Clinical Intervention to Reduce Dietary Sugar Does Not Affect Liver Fat in Latino Youth, Regardless of PNPLA3 Genotype: A Randomized Controlled Trial.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) among Latinos is partially attributed to a prevalent C>G polymorphism in the patatin-like phospholipase 3 (PNPLA3) gene. Cross-sectional analyses in Latino children showed the association between dietary sugar and liver fat was exacerbated by GG genotype. Pediatric feeding studies show extreme sugar restriction improves liver fat, but no prior trial has examined the impact of a clinical intervention or whether effects differ by PNPLA3 genotype. OBJECTIVES: We aimed to test effects of a clinical intervention to reduce dietary sugar compared with standard dietary advice on change in liver fat, and secondary-endpoint changes in liver fibrosis, liver enzymes, and anthropometrics; and whether effects differ by PNPLA3 genotype (assessed retrospectively) in Latino youth with obesity (BMI ≥ 95th percentile). METHODS: This parallel-design trial randomly assigned participants (n = 105; mean baseline liver fat: 12.7%; mean age: 14.8 y) to control or sugar reduction (goal of ≤10% of calories from free sugar) for 12 wk. Intervention participants met with a dietitian monthly and received delivery of bottled water. Changes in liver fat, by MRI, were assessed by intervention group via general linear models. RESULTS: Mean free sugar intake decreased in intervention compared with control [11.5% to 7.3% compared with 13.9% to 10.7% (% energy), respectively; P = 0.02], but there were no significant effects on liver outcomes or anthropometrics (Pall > 0.10), and no PNPLA3 interactions (Pall > 0.10). In exploratory analyses, participants with whole-body fat mass (FM) reduction (mean ± SD: -1.9 ± 2.4 kg), irrespective of randomization, had significant reductions in liver fat compared with participants without FM reduction (median: -2.1%; IQR: -6.5% to -0.8% compared with 0.3%; IQR: -1.0% to 1.1%; P < 0.001). CONCLUSIONS: In Latino youth with obesity, a dietitian-led sugar reduction intervention did not improve liver outcomes compared with control, regardless of PNPLA3 genotype. Results suggest FM reduction is important for liver fat reduction, confirming clinical recommendations of weight loss and a healthy diet for pediatric NAFLD.This trial was registered at clinicaltrials.gov as NCT02948647.

External food cue responsiveness and emotional eating in adolescents: A multimethod study.

Eating in response to external food cues (i.e., external eating) and internal emotional experiences (i.e., emotional eating) are associated with obesity. While external and emotional eating co-occur, little is known about how external food cue responsiveness may interact with internal emotional cues to influence eating episodes in adolescents. The current study examined how trait-level external food cue responsiveness modulates momentary associations between affective states and eating in adolescents. Participants were drawn from a prior study of siblings (N = 78; ages 13-17) who completed an ecological momentary assessment protocol to assess eating episodes and affective states. External food cue responsiveness was determined by comparing energy consumption following presentation of an appetizing food (pizza) on one day and a control activity (reading) on another day. Generalized linear mixed models examined positive and negative affective states, cue responsiveness, and their interactions as predictors of the likelihood of eating. The relationship between affective states and likelihood of eating was stronger among adolescents with higher versus lower external food cue responsiveness. Among adolescents with higher cue responsiveness, endorsing negative affect was associated with a lower likelihood of eating, whereas endorsing positive affect was associated with a higher likelihood of eating (within-person effects). Findings suggest that high sensitivity to external food cues and greater proclivity for emotional eating may be likely to coincide such that any cue, internal or external, is likely to disrupt sensitivity to internal hunger and satiety signals. Future studies are needed to elucidate how sensitivities to internal and external cues may interact to influence obesity risk.

Bi-Directional Associations Between Real-Time Affect and Physical Activity in Weight-Discordant Siblings.

Pediatric obesity confers increased risk for a host of negative psychological and physical health consequences and is reliably linked to low levels of physical activity. Affective antecedents and consequences of physical activity are thought to be important for the development and maintenance of such behavior, though research examining these associations in youth across the weight spectrum remains limited. OBJECTIVE: This study examined bi-directional associations between affect and physical activity (i.e., moderate-to-vigorous physical activity [MVPA] and total activity counts), and the extent to which weight (body mass index z-score [z-BMI]) moderated these associations. METHODS: Participants were drawn from a prior study of siblings (N = 77; mean age = 15.4 ± 1.4 years) discordant for weight status (39 nonoverweight siblings, 38 siblings with overweight/obesity) who completed ecological momentary assessment (EMA) with accelerometer-assessed physical activity. RESULTS: Generalized linear mixed models indicated z-BMI moderated trait-level and momentary associations. When adolescents with higher z-BMI reported momentary negative affect, they evidenced less MVPA within the next hour. Across the sample, greater overall activity was associated with lower negative affect. However, at the momentary level, when adolescents with higher (but not lower) z-BMI evidenced greater activity, they reported decreases in negative affect. CONCLUSIONS: Findings indicate affective experiences surrounding physical activity differ according to z-BMI. Specifically, momentary negative affect may impede momentary MVPA among youth with higher z-BMI. Further research is warranted to elucidate factors influencing these momentary associations and the extent to which these momentary associations prospectively predict weight change.

Weight discordant siblings' ability to reduce energy intake at a meal as compensation for prior energy intake from sugar-sweetened beverages (SSBs).

BACKGROUND: Insufficient compensation for energy from sugar-sweetened beverages (SSBs) consumed prior to meals may promote greater overall energy intake. If so, ability to compensate for prior energy intake may account for difference in adiposity between adolescents with and without overweight. Studies of fraternal siblings discordant for weight status control for some genetic and shared within-family factors, which allows for testing how putative non-shared factors, such as parental control of feeding, predicts sibling weight differences. AIM: To determine whether same-sex weight-discordant (one with, one without overweight) adolescent siblings differ in ability to compensate for prior energy intake. METHODS: Same-sex biological sibling pairs (mean age = 15.4; 95% confidence interval (CI) 15.1, 15.7) (n = 38 pairs; 21 male pairs) consumed a sugar-sweetened (450 kcal) or a non-nutritive-sweetened (10 kcal) liquid preload of equal volumes on separate days, followed by an ad libitum lunch. Multilevel models examined ability to compensate, dietary restraint, and parental control of child's feeding. RESULTS: Siblings showed insufficient compensation and overate (with overweight = 44 kcal; without overweight = 32 kcal). Siblings shared little within-family similarity in compensation (intra-class correlation coefficient (ICC) = 0.20). Compensation was predicted by parental restriction and general restriction (p = 0.02) Differences in siblings' BMI z-scores were associated with differences in dietary restraint (p = 0.04) not with differences in compensation. CONCLUSION: Sibling differences in compensation for energy from sweetened beverages were not associated with differences in their adiposity. Compensation may be determined by a constellation of factors, including age, parental feeding practices, and food characteristics.

Effectiveness of social media (Facebook), targeted mailing, and in-person solicitation for the recruitment of young adult in a diabetes self-management clinical trial.

BACKGROUND/AIMS: Research is needed to identify promising recruitment strategies to reach and engage diverse young adults in diabetes clinical research. The aim of this study was to examine the relative strengths and weaknesses of three recruitment strategies used in a diabetes self-management clinical trial: social media advertising (Facebook), targeted mailing, and in-person solicitation of clinic patients. METHODS: Strategies were compared in terms of (1) cost-effectiveness (i.e. cost of recruitment/number of enrolled participants), (2) ability to yield participants who would not otherwise be reached by alternative strategies, and (3) likelihood of participants recruited through each strategy to adhere to study procedures. We further explored the appeal (overall and among age and gender subgroups) of social media advertisement features. RESULTS: In-person recruitment of clinic patients was overall the most cost-effective strategy. However, differences in demographic, clinical, and psychosocial characteristics of participants recruited via different strategies suggest that the combination of these approaches yielded a more diverse sample than would any one strategy alone. Once successfully enrolled, there was no difference in study completion and intervention adherence between individuals recruited by the three recruitment strategies. CONCLUSIONS: Ultimately, the utility of a recruitment strategy is defined by its ability to effectively attract people representative of the target population who are willing to enroll in and complete the study. Leveraging a variety of recruitment strategies appears to produce a more representative sample of young adults, including those who are less engaged in diabetes care.

Associations Between Social Network Characteristics and Loneliness During Pregnancy in a Sample of Predominantly African American, Largely Publicly-Insured Women.

OBJECTIVES: Most research evaluating relationships between social network attributes and loneliness have focused on older adult and adolescent networks. The present study examines the relationships between social network size (number of relationships), social network density (whether named relationships are connected to one another) and maternal loneliness during pregnancy. METHODS: Eligible women were enrolled at the time of their dating ultrasound (between 8 and 12 weeks of gestation). Interested women provided written consent and completed demographic, social network and loneliness measures. Participants completed the same surveys in their third trimester. Mixed-regression models, adjusted for age, race, ethnicity, and insurance type, were used to assess the relationship between social network size, network density, and loneliness. RESULTS: A total of 94 pregnant women (mean age = 23.77, 70.2% Black, 87.2% public insurance) completed baseline study measures, and 60 participants completed both assessment time points. Completers and non-completers did not differ on key characteristics. Social network density, but not social network size, predicted maternal loneliness ([Formula: see text]= - 1.27, 95% CI - 2.53, - 0.01, p = 0.0489) in the first and third trimester. CONCLUSIONS: These findings indicate that pregnant women's social network density may be more intimately related to feelings of loneliness than the objective number of relationships. This knowledge can begin to inform the design of supportive approaches to improve women's health.

Neighborhood, Family and Peer-Level Predictors of Obesity-Related Health Behaviors Among Young Adolescents.

Objective: This longitudinal study examines peer social functioning (PSF), familism, and neighborhood socioeconomic status (NSES) on adolescents' obesity risk. Methods: Participants ( N = 2,144) were originally sampled from 16 middle schools in Southern California (45% male; 45% Hispanic) as part of an alcohol and other drug use prevention program (CHOICE). Multilevel regression modeling tested main effects and interaction terms of PSF, familism, and NSES assessed at Wave 5 ( M age = 14.15) on body mass index and risk of obesity-related behaviors at Wave 6. Results: Higher PSF predicted healthier eating habits, less screen time, and more physical activity. Higher familism also predicted more physical activity. The positive effect of PSF on healthy eating was stronger among youth who reported higher familism. PSF also moderated the associations of NSES with healthy eating and physical activity. Conclusion: Findings emphasize the importance of targeting both peer and family factors, which may be more amenable to change than NSES.

Intermittent Fasting in Youth: A Scoping Review.

Intermittent fasting (IF) focuses on the timing of eating rather than diet quality or energy intake, with evidence supporting its effects on weight loss and cardiometabolic outcomes in adults. However, there is limited evidence for its efficacy in adolescents and emerging adults. To address this, a scoping review examined IF regimens in individuals aged 10 to 25, focusing on methodology, intervention parameters, outcomes, adherence, feasibility, and efficacy. The review included 39 studies with 731 participants aged 15 to 25. Methodologies varied, with 18 studies on time-restricted eating and others requiring caloric restriction. Primary outcomes included cardiometabolic risk factors (11/29), body composition (9/29), anthropometric measurements (8/29), and feasibility (2/29). Most studies reported significant weight loss. This review underscores IF's potential in treating obesity in this age group but highlights the need for rigorous studies with standardized frameworks for feasibility to ensure comparability and determine IF's practicality in this age group.

Timing of meal consumption on glucose profiles in Latino adolescents with obesity.

INTRODUCTION: To date, there has been no study investigating how meal-timing impacts glucose and insulin resistance among Latino youth at high risk of type 2 diabetes. A proof-of-concept study was conducted to assess metabolic response to a test-meal consumed in the morning, afternoon, and evening among 15 Latino adolescents with obesity using a within-participant design. METHODS: Youth, 13 to 19 years of age, with obesity, consumed the same test-meal after a 16 hour fast at three different times on separate days. Immediately after consumption of the test meal, a mixed meal tolerance test (MMTT) was performed. The co-primary outcomes were the area under the curve (AUC) for glucose, insulin, and c-peptide, and insulinogenic index (IGI). RESULTS: Twenty-two youth consented to participate for a 24% recruitment rate (78% female, 100% Latino, mean age 16.5±1.3 years, 70% publicly insured). There was a significantly greater rise in glucose and c-peptide levels following at 4 PM compared to 8 AM (glucose: p = 0.006; c-peptide: p < 0.0001) with no significant association found between insulin levels and timing of meal consumption. Pairwise comparisons showed a greater rise in AUC glucose and c-peptide levels at 4 PM compared to 8 AM (glucose p = 0.003; c-peptide p < 0.001) with no significant association found between insulin AUC and timing of meal consumption (p = 0.09). There was a greater reduction in IGI at 4 PM compared to 8 AM (p = 0.027). CONCLUSION: Similar to findings in adults at risk for diabetes, Latino youth with obesity show greater insulin resistance in response to a meal consumed in the afternoon and evening compared to early morning food consumption.

Effects of 8-h time-restricted eating on energy intake, dietary composition and quality in adolescents with obesity.

BACKGROUND: The precise mechanisms underlying the health benefits of time-restricted eating (TRE) are unclear, particularly in adolescents. OBJECTIVES: This secondary analysis examines the impact of 8-h TRE on energy intake, dietary composition and quality in adolescents with obesity, using data from a 12-week randomized, controlled pilot trial. METHODS: Participants (14-18 years with BMI >95th percentile) were assigned to either 8-h TRE with real-time or blinded continuous glucose monitoring or a control group with a 12+ h eating window. Dietary intake was analysed using the Nutrient Data System Recall 24-h Dietary Recall and the Healthy Eating Index (HEI-2020) for assessing diet quality. RESULTS: The study included 44 participants (32 TRE, 12 control), predominantly female and Hispanic/Latino. The TRE group showed a significant reduction in mean energy intake (-441 kcal/day), carbohydrates (-65 g/day), added sugar (-19 g/day) and fat (-19 g/day), while the control group had a similar reduction in energy intake (-437 kcal/day) and carbohydrates (-63 g/day), but no significant changes in added sugar or fat. The percent energy intake from protein increased more in the TRE group compared to the control. The TRE group experienced a significant improvement in diet quality, with a 6.3-point increase in HEI-2020 score; however, between-group comparisons were not statistically significant. CONCLUSION: There were no significant differences between the TRE and control groups in energy intake, dietary composition or quality. Future research with larger sample sizes is needed to further evaluate the potential impact of TRE on dietary behaviours.

Randomized Controlled Feasibility Trial of Late 8-Hour Time-Restricted Eating for Adolescents With Type 2 Diabetes.

Background: No trial to date has tested the effects of late time-restricted eating (lTRE) on glycemic control or body composition in adolescents with type 2 diabetes (T2D). Objective: The objective of the current study was to examine the feasibility, acceptability, and preliminary efficacy of lTRE compared to a prolonged eating window in adolescents with T2D. Design: A 12-week, randomized, controlled, feasibility study of lTRE compared to control in adolescents with obesity and new onset T2D was conducted. Participants/setting: Eligible participants were 13-21 years old; with a diagnosis of T2D, on metformin monotherapy, recruited from Children's Hospital Los Angeles, between January 2021 and December of 2022. From 36 eligible participants, 27 were enrolled (75% recruitment rate; age: 16.5 ± 1.7 years, HbA1c: 6.6 ± 0.9%, 22/27 [81%] Hispanic, 17/27 [63%] female, 23/27 [85%] public insurance; all p-values >.05), and 23 of 27 completed the protocol. Intervention: Participants wore a continuous glucose monitor (CGM) daily and were randomized to one of two meal-timing schedules for 12-weeks: (1) lTRE (eating all food between 12:00 PM and 20:00 PM without calorie counting or recommended daily caloric intake) or (2) Control (eating over a period of 12 or more hours per day). Main outcome measures: Study recruitment, retention and adherence to intervention arms were captured to operationalize feasibility. Glucose control (HbA1c), weight loss (%BMIp95), total body fat mass on DEXA, sleep, and dietary intake were explored as secondary outcomes. Statistical Analysis: Analyses were based on the intention to treat (ITT) population. Between-group differences in clinical outcomes were assessed using mixed-effects longitudinal regression models. Results: Overall adherence to the 8-hr lTRE was 6.2 ± 1.1 d/wk and Control was 5.9 ± 0.9 d/wk. Participants assigned to lTRE indicated that limiting their eating window did not negatively affect their daily functioning and no adverse events were reported. In this pilot study, lTRE led to a reduction in %BMIp95 (-3.4%-95%CI: -6.1, -0.7, p = 0.02), HbA1c (-0.4%, 95%CI: -0.9, -0.01, p = .06), and ALT (-31.1 U/L, 95%CI: -60, -2, p = .05) within the group. There was no significant difference observed between lTRE and control across these measures (all p > .05). The lTRE group had a -271.4 (95% CI, -565.2, 5.2) kcal/day energy reduction compared to a +293.2 (95% CI: 30.4, 552.7) kcal/day increase in Control (p = .01). There were no significant changes observed in sleep or eating behaviors over the study period between groups. Conclusions: Recruitment and retention rates suggest a trial of lTRE in adolescents with T2D was feasible. lTRE was seen as acceptable by participants and adherence was high. A revised intervention, building on the successful elements of this pilot alongside adapting implementations strategies to augment adherence and engagement, should therefore be considered.

Complementary Feeding and Child Appetitive Traits in a Sample of Hispanic Mother-Child Dyads.

BACKGROUND: Complementary feeding practices may contribute to toddler eating practices that affect weight outcomes. Studies are needed to understand the relationship between complementary feeding practices and toddler dietary self-regulation. OBJECTIVE: This study tests the hypothesis that earlier complementary food introduction predicts toddler food responsiveness and emotional overeating (ie, tendency to overeat in response to food cues and emotions, respectively), and considers whether introduction of certain foods better predict toddler dietary self-regulation. DESIGN: This study is a secondary analysis of data from a parent longitudinal birth cohort study on early growth/development among Hispanic mother-infant dyads. PARTICIPANTS/SETTING: The analytic sample included 174 mother-child dyads recruited from maternity clinics affiliated with the University of Southern California in Los Angeles County. Recruitment and data collection were ongoing from July 2016 to April 2020. At 1-, 6-, 12-, and 24-months postpartum, mothers reported exclusive breastfeeding duration and age of complementary food introduction via questionnaire. MAIN OUTCOME MEASURES: Child food responsiveness and emotional overeating scores calculated from the Child Eating Behavior Questionnaire at 12 and 24 months of age. STATISTICAL ANALYSES PERFORMED: Separate linear mixed models with repeated measures were used to examine associations between age of complementary food introduction as a predictor of child food responsiveness or emotional overeating, controlling for infant sex, birth body mass index z score, duration of exclusive breastfeeding, and mother's body mass index. RESULTS: In separate models, delaying complementary food introduction by 1 month was associated with a 6% reduction in food responsiveness (P = 0.007) and a 5% reduction in emotional overeating scores (P = 0.013). Fifty-eight unique combinations of complementary foods introduced first were found, precluding analyses to examine whether specific combinations were related to eating behavior outcomes due to sample size limitations. CONCLUSIONS: Earlier complementary feeding was associated with higher food responsiveness and emotional overeating scores among Hispanic children. Future studies in larger samples are needed to characterize patterns of complementary food introduction and their influence on child self-regulation.

The 24-Hour Movement Paradigm: An integrated approach to the measurement and promotion of daily activity in cancer clinical trials.

Increased physical activity (PA), improved sleep, and decreased sedentary behavior (SB) are essential components of supportive care for cancer survivors. However, researchers and health care professionals have achieved limited success in improving these behaviors among cancer survivors. One potential reasoning is that, over the past two decades, guidelines for promoting and measuring PA, sleep, and SB have been largely siloed. With greater understanding of these three behaviors, health behavior researchers have recently developed a new paradigm: the 24-Hour movement approach. This approach considers PA, SB, and sleep as movement behaviors along a continuum that represent low through vigorous intensity activity. Together these three behaviors form the sum of an individual's movement across a 24-hour day. While this paradigm has been studied in the general population, its usage is still limited in cancer populations. Here, we seek to highlight (a) the potential benefits of this new paradigm for clinical trial design in oncology; (b) how this approach can allow for greater integration of wearable technology as a means of assessing and monitoring patient health outside the clinical setting, improving patient autonomy through self-monitoring of movement behavior. Ultimately, implementation of the 24-Hour movement paradigm will allow health behavior research in oncology to better promote and assess critical health behaviors to support the long-term well-being for cancer patients and survivors.

Impact of early time-restricted eating on diet quality, meal frequency, appetite, and eating behaviors: A randomized trial.

OBJECTIVE: Time-restricted eating (TRE) can reduce body weight, but it is unclear how it influences dietary patterns and behavior. Therefore, this study assessed the effects of TRE on diet quality, appetite, and several eating behaviors. METHODS: Adults with obesity were randomized to early TRE plus energy restriction (eTRE + ER; 8-hour eating window from 7:00 a.m. to 3:00 p.m.) or a control eating schedule plus energy restriction (CON + ER; ≥12-hour window) for 14 weeks. Food intake was assessed via the Remote Food Photography Method, while eating patterns, appetite, and eating behaviors were assessed via questionnaires. RESULTS: A total of 59 participants completed the trial, of whom 45 had valid food records. eTRE + ER did not affect eating frequency, eating restraint, emotional eating, or the consistency of mealtimes relative to CON + ER. eTRE + ER also did not affect overall diet quality. The intensity and frequency of hunger and fullness were similar between groups, although the eTRE + ER group was hungrier while fasting. CONCLUSIONS: When combined with a weight-loss program, eTRE does not affect diet quality, meal frequency, eating restraint, emotional eating, or other eating behaviors relative to eating over more than a 12-hour window. Rather, participants implement eTRE as a simple timing rule by condensing their normal eating patterns into a smaller eating window.

Early time-restricted eating affects weight, metabolic health, mood, and sleep in adherent completers: A secondary analysis.

OBJECTIVE: Data are mixed on whether intermittent fasting improves weight loss and cardiometabolic health. Here, the effects of time-restricted eating (TRE) in participants who consistently adhered ≥5 d/wk every week were analyzed. METHODS: Ninety patients aged 25 to 75 years old with obesity were randomized to early TRE (eTRE; 8-hour eating window from 07:00 to 15:00) or a control schedule (≥12-hour window) for 14 weeks. A per-protocol analysis of weight loss, body composition, cardiometabolic health, and other end points was performed. RESULTS: Participants who adhered to eTRE ≥5 d/wk every week had greater improvements in body weight (-3.7 ± 1.2 kg; p = 0.003), body fat (-2.8 ± 1.3 kg; p = 0.04), heart rate (-7 ± 3 beats/min; p = 0.02), insulin resistance (-2.80 ± 1.36; p = 0.047), and glucose (-9 ± 5 mg/dL; p = 0.047) relative to adherers in the control group. They also experienced greater improvements in mood, including fatigue and anger; however, they self-reported sleeping less and taking longer to fall asleep. CONCLUSIONS: For those who can consistently adhere at least 5 d/wk, eTRE is a valuable approach for improving body weight, body fat, cardiometabolic health, and mood. Further research is needed to determine whether eTRE's effects of shortening sleep but reducing fatigue are healthful or not.

Influence of peers and friends on overweight/obese youths' physical activity.

This review offers a theoretical framework to account for the effects of peers on youths' physical activity. Our research indicates the following: 1) that the youth are more physically active in the presence of friends and peers than in the presence of family members or when alone, 2) peers and friends increase overweight/obese youths' motivation to be physically active, 3) peers' weight status does not moderate the effect of peers on youths' physical activity, and 4) experiencing negative peer interaction, such as ostracism, decreases physical activity in youth. We propose that the consideration of the peer social context as a contributor to physical (in)activity and maintenance of overweight status may further our understanding of physical and behavioral health trajectories and improve prevention and intervention efforts.

Effects of ostracism and social connection-related activities on adolescents' motivation to eat and energy intake.

OBJECTIVE: Assess the effect of ostracism and social connection-related activities on adolescents' motivation to eat and their energy intake. METHODS: Participants (n = 103; M age = 13.6 years) were either ostracized or included when playing a computer game, Cyberball. Next, they wrote about their friend (social-connection), watched television (distraction), or completed Sudoku puzzles (cognitive-load), and then completed a task to earn points toward snack food and/or socializing. Afterwards, participants were given access to food and social activities. RESULTS: Ostracized adolescents were more motivated to earn food than adolescents who were in the included/control condition. Follow-up contrasts indicated that ostracized adolescents who wrote about friends worked more for food points and consumed more food than other adolescents. CONCLUSION: Results suggest that social connection-related activities following ostracism may further deplete self-regulatory resources, thereby resulting in increased unhealthy food patterns. Study limitations as well as clinical implications of these findings are discussed.

Exploring Latino Promotores/a de Salud (Community Health Workers) knowledge, attitudes, and perceptions of COVID-19 vaccines.

Promotoras/promotores (i.e., community health workers) are uniquely positioned to provide much needed COVID-19 education and outreach in Latino communities, particularly in areas with disparities in vaccination rates. This study used qualitative methods to explore promotoras perspectives on COVID-19 vaccines, with a focus on understanding how vaccine knowledge and viewpoints among Latino communities can formulate recommendations to improve uptake of vaccination. Promotoras (N=22) were recruited to participate in semi-structured focus groups conducted virtually. Reflexive thematic analysis identified three overarching themes: (1) prevalence of misinformation (related to lack of trustworthy information, mistrust in the government, immigration status concerns, and conspiracy theories); (2) hesitancy (related to health concerns and eligibility confusion); and (3) recommendations for improving vaccine uptake. Delays in vaccination were not strictly due to doubts or fears but were also related to access barriers. The themes provide insight into the Latino communities' perceptions of COVID-19 vaccines and reasons why some remain unvaccinated. Promotoras' perspectives are integral to the development of strategies and approaches to address COVID-19 vaccine hesitancy, uptake, and implementation among underserved communities.

Diet and Physical Activity Behaviors of Families Receiving Maternal and Child Health Services: The Perspective of the Home Visitor.

Women and children enrolled in federally funded home visitation services are at an increased risk for unhealthy diet and physical activity patterns. Home visitors have a privileged relationship with their clients and hold a unique perspective of the multilevel influences surrounding these behaviors. This study explored the question: "What are home visitors' perspectives and experiences with their families' diet and physical activity behaviors?" Home visitors enrolled in a larger trial were invited to participate in focus group sessions (n=13). Topics covered their clients' constraints and capacity building opportunities for healthful diet and activity practices. Reflexive thematic analysis was used to analyze the data. The home visitors discussed key influences on diet and activity, and three overarching themes were identified: (a) acute periods of crises and mental health issues; (b) the role of the mother within the family; and (c) support and barriers within mothers' broader social network. The themes identified in this study highlight the complex, multidimensional influences on the dietary and physical activity patterns of these families, and pinpoint key areas of opportunity for intervention.

Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth.

PURPOSE OF REVIEW: Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep. RECENT FINDINGS: Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.