health issue. The results demonstrate the promise of the NSCDC framework and modifiable protective factors to mitigate the impact of ACEs on mental health outcomes. Interventions that teach children skill-based self-regulation and parent/caregiver co-regulation while providing safe and supportive environments can build self-regulation to overcome ACEs. Promoting resilience-building parent-child relationships also have the potential to build resilience to mitigate ACEs.

Exploring Condom Use Behaviors Among African American Adolescent Boys in the Deep South.

Risky sexual behaviors among adolescents can increase adverse outcomes including unplanned pregnancy or contraction or transmission of disease. Adolescents who engage in risky sexual activities are at increased risk for adverse health and social outcomes compared to those who do not engage. Despite declines in adolescent pregnancy and birth rates, the diagnosis of sexually transmitted infections (STIs) is steadily increasing among adolescents. Moreover, African American adolescent boys in the United States, specifically in the southeastern region are disproportionally at greater risk for STIs, and STI diagnosis within this population has increased over time, compared to their white counterparts. This study sought to identify factors associated with condom use among adolescent boys in the Deep South. Using data from the Mobile Youth Survey, a longitudinal adolescent community-based survey, this study assessed the relationship between personal, behavioral, and environmental factors and condom use among African American adolescent boys (14-19 years). Younger participants (14-15 and 16-17) were more likely to use a condom during the last sexual intercourse compared to older participants (18-19 years). High positive attachment to boy/girlfriend was associated with increased condom use. The number of sexual partners, age at their first sexual encounter, recent sexual behavior, and having an STI were also associated with increased condom use among participants. The study provides further insights into factors associated with condom use among African American adolescent boys and results can inform the development of sexual health interventions.

Hidden Communities of Practice in Social Media Groups: Mixed Methods Study.

BACKGROUND: Although most US mothers initiate breastfeeding, suboptimal breastfeeding rates still exist. Although breastfeeding is a complex process, social support has been linked with increases in positive breastfeeding outcomes. Recent technological advances, including the development of social networking sites, provide mothers with convenient access to a unique array of audiences from which to seek advice about parenting, including breastfeeding. However, little is known about how the use of the sites-specifically groups centered around breastfeeding-influences breastfeeding knowledge, attitudes, or behaviors. OBJECTIVE: This mixed methods study aimed to explore utilization of an existing probreastfeeding Facebook group and how utilization influences breastfeeding-related knowledge, attitudes, and behaviors. METHODS: Participants were recruited online through Facebook wall posts from within the existing group. Mothers aged between 18 and 50 years who were pregnant and intended to breastfeed, were currently breastfeeding, or had recently weaned their infant in the past 3 years were eligible to participate. Participants engaged in online focus group discussions (n=21) and individual interviews (n=12). Inductive content analysis of qualitative data led to the conceptualization and contextualization of a breastfeeding community of practice (COP). Using qualitative results, a quantitative survey was then developed to assess the prevalence of qualities of a COP as well as how COP usage influenced breastfeeding-related attitudes and knowledge. A total of 314 mothers completed the online survey. RESULTS: Qualitative findings showed an overall sense of community, with subthemes of group trust, interaction, and the promotion of breastfeeding. A majority (287/314, 91.5%) of mothers initiated breastfeeding, with 69.0% (216/314) of mothers reporting exclusive breastfeeding their infant at 6 months. Approximately 98.5% (309/314) of mothers reported that the Facebook group captured and stored knowledge; therefore, information could be easily accessed and applied. In addition, 96.2% (302/317) of mothers reported that the Facebook group motivated them to share breastfeeding-related knowledge. CONCLUSIONS: The results suggest that this existing probreastfeeding Facebook group exhibits characteristics of an online COP, which was organically formed. Utilization of the Facebook group, in the context of an online COP, could be beneficial in impacting breastfeeding-related knowledge, attitudes, and behaviors. However, further examination and exploration of breastfeeding COPs, including using this type of model as a method of lactation support or as a telemedicine framework, is a clear need.

Research on freshman and sleeping habits: A text message-based sleep intervention.

OBJECTIVE: Lack of understanding regarding the function of sleep and lack of education regarding healthy sleep practices may hinder college students from getting sufficient quality sleep. The current study examines the effect of a text message based educational intervention aimed at improving sleep quality and sleep hygiene behaviors in freshman undergraduate college students. PARTICIPANTS: 135 undergraduate students were recruited fall of 2016. METHODS: Three discussion groups were held to test and refine the text message content. Students were randomized into a three-group pretest-posttest experimental design. Participants completed measures of sleep quality, sleep hygiene, and sleep knowledge. RESULTS: Data analysis indicated the intervention did not demonstrate significant differences between groups over time on sleep quality, sleep hygiene behaviors, and sleep knowledge. CONCLUSION: More research is needed to understand how best to harness text messaging technology and sleep health education to promote healthy sleep behaviors in college students.

Responses of health and physical educators to overweight children in Alabama.

The purpose of this article is to provide an overview of the increasing problem of overweight children in Alabama including clinical definition, risk factors, and prevalence data. Health and physical educators should become familiar with guidelines released by national organizations, such as the Centers for Disease Control and Prevention, the Institute of Medicine, and state departments of education and public health. These guidelines provide direction to health promotion program activities in schools, community, and recreational settings aimed at modifying predisposing, reinforcing, and enabling factors. Four examples are presented in the narrative to illustrate collaborative partnerships among health care organizations, a health insurer, public schools, an academic research university, and state agencies to enhance youth health. The final section provides practical recommendations for professional health and physical educators regarding obesity risk reduction.

Benefits and barriers to medically supervised pediatric weight-management programs.

Obesity in children and adolescents is now the most common chronic condition in the USA. Data indicate that approximately one in five children in the USA is now overweight. Public health professionals have increased efforts in recent years to develop medically supervised programs for this population. However, research shows that only a small amount of obese children participate in weight-reduction programs. Also, the long-term effects of these weight-reduction interventions for obese children have not been well researched. Several recent studies report that most of the successful obesity programs utilize an interdisciplinary approach that combines a diet, physical activity, parental involvement and behavioral modification. This article provides a review of the professional literature related to the benefits and barriers of medically supervised pediatric weight-management programs. It summarizes the programs that work and the perceived barriers that parents and families struggle with in adhering to treatment plans.

Exploring Social Media Group Use Among Breastfeeding Mothers: Qualitative Analysis.

BACKGROUND: Breastfeeding is well known as the optimal source of nutrition for the first year of life. However, suboptimal exclusively breastfeeding rates in the United States are still prevalent. Given the extent of social media use and the accessibility of this type of peer-to-peer support, the role of social networking sites in enabling and supporting breastfeeding mothers needs to be further explored. OBJECTIVE: This study aimed to leverage mothers' attitudes and behaviors of social media usage to understand effects on breastfeeding outcomes. METHODS: Participants were recruited from 1 probreastfeeding social media group with over 6300 members throughout the United States. Online focus group discussions were conducted with 21 women; interviews were conducted with 12 mothers. Qualitative data were aggregated for thematic analysis. RESULTS: Participants indicated that the social media group formed a community of support for breastfeeding, with normalizing breastfeeding, empowerment for breastfeeding, resource for breastfeeding, and shared experiences in breastfeeding as additional themes. CONCLUSIONS: According to participants, social media groups can positively influence breastfeeding-related attitudes, knowledge, and behaviors as well as lead to longer duration of breastfeeding. The results of this study should be taken into account when designing interventions for breastfeeding mothers.

Utilization of online focus groups to include mothers: A use-case design, reflection, and recommendations.

Advances in technology over the past decade have allowed unique methodologies to emerge, enabling the engagement of hard-to-reach populations on sensitive topics in a way that was before thought not possible with traditional face-to-face modalities. This study aimed to use online focus group discussions (FGDs) to explore breastfeeding mothers' use of social media. Results indicate participants had a positive experience with online FGDs, and almost all preferred this method to traditional face-to-face focus groups. We discuss reflections of the online FGD experience, including best practices and recommendations for innovative ways to include time-constrained or hard-to-reach participants, for yielding rich qualitative data.

Preferred body type of fitness instructors among university students in exercise classes.

This study examined the relationship between participants' physique anxiety, eating behaviors, somatotype, and the preferred qualifications and body type of a fitness instructor. Subjects were 171 students attending fitness classes at a university. Analysis indicated that the women preferred a thinner fitness instructor than men and that enthusiasm, motivation, and being physically fit were considered the most important characteristics overall. No significant racial differences in key variables were found.

Component analysis and initial validity of the exercise fear avoidance scale.

OBJECTIVES: To develop the Exercise Fear Avoidance Scale (EFAS) to measure fear of exercise-induced discomfort. METHODS: We conducted principal component analysis to determine component structure and Cronbach's alpha to assess internal consistency of the EFAS. Relationships between EFAS scores, BMI, physical activity, and pain were analyzed using multivariate regression. RESULTS: The best fit was a 3-component structure: weight-specific fears, cardiorespiratory fears, and musculoskeletal fears. Cronbach's alpha for the EFAS was α=.86. EFAS scores significantly predicted BMI, physical activity, and PDI scores. CONCLUSION: Psychometric properties of this scale suggest it may be useful for tailoring exercise prescriptions to address fear of exercise-related discomfort.

Preparing students to practice evidence-based dentistry: a mixed methods conceptual framework for curriculum enhancement.

This article describes a mixed methods conceptual framework for evidence-based dentistry to enhance the curriculum at the University of Alabama at Birmingham School of Dentistry. A focus of recent curriculum reform has been to prepare students to integrate evidence-based dentistry into clinical practice. The authors developed a framework consisting of four conceptual phases to introduce curriculum innovation: 1) exploration of the phenomenon; 2) development of two new instruments; 3) data collection, analysis, outcomes, and evaluation; and 4) application to curricular reform. Eight sequential procedural steps (literature review; focus group discussions; development of themes; survey design; internal review; data collection, analysis, and evaluation; development of recommendations with external review; and implementation of recommendations for curricular enhancement) guided the curricular enhancement. Faculty members supported the concept of teaching evidence-based dentistry to facilitate major curriculum reform, and course directors incorporated evidence-based teaching to prepare scientist-practitioners who meet dental performance standards. The new curriculum implemented following completion of the study is in its third year. Much of its structure is based on evidence-based teaching methodologies, and approximately one-third of the content consists of small groups researching clinical problems with applied science and discussing the findings. The framework described in this article proved useful to guide revision of predoctoral clinical education at one dental school and may be useful in other settings.

Responding to Health Information and Training Needs of Individuals with Disabilities.

The role of a medical librarian includes guiding consumers to search for information related to specific health needs and interpret information for personal use. Little is known about barriers to accessing health information and clinical services for those with cognitive and physical disabilities. The purpose of this paper is to describe a statewide needs assessment of the health information and services needs of individuals with disabilities and their caregivers.Data from the needs assessment conducted by the Health Services Training Project of more than 1,000 respondents indicate unmet needs for outreach to increase effective use of library and information resources. Fewer consumers and their caregivers utilized the Internet to search for health information as compared to clinical service providers and students in health professions. A majority of consumers reported difficulty obtaining and understanding online health information. Service providers and students shared concerns about information quality. Consumers and caregivers expressed highest levels of trust in information provided by service providers, nonprofit health agencies, reference books, and libraries.

Ecological strategies to promote healthy body image among children.

BACKGROUND: Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro- and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. METHODS: Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. RESULTS: For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. CONCLUSIONS: Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.

Body-shape perceptions and body mass index of older African American and European American women.

The prevalence of obesity is higher in African American compared to European American women. Ethnic differences in body-shape perceptions such as greater acceptance of overweight figures, higher levels of body shape satisfaction, or an underestimation of one's body-shape have been suggested as possible contributors. The purpose of this investigation was to compare body-shape perceptions and body mass index of older African American and European American women. Eighty-nine European American and 115 African American women (mean age, 72 years) completed a questionnaire, composed of three parts: general demographic and anthropometric information, and questions regarding body-shape perceptions. The results suggested an underestimation of body-shape in African American women as a possible contributor to obesity. The findings of the present study suggested that in order to enhance the effectiveness of dietary interventions in older African American women, measures to assess the accuracy of self-perceived body-shape should be included.

An analysis of health promotion and risk behaviors of freshman college students in a rural southern setting.

This study described health promotion and risk behaviors of entering college students in a rural southern setting. A sample of 251 students completed the Health Promotion and Health Risk Survey during a testing period that included other academic surveys. Results indicated that participants believe they are in control of their health. In addition, participants reported that happiness and health were the most important personal values for them. When compared with the National College Health Risk Behavior data, participants in this study were significantly lower in many of the health risk behaviors.