Correlating neighborhood-level deprivation and pediatric metabolic dysfunction-associated steatotic liver disease.

OBJECTIVES: The primary objective of this study is to further explore associations between social influencers of health and markers of disease severity at the time of presentation of patients with pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) using neighborhood-level Area Deprivation Index (ADI) scores. METHODS: A retrospective cross-sectional study was conducted among 344 pediatric MASLD patients. Each patient received an ADI score based on their 9-digit zip code. Groups were defined as low (≤5) and high (6≥) ADI. Associations between ADI and symptomatology and laboratory values at presentation, as well as initial liver biopsy pathology were tested via analyses of covariance, χ2 testing, and logistic regressions. RESULTS: The mean ADI was 6.54 (standard deviation = 2.09). ADI groups did not significantly differ in age of presentation, type of presentation, or associated conditions, except for the higher ADI group having on average lower vitamin D levels (26.70 vs. 29.91, p = 0.02) and being two times more likely to also be diagnosed with low high-density lipoprotein (HDL) levels (p = 0.04, 95% CI 1.04-3.89). Mean transaminases and histopathologic nonalcoholic fatty liver disease (NAFLD) Activity Scores did not significantly differ between ADI groups. CONCLUSIONS: Pediatric patients with MASLD in this study span the entire spectrum of neighborhood deprivation. There were no differences in presentation characteristics or severity of MASLD, aside from lower HDL-cholesterol and vitamin D values in the high ADI group. Area deprivation was not predictive of more severe disease as assessed by serum transaminases and liver biopsy NAFLD activity scores.

COVID-19 monoclonal antibody treatment impact on symptoms and post-COVID conditions among high-risk patients at a Federally Qualified Health Center.

BACKGROUND: Monoclonal antibody (mAb) treatment for COVID-19 is associated with improved clinical outcomes. However, there is limited information regarding the impact of treatment on symptoms and the prevalence of post-COVID Conditions (PCC). Understanding of the association between time to mAb infusion and the development of PCC is also limited. METHODS: This longitudinal study was conducted among patients with COVID-19 who received mAb infusions at a Federally Qualified Health Center in San Diego, CA. A series of telephone interviews were conducted at baseline and follow-up (14 days and 28+ days). A comprehensive symptom inventory was completed and physical and mental health status were measured using PROMIS-29 and PHQ-2. Pearson's Chi-squared tests and independent two-sample t-tests were performed to test for association between time to mAb infusion and outcomes at follow-up. A Poisson regression model was used to analyze whether time to mAb infusion predicts risk of developing PCC. RESULTS: Participants (N = 411) were 53% female, ranged in age from 16 to 92 years (mean 50), and a majority (56%) were Latino/Hispanic. Cross-sectional findings revealed a high symptom burden at baseline (70% of patients had cough, 50% had fever, and 44% had headache). The prevalence of many symptoms decreased substantially by the final follow-up survey (29% of patients had cough, 3% had fever, and 28% had headache). Longitudinal findings indicated that 10 symptoms decreased in prevalence from baseline to final follow-up, 2 remained the same, and 14 increased. The severity of symptoms and most patient-reported physical and mental health measure scores decreased over time. The prevalence of PCC was 69% when PCC was defined as ≥ 1 symptom at final follow-up. Time to mAb infusion was not significantly associated with any outcome at follow-up. Time to infusion was not associated with PCC status at final follow-up in the crude or adjusted Poisson regression models. CONCLUSIONS: The prevalence of PCC was high among this patient population following COVID-19 mAb treatment. Time to mAb infusion did not predict the development of PCC. Further research in these areas is essential to answer urgent clinical questions about effective treatments of COVID-19.

Evaluating US smokers' willingness to pay for different cigarette packaging designs before and after real-world exposure in a randomised trial.

INTRODUCTION: Removal of tobacco industry branding from cigarette packs may reduce their appeal. Adding graphic warning labels (GWLs) should enhance this effect. We investigate whether willingness to pay for various packaging designs changes after 3 months' use of: (1) US branded packs without GWLs (US), (2) non-branded packs without GWLs (Blank), and (3) rotating non-branded packs with GWLs (gangrene; throat cancer; neonatal baby) covering >75% of pack (GWL). METHODS: Californian adult daily smokers not planning to quit (n=287; 56% female; mean age=39.6) completed a discrete choice purchase task before and after 3 months' experience using one of three packaging options. Conjoint analysis and pre-post modelling evaluated the change in importance of pack attributes and willingness to pay for US, Blank or GWL (blindness; teeth; gangrene) pack designs. RESULTS: Price determined ~70% of purchase choices, while pack design determined ~22%. Irrespective of intervention arm, US packaging generated appeal valuations compared with Blank packaging, while GWLs consistently provoked strong aversive valuations at baseline and follow-up. Compared with the US pack arm, using GWL packs for 3 months decreased willingness to pay for US packaging (ß=-$0.38, 95% CI -0.76 to 0.00). Wear-out effects were detected in the discount needed to willingly purchase the gangrene-GWL pack (ß=$0.49, 95% CI 0.16 to 0.82) and Blank pack (ß=$0.42, 95% CI 0.09 to 0.74) but not for GWLs (blindness, teeth) not used in trial. CONCLUSION: Compared with US branded packs, the negative valuation of non-branded GWL packs attenuates with even 3 months' use but does not generalise to non-used GWLs. This suggests that GWLs should be regularly refreshed. The appeal valuation of industry imagery suggests that the US plan to retain such imagery on packs may ameliorate the effect of GWLs.

Role of affective reactivity induced by cigarette packaging including graphic warning labels: the CASA Study.

OBJECTIVE: To identify whether three types of cigarette pack designs, including three versions of graphic warning label (GWL) plain packs, one GWL absent and branding absent pack (blank) and the smoker's own GWL absent and branding present pack (US), elicit different valence, type and levels of affect. DESIGN: US daily smokers (n=324) were asked to handle each of the five pack types and 'think aloud' their reactions. To avoid a muted familiarity response, exposure to their own US pack followed exposure to at least one GWL plain pack. Reactions were scored on a reactivity scale (-3 to +3) and the text was coded for speech polarity (-1 to +1) and emotive word frequency. RESULTS: Reactivity scores had excellent inter-rater reliability (agreement ≥86%; intraclass correlation coefficient ≥0.89) and were correlated with speech polarity (r=0.21-0.37, p<0.001). When considering their US pack, approximately two-thirds of smokers had a low (31.5%) to medium (34.6%) positive response (reactivity=1.29; polarity=0.14) with expressed feelings of joy and trust. Blank packaging prompted a largely (65.4%) neutral response (reactivity=0.03; polarity=0.00). The gangrenous foot GWL provoked mostly medium (46.9%) to high (48.1%) negative responses (reactivity=-2.44; polarity=-0.20), followed by neonatal baby (reactivity=-1.85; polarity=-0.10) and throat cancer (reactivity=-1.76; polarity=-0.08) warnings. GWLs varied in their elicitation of disgust, anger, fear and sadness. CONCLUSION: Initial reactions to GWL packs, a blank pack, and smokers' current US pack reflected negative, neutral, and positive affect, respectively. Different versions of the GWL pack elicited different levels and types of immediate negative affect.

Efficacy of the 'Stand and Move at Work' multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial.

BACKGROUND: Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk. METHODS: Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months. RESULTS: Worksites (N = 24; academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) and employees (N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was - 59.2 (CI: - 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (- 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat. CONCLUSIONS: Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

Strategies to reduce meat consumption: A systematic literature review of experimental studies.

INTRODUCTION: Meat consumption has been linked to some negative health and environmental outcomes. Studies have assessed motivations among those who have reduced or eliminated meat consumption; less work identifies strategies to reduce meat consumption among those who consume meat. This paper describes factors associated with lower meat consumption and reviews experimental studies that targeted those factors to either change behavior or intention/willingness to reduce meat. METHODS: A systematic review of the literature was conducted among four databases. Inclusion criteria were experimental and quasi-experimental designs and studies that measured variables indirectly or directly related to meat consumption. RESULTS: Twenty-two articles were identified. These studies targeted factors such as knowledge and skills with informational provisions about health and the environment; values and attitudes concerning the relationship between social dominance and meat; evocation of emotion such as empathy and disgust; social norms both dynamic and growing; changes to the food environment with default vegan menu options, perceived behavioral control, and intentions. The majority of studies (n = 15) investigated the effects of providing information such as personal health effects of meat consumption. In general, increasing knowledge alone or when combined with other methods was shown to successfully reduce meat consumption behavior or intentions/willingness to eat meat. Evoking emotions with animal images and making changes to the environment proved effective. DISCUSSION: Factors identified in correlational studies were generally found to be useful agents of behavior change in experimental studies. However, several factors have not been tested experimentally. More experimental studies are required to confirm the results of this review; for example, experiments focused on modifications of the food environment such as increasing the number of meatless meals on restaurant menus.

Social ecological correlates of workplace sedentary behavior.

BACKGROUND: To identify social ecological correlates of objectively measured workplace sedentary behavior. METHODS: Participants from 24 worksites - across academic, industrial, and government sectors - wore an activPAL-micro accelerometer for 7-days (Jan-Nov 2016). Work time was segmented using daily logs. Sedentary behavior outcomes included time spent sitting, standing, in light intensity physical activity (LPA, stepping cadence <100 steps/min), and in prolonged sitting bouts (>30 min). Outcomes were standardized to an 8 h work day. Two electronic surveys were completed to derive individual (job type and work engagement), cultural (lunch away from the desk, walking at lunch and face-to-face interaction), physical (personal printer and office type) and organizational (sector) factors. Mixed-model analyses with worksite-level clustering were performed to examine multi-level associations. Secondary analyses examined job type and sector as moderators of these associations. All models were adjusted for age, race/ethnicity and gender. RESULTS: Participants (N = 478; 72% female; age: 45.0 ± 11.3 years; 77.8% non-Hispanic white) wore the activPAL-micro for 90.2 ± 15.5% of the reported workday. Walking at lunch was positively associated with LPA (5.0 ± 0.5 min/8 h, P < 0.001). Regular face-to-face interaction was negatively associated with prolonged sitting (-11.3 ± 4.8 min/8 h, P < 0.05). Individuals in private offices sat more (20.1 ± 9.1 min/8 h, P < 0.05), stood less (-21.5 ± 8.8 min/8 h, P < 0.05), and engaged in more prolonged sitting (40.9 ± 11.2 min/8 h, P < 0.001) than those in public office space. These associations were further modified by job type and sector. CONCLUSIONS: Work-specific individual, cultural, physical and organizational factors are associated with workplace sedentary behavior. Associations vary by job type and sector and should be considered in the design of workplace interventions to reduce sedentary behavior. TRIAL REGISTRATION: Clinical trial No. NCT02566317 ; Registered Sept 22nd 2015.

Feasibility and Parental Acceptability of an 8-Week, Slow-Speed, High-Intensity, Community-Based Resistance Training Program for Preadolescent Children.

High-intensity resistance training (RT) shows promise for improved cardiometabolic health in children. Achieving high-intensity RT safely is a challenge for community-based programs because of parental concerns and group engagement. Twenty preadolescent children completed an 8-week, twice per week program using slow speed to achieve high-intensity RT. Parent and child surveys were conducted to measure acceptability and effectiveness. Child fitness levels were assessed, and fasting blood draws and dual-energy x-ray absorptiometry were performed on a subset population. Perceived RT safety, self-efficacy, body composition, waist circumference, and fitness tests exhibited significant improvements. Using slow speed to achieve high-intensity RT may provide a safe and effective community-based alternative for preadolescents.

The relative contribution of layers of the Social Ecological Model to childhood obesity.

OBJECTIVE: The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children's weight status. DESIGN: Cross-sectional survey of randomly selected households with children living in low-income diverse communities. SETTING: A telephone survey conducted in 2009-2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child's residence to food and physical activity outlets. SUBJECTS: Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights. RESULTS: Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children's weight status. CONCLUSIONS: The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.

Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness.

Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.

HPV Vaccine Misperceptions Among Hispanics/Latinos in Southern California.

BACKGROUND: Cervical and other vaccine-preventable HPV-associated cancers disproportionately impact Hispanic/Latinos in the USA. HPV vaccine uptake may be impacted by community agreement with common HPV vaccine misperceptions. It is unknown whether Hispanics/Latinos have a greater agreement with these misperceptions relative to non-Hispanic whites. METHODS: HPV vaccine misperceptions were assessed through a 12-item Likert scale included in a population health assessment mailed to households in the southwest United States. Linear regression models assessed the association between identifying as Hispanic/Latino and summed misperception score. RESULTS: Among the 407 individuals in the analytic sample, 111 (27.3%) were Hispanic/Latino and 296 (72.7%) were non-Hispanic white. On average, Hispanics/Latinos had a 3.03-point higher HPV vaccine misperception sum score relative to non-Hispanic whites, indicating greater agreement with misperceptions (95% confidence interval: 1.16-4.88; p < 0.01). DISCUSSION: Culturally relevant interventions are needed to address HPV vaccine misperceptions among Hispanics/Latinos as part of efforts toward HPV-associated cancer health equity.

Cold Exposures in Relation to Dysmenorrhea among Asian and White Women.

Dysmenorrhea is highly prevalent, ranging from 16% to 91% among women, and it can lead to multiple reproductive disorders. However, risk factors associated with dysmenorrhea remain unexamined. Cold exposures can significantly disturb blood circulation and prostaglandin production in the uterus, leading to dysmenorrhea. This study investigated the relationship between cold exposures and dysmenorrhea, as well as potential disparities between Asians and Whites and the potential cultural influences on these associations. This was a cross-sectional survey among 197 Asian and 222 non-Asian women recruited from the U.S., with more than 40% from California. We assessed cold exposures, such as the frequency of consumption of cold water/drinks and ice cream, as well as room temperatures at home and public places, for both summer and winter over the past 12 months. The type of cold exposure associated with dysmenorrhea differs between Asian and White women. We found that among Asian women, a higher frequency of ice cream consumption in winter (beta = 1.19, p = 0.0002 when comparing high to low categories) was associated with dysmenorrhea; however, among White women, increased consumption of cold water/drinks in winter (beta = 0.49, p = 0.04 when comparing high to low categories) was also associated with dysmenorrhea. Higher home room temperatures in winter were associated with reduced severity of dysmenorrhea among White women but not among Asian women. All these associations supported our hypothesis and were stronger among women who lived in states with colder winters. However, there are a few exceptions. For instance, women who drank cold water/drinks less frequently during their menstrual period were more likely to experience more severe dysmenorrhea. In conclusion, this study provides crucial evidence to support the link between cold exposures and dysmenorrhea among Asians and Whites. The associations contradictory to our hypothesis are likely due to reserved causation influenced by Asian cultural practice. This paper sheds light on an understudied area that profoundly affects women's quality of life.

Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Niños Study.

BACKGROUND: Community-based interventions are needed to reduce the burden of childhood obesity. PURPOSE: To evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children. METHODS: Thirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2(nd) grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors. RESULTS: There were no significant intervention effects on children's BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring). CONCLUSION: A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.

Parent awareness of young children's physical activity.

OBJECTIVE: Parents who overestimate their child's physical activity (PA) level may not encourage their children to increase their PA. We assessed parental awareness of child PA, and investigated potential correlates of overestimation. METHOD: Child PA (accelerometer) and parent-classified child PA ['active' ≥ 60 min/day vs. 'inactive' <60 min/day moderate and vigorous PA (MVPA)] were measured over 7 days [n=329, 44% male, 39% Latino; mean (SD) 9.1 (0.7)years] in an obesity prevention study in San Diego (Project MOVE). Agreement between date-matched objective MVPA and parent-classified child PA was assessed; % days parental overestimation was the outcome variable. Associations between parental overestimation and potential correlates were investigated using three-level mixed-effects linear regression. RESULTS: Children met the PA guidelines on 43% of days. Parents overestimated their children's PA on 75% of days when children were inactive. Most parents (80%) overestimated their child's PA on ≥ 1 measurement day. Parental support for child PA (transport, encouragement and participation with child) (p<0.01) was positively associated with higher overestimation. Parents of girls showed more overestimation than parents of boys (p=0.04). CONCLUSION: Most parents incorrectly classified their child as active when their child was inactive. Strategies addressing parental overestimation may be important in PA promotion.

Predictors of change in sports participation in Latino and non-Latino children.

BACKGROUND: Few prospective studies have examined predictors of change in specific physical activity (PA) behaviours in different ethnic groups. PURPOSE: To assess predictors of change in sports participation in Latino and non-Latino 5-8 year-old children in San Diego, California. METHODS: Average sports participation frequency (days/week) was assessed by validated parent-report at baseline (Nov 2006-May 2008) and 1 year later in 541 children (45.0% male, 41.1% Latino; mean ± SD age: 6.6 ± 0.7 years) taking part in an obesity prevention study (Project MOVE). Biological (sex, age, Body Mass Index z-score), socio-cultural (ethnicity, income, care giver education), parental (PA rules, PA encouragement) and environmental factors (home PA equipment, PA location) were assessed at baseline. Associations between change in sports participation and potential predictors were studied using multilevel linear regression stratified by Latino ethnicity, adjusted for sex, baseline sport participation, study condition and recruitment area. RESULTS: Sports participation increased over 1 year (mean change: +0.5 days; p<0.001) and change was similar for boys and girls (p=0.95), but Latino children showed a greater increase (p=0.03). The number of locations used for PA (p=0.024) and the total frequency of PA location use (p=0.018) were positively associated with increased sports participation among Latinos. No predictors were identified for non-Latino children. CONCLUSIONS: Only factors relating to PA location were identified as predictors of change in sports participation for Latino children. Interventions targeting specific PA behaviours such as sports participation may need to consider PA locations for Latino children and be tailored for specific ethnic groups.

Equitable COVID-19 Vaccination for Hispanics in the United States: A Success Story from California Border Communities.

The ongoing 2019 novel coronavirus disease (COVID-19) pandemic continues to impact the health of individuals worldwide, including causing pauses in lifesaving cancer screening and prevention measures. From time to time, elective medical procedures, such as those used for cancer screening and early detection, were deferred due to concerns regarding the spread of the infection. The short- and long-term consequences of these temporary measures are concerning, particularly for medically underserved populations, who already experience inequities and disparities related to timely cancer care. Clearly, the way out of this pandemic is by increasing COVID-19 vaccination rates and doing so in an equitable manner so that communities most affected receive preferential access and administration. In this article, we provide a perspective on vaccine equity by featuring the experience of the California Hispanic community, who has been disproportionately impacted by the pandemic. We first compared vaccination rates in two United States-Mexico border counties in California (San Diego County and Imperial County) to counties elsewhere in California with a similar Hispanic population size. We show that the border counties have substantially lower unvaccinated proportions of Hispanics compared to other counties. We next looked at county vaccination rates according to the California Healthy Places Index, a health equity metric and found that San Diego and Imperial counties achieved more equitable access and distribution than the rest of the state. Finally, we detail strategies implemented to achieve high and equitable vaccination in this border region, including Imperial County, an agricultural region that was California's epicenter of the COVID-19 crisis at the height of the pandemic. These United States-Mexico border county data show that equitable vaccine access and delivery is possible. Multiple strategies can be used to guide the delivery and access to other public health and cancer preventive services.

Effects of a Community-Based Pilot Intervention on Home Food Availability among U.S. Households.

The purpose of this study was to assess the effects of a pilot community-based behavioral intervention on the home food environment in U.S. households. Parents (21 females, 2 males; age = 36 ± 5.5 years; 78% Hispanic) of elementary school-aged children attended a 10-week dietary improvement behavioral intervention targeting an increase in fruit and vegetable consumption and a reduction in sugar intake. Home food availability of fruit, vegetables, and sugar-laden foods and beverages were assessed before and after the intervention using a modified version of the Home Food Inventory. Relative to baseline, the intervention resulted in significant increases in fruit availability (7.7 ± 3.2 items vs. 9.4 ± 3.1 items; p = 0.004) and low sugar cereal (2.3 ± 1.4 types vs. 2.7 ± 1.4 types; p = 0.033). There was a significant reduction in sugar-sweetened beverage availability (3.2 ± 1.9 types vs. 1.7 ± 1.3 types; p = 0.004). There was a significant increase in the number of households with accessible ready-to-eat vegetables and fruit, and a significant reduction in available prepared desserts, and candy (p < 0.01). There were no significant changes in the availability of vegetables and sugar-laden cereals. The current intervention resulted in positive changes in the home food environment. Further research to confirm these results in a randomized controlled trial is warranted.

Examining Mexican-Heritage Mothers' Perceptions of Their Children's Weight: Comparison of Silhouette and Categorical Survey Methods.

Background: Failure to recognize children's overweight status by parents may contribute to children's risk for obesity. We examined two methods of measuring mothers' perceptions of children's weight and factors associated with weight perception inaccuracy. Methods: Cross-sectional analyses of clinical and self-report data from 287 Mexican-heritage mother-child dyads. Mothers identified their child's weight category using a scale (e.g., "normal/overweight/obese") and a visual silhouette scale (11 child gender-specific weight-varying images). Children's height and weight were measured to calculate body mass index (BMI). Chi-square tests examined associations between categorical, silhouette, and BMI percentile categories of children's weight. Bivariate logistic regression analyses examined factors associated with mothers' inaccuracy of their children's weight. Results: Only 13% of mothers accurately classified their child as obese using the categorical scale, while 78% accurately classified their child as obese using the silhouette scale. Mothers were more likely to underestimate their child's weight using BMI categories (62%) compared to using the silhouette scale (23%). Predictors of mothers' underestimation using the categorical method were child sex [female] (adjusted odds ratio [AOR] = 1.99; 95% CI: 1.02-3.86), child age [younger age] (AOR = 10.39; 95% CI: 4.16-25.92 for ages 5-6 years), and mother's weight status (overweight AOR = 2.99; 95% CI: 1.05-8.51; obese AOR = 5.19; 95% CI: 1.89-14.18). Child BMI was the only predictor of mothers' overestimation (AOR = 0.89; 95% CI: 0.85-0.94) using the silhouette method. Conclusions: Using silhouette scales to identify children's body weight may be a more accurate tool for clinicians and interventionists to activate parents' awareness of unhealthy weight in children compared to using traditional categorical weight-labeling methods.

Athletes for life: Rationale and methodology of a community- and family-based randomized controlled trial to promote cardiovascular fitness among primarily Latino families.

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).

Enrollment Strategies, Barriers to Participation, and Reach of a Workplace Intervention Targeting Sedentary Behavior.

PURPOSE: To review enrollment strategies, participation barriers, and program reach of a large, 2-year workplace intervention targeting sedentary behavior. APPROACH: Cross-sectional, retrospective review. SETTING: Twenty-four worksites balanced across academic, industry, and government sectors in Minneapolis/Saint Paul (Minnesota) and Phoenix (Arizona) regions. PARTICIPANTS: Full-time (≥30+ h/wk), sedentary office workers. METHODS: Reach was calculated as the proportion of eligible employees who enrolled in the intervention ([N enrolled/(proportion of eligible employees × N total employees)] × 100). Mean (1 standard deviation) and median worksite sizes were calculated at each enrollment step. Participation barriers and modifications were recorded by the research team. A survey was sent to a subset of nonparticipants (N = 57), and thematic analyses were conducted to examine reasons for nonparticipation, positive impacts, and negative experiences. RESULTS: Employer reach was 65% (56 worksites invited to participate; 66% eligible of 56 responses; 24 enrolled). Employee reach was 58% (1317 invited to participate, 83% eligible of 906 responses; 632 enrolled). Postrandomization, on average, 59% (15%) of the worksites participated. Eighteen modifications were developed to overcome participant-, context-, and research-related participation barriers. CONCLUSION: A high proportion of worksites and employees approached to participate in a sedentary behavior reduction intervention engaged in the study. Interventions that provide flexible enrollment, graded participant engagement options, and adopt a participant-centered approach may facilitate workplace intervention success.