Validation of Food Compass with a healthy diet, cardiometabolic health, and mortality among U.S. adults, 1999-2018.

The Food Compass is a nutrient profiling system (NPS) to characterize the healthfulness of diverse foods, beverages and meals. In a nationally representative cohort of 47,999 U.S. adults, we validated a person's individual Food Compass Score (i.FCS), ranging from 1 (least healthful) to 100 (most healthful) based on cumulative scores of items consumed, against: (a) the Healthy Eating Index (HEI) 2015; (b) clinical risk factors and health conditions; and (c) all-cause mortality. Nationally, the mean (SD) of i.FCS was 35.5 (10.9). i.FCS correlated highly with HEI-2015 (R = 0.81). After multivariable-adjustment, each one SD (10.9 point) higher i.FCS associated with more favorable BMI (-0.60 kg/m2 [-0.70,-0.51]), systolic blood pressure (-0.69 mmHg [-0.91,-0.48]), diastolic blood pressure (-0.49 mmHg [-0.66,-0.32]), LDL-C (-2.01 mg/dl [-2.63,-1.40]), HDL-C (1.65 mg/d [1.44,1.85]), HbA1c (-0.02% [-0.03,-0.01]), and fasting plasma glucose (-0.44 mg/dL [-0.74,-0.15]); lower prevalence of metabolic syndrome (OR = 0.85 [0.82,0.88]), CVD (0.92 [0.88,0.96]), cancer (0.95 [0.91,0.99]), and lung disease (0.92 [0.88,0.96]); and higher prevalence of optimal cardiometabolic health (1.24 [1.16,1.32]). i.FCS also associated with lower all-cause mortality (HR = 0.93 [0.89,0.96]). Findings were similar by age, sex, race/ethnicity, education, income, and BMI. These findings support validity of Food Compass as a tool to guide public health and private sector strategies to identify and encourage healthier eating.

Implementation of nutrition and physical activity-related policies and practices on college campuses participating in the Healthier Campus initiative.

Objective: To evaluate implementation of nutrition/physical activity-related policies/practices at colleges participating in a healthy campus initiative and campus health leaders' perceptions of policies/practices' support for student health and ease of/barriers to implementation. Participants: Health leaders at colleges participating in the Healthier Campus Initiative (HCI), with completed or ongoing three-year HCI commitments. Methods: Surveys asked which of 41 guidelines were implemented and perceptions around support for student health and ease of/barriers to implementation. Qualitative interviews explored similar domains. Results: Campuses with completed HCI commitments (n = 17) averaged 27.6 guidelines implemented, versus 21.1 on campuses with commitments ongoing (n = 13; p = 0.003). Perceived support for student health and implementation ease varied by guideline. Common implementation barriers included financial costs and time. Interviews largely reinforced these findings. Conclusions: Completion of a campus environmental change initiative may be associated with more health-supporting practices. Campuses may benefit from implementing coordinated policy/practice changes supporting healthy eating and physical activity.

Longitudinal Analysis of Psychosocial Stressors and Body Mass Index in Middle-Aged and Older Adults in the United States.

OBJECTIVES: Psychosocial stress may be a risk factor for obesity and overweight in middle-aged and older adults. However, research on psychosocial stress and excess body weight has typically been cross-sectional and focused on single stressors. METHODS: Using 3 waves of data from the Health and Retirement Study, we conducted longitudinal analyses to assess associations between 5 psychosocial stressors-individually and in combination-and body mass index (BMI), adjusting for sociodemographic factors, alcohol use, and smoking history. We tested interaction effects between race and gender with stressors on BMI. RESULTS: A total of 3,956 participants were included in the main analyses. Most participants were White (88.04%) and more than half were female (60.39%). Perceived discrimination, financial stress, and relationship stress were positively associated with BMI. A greater cumulative stress burden was associated with higher BMI. In stratified analyses, greater financial stress was associated with higher BMI among White participants, whereas greater neighborhood stress was associated with lower BMI among Black participants. Greater relationship stress, financial stress, cumulative high stress, and overall cumulative stress burden were associated with higher BMI for women, but not men. DISCUSSION: Different sources of stress may be risk factors to weight gain and affect BMI in adults. White and female adults may be more susceptible to the obesogenic effects of stressors. Reducing exposure to stress may help reduce the burden of high BMI among middle-aged and older adults.

Impact of physical activity, diet quality and stress on cardiometabolic health in school employees.

Among school employees, it has been reported that poor physical and mental health, as well as high stress and large workloads, have resulted in high absenteeism and low retention. The consequences of unhealthy behaviors and stress can extend to students, impacting academic achievement and school costs. Our objective was to examine the impact of school employees' physical activity (PA), diet quality and perceived occupational stress on cardiometabolic health, and explore how stress may influence the impact of PA and diet on health. In this cross-sectional study, employees from lower-income Massachusetts schools participated in Wellness Assessments (2015-2016), including measured height, weight, and lipids [total (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C)]. Self-administered surveys were used to collect demographic, stress, PA and 24-hour food intake data. Linear regression models were used to examine the relationship among health behaviors (PA and diet), stress and cardiometabolic health. An interaction between stress and health behaviors was also explored. Seventy-four employees (66% teachers) participated. Overweight/obesity (mean BMI: 25.6 kg/m2), high TC and LDL-C were observed in 47%, 4%, and 34%, respectively, and moderate-to-vigorous PA (MVPA) was low (median: 17 min/day). Positive associations were identified between MVPA and cardiometabolic health, but not diet. The effect of MVPA on BMI was modified by stress (p-for-interaction = 0.001), with higher levels of stress associated with a diminished protective association between MVPA and BMI. Higher levels of PA were associated with more favorable cardiometabolic health, with increasing levels of stress minimizing the beneficial effect of PA on BMI.

Beat osteoporosis - nourish and exercise skeletons (BONES): a group randomized controlled trial in children.

BACKGROUND: Lifelong healthy habits developed during childhood may prevent chronic diseases in adulthood. Interventions to promote these habits must begin early. The BONES (Beat Osteoporosis - Nourish and Exercise Skeletons) project assessed whether early elementary school children participating in a multifaceted health behavior change, after-school based intervention would improve bone quality and muscular strength and engage in more bone-strengthening behaviors. METHODS: The 2-year BONES (B) intervention included bone-strengthening physical activity (85 min/week), educational materials (2 days/week), and daily calcium-rich snacks (380 mg calcium/day) delivered by after-school program leaders. BONES plus Parent (B + P) included an additional parent education component. From 1999 to 2004, n = 83 after-school programs (N = 1434 children aged 6-9 years) in Massachusetts and Rhode Island participated in a group randomized trial with two intervention arms (B only, n = 25 programs; B + P, n = 33) and a control arm (C, n = 25). Outcome measures (primary: bone quality (stiffness index of the calcaneus) and muscular strength (grip strength and vertical jump); secondary: bone-strengthening behaviors (calcium-rich food knowledge, preference, and intake; and physical activity level (metabolic equivalent time (MET) score, and weight-bearing factor (WBF) score)) were recorded at baseline, and after years one and two. Analyses followed an intent-to-treat protocol, and focused on individual subjects' trajectories along the three time points adjusting for baseline age and race via a mixed-effects regression framework. Analyses were performed with and without sex stratification. RESULTS: Children in B + P increased bone stiffness compared to C (p = 0.05); No significant changes were observed in muscle strength, food knowledge, or vertical jump. Children in B + P showed significant improvement in their MET and WBF scores compared to C (p < 0.01) with a stronger effect in boys in both B and B + P (all p < 0.01). CONCLUSION: After-school programs, coupled with parental engagement, serving early elementary school children are a potentially feasible platform to deliver bone-strengthening behaviors to prevent osteoporosis in adulthood, with some encouraging bone and physical activity outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT00065247. Retrospectively registered. First posted July 22, 2003.

Identifying Food Literacy Educational Opportunities for Youth.

BACKGROUND: Recent efforts supporting children's dietary behaviors suggest the importance of food literacy (FL), which is a multidimensional concept that encompasses food-related knowledge, skills, and behaviors. To date, FL has been largely informed by adult and adolescent research. AIMS: To assess the FL experiences, perceived skills, and knowledge of school-age children to inform FL educational opportunities. METHOD: Six focus groups were conducted with children (age 9-12 years) from three Massachusetts elementary schools. Two team members independently reviewed and coded a portion of the transcripts to assess interrater reliability. Predominant themes connected to children's perceived FL skills and knowledge were identified using an inductive and deductive content analysis approach. RESULTS: There were five central FL themes identified during the focus groups ( n = 31 children), including (1) food systems concepts; (2) food safety and food freshness; (3) gardening environment, perceived skills, and knowledge; (4) cooking environment, perceived skills, and safety; and (5) autonomy of meal preparation. DISCUSSION: The themes that emerged in these focus groups with children provided new information surrounding children's perceived FL skills and knowledge as well as important context regarding the food environment (school vs. home). These findings captured important concepts across the "farm to plate" spectrum and highlight potential school-based opportunities where FL topics could be expanded upon most successfully. CONCLUSION: This formative research informed educational opportunities for a FL curriculum, which holds promise for improving food-based education and programs, designing more effective interventions, and developing measurement tools.

Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: a cross-sectional analysis.

BACKGROUND: Tens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states. METHODS: An online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5-12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively). RESULTS: About half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three. CONCLUSIONS: Most programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted.

The critical role of communications in a multilevel obesity-prevention intervention: Lessons learned for alcohol educators.

OBJECTIVE: Multilevel interventions to prevent underage drinking are more effective than individual-level strategies, and messaging campaigns are key to such approaches. Recognizing the benefits of translating best practices across public health domains, this paper details the communications campaign from Shape Up Somerville (SUS), an exemplar for multilevel community-based approaches to address pediatric obesity, highlighting lessons learned for alcohol educators. METHODS: All elements of SUS, including the communications strategy, were developed collaboratively with local partners. Communication initiatives included community-engaged brand development to unify diverse intervention components; school-based communications to promote new opportunities for healthy eating and physical activity; and media partnerships to promote healthy behaviors community-wide. RESULTS: The overall SUS intervention was effective in reducing prevalence of overweight/obesity among first- to third-graders in Somerville relative to control communities. Process evaluation showed that communications successfully reached diverse community segments and raised awareness of and receptivity to changes. CONCLUSIONS AND PRACTICE IMPLICATIONS: Communications campaigns are essential components of multilevel interventions addressing public health challenges including obesity and underage drinking. Such communications should be developed collaboratively with the target audience and stakeholders, designed to engage community members at multiple levels through multiple channels within a systems framework, and sustained through local partnerships.

Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods.

BACKGROUND: Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age. OBJECTIVE: In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL). METHODS: A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories. RESULTS: The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents' awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors' long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change. CONCLUSIONS: Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors' targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors' health outcomes.

Occupational Physical Activity and Weight-Related Outcomes in Immigrant Mothers.

INTRODUCTION: New immigrants are likely to be employed in occupations that provide physical activity; however, these positions may place workers at risk for adverse health outcomes. Relationships between occupational physical activity (OPA); weight-related behaviors; obesity; and depression remain underexplored among recent immigrants. METHODS: Participants (N=385) were Brazilian, Haitian, and Latino mothers enrolled in a community-based participatory research lifestyle intervention among immigrant mothers (<10 years in U.S.). Baseline BMI was calculated using objectively measured height and weight. Self-reported baseline data included sociodemographics; physical activity (Pregnancy Physical Activity Questionnaire); depressive symptoms (Center for Epidemiological Studies-Depression Scale); and prepared food purchasing frequency. Logistic regression models estimated the odds of obesity (BMI ≥30.0); high depressive symptoms (score ≥16); and purchasing prepared foods (≥1 times/week) by OPA quartile. Models adjusted for covariates, including household composition, origin group, maternal age, education, household income, and recruitment year (2010, 2011). Data were analyzed in 2013. RESULTS: Employed participants (49%) primarily worked as domestic workers, nursing assistants, and food service staff. In adjusted models, women in the highest OPA quartile versus lowest had 65% lower obesity odds (95% CI=0.16, 0.76) and approximately twice the odds of presenting high depressive symptoms (2.01, 95% CI=1.02, 4.27) and purchasing takeout food (1.85, 95% CI=0.90, 3.90), which was attenuated after adjusting for income and education (unadjusted OR=1.98, 95% CI=1.10, 3.52). CONCLUSIONS: OPA contributes to energy expenditure and may protect against obesity among new immigrant mothers; however, it is also associated with high depressive symptoms. Implications for physical and psychosocial well-being are mixed.

Disparities in moderate-to-vigorous physical activity among girls and overweight and obese schoolchildren during school- and out-of-school time.

BACKGROUND: Increasing physical activity (PA) during the school day and out-of-school time are critical strategies for preventing childhood obesity and improving overall health. The purpose of the present investigation was to examine schoolchildren's volume and type of PA during school-time and out-of-school, compared to national recommendations and differences by sex and weight status. METHODS: This cross-sectional analysis included 517 3(rd)-5(th) grade schoolchildren from 13 New England elementary schools (October 2013-January 2014). Demographics were collected by parent questionnaire. Measured height and weight were used to categorize child weight status. Accelerometer data were collected over 7 days. PA was coded as total activity counts and minutes of sedentary, light, and moderate-to-vigorous physical activity (SED, LPA, MVPA) during 1) school, 2) weekday out-of-school, 3) weekend, and 4) total daily time. Multivariable mixed models were used to examine associations between sex and weight status and total counts, SED, LPA, and MVPA, controlling for demographics, wear-time, and clustering within schools. RESULTS: 453 participants (60.5% girls; mean age 9.1 years; 30.5% overweight/obese) had valid accelerometer wear time (≥3 days, ≥ 10 h/day). Few children achieved 60 min total daily (15.0%) or school-time (8.0 %) MVPA recommendations. For all time-of-day categories, girls achieved fewer MVPA minutes than boys (p < .0001), and overweight/obese participants achieved fewer MVPA minutes than normal/underweight participants (p = 0.05). Minutes of LPA declined by grade-level (p < .05) and were lower in girls than boys during school-time only (p < .05). CONCLUSION: Disparities in MVPA by sex and weight status across school and out-of-school time highlight the need for programs with equitable reach.

Energy Contents of Frequently Ordered Restaurant Meals and Comparison with Human Energy Requirements and U.S. Department of Agriculture Database Information: A Multisite Randomized Study.

BACKGROUND: Excess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non-chain) establishments that do not provide nutrition information. OBJECTIVE: To measure the energy content of frequently ordered meals in non-chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information. DESIGN: A multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non-chain restaurants, together with equivalent meals from large-chain restaurants. SETTING: Meals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014. MAIN OUTCOME MEASURES: Meal energy content determined by bomb calorimetry. STATISTICAL ANALYSIS PERFORMED: Regional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non-chain and chain meals, human energy requirements, and food database values. RESULTS: Meals from non-chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P=0.41). There was a significant effect of cuisine on non-chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion. CONCLUSIONS: Non-chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.

Engaging Stakeholders From Volunteer-Led Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and Physical Activity.

BACKGROUND: Little effort has focused on the role of volunteer-led out-of-school time (OST) programs (ie, enrichment and sports programs) as key environments for the promotion of healthy eating and physical activity habits among school-aged children. The Healthy Kids Out of School (HKOS) initiative developed evidence-based, practical guiding principles for healthy snacks, beverages, and physical activity. The goal of this case study was to describe the methods used to engage regional partners to understand how successful implementation and dissemination of these principles could be accomplished. COMMUNITY CONTEXT: HKOS partnered with volunteer-led programs from 5 OST organizations in Maine, Massachusetts, and New Hampshire to create a regional "learning laboratory." METHODS: We engaged partners in phases. In the first phase, we conducted focus groups with local volunteer program leaders; during the second phase, we held roundtable meetings with regional and state program administrators; and in the final phase, we conducted additional outreach to refine and finalize implementation strategies. OUTCOMES: Implementation strategies were developed based on themes and information that emerged. For enrichment programs, strategies included new patch and pin programs that were consistent with the organizations' infrastructure and usual practices. For sports programs, the main strategy was integration with online trainings for coaches. INTERPRETATION: Through the engagement process, we learned that dissemination of the guiding principles in these large and complex OST organizations was best accomplished by using implementation strategies that were customized, integrated, and aligned with goals and usual practices. The lessons learned can benefit future efforts to prevent obesity in complex environments.

Cross-Sectional Associations between Empirically-Derived Dietary Patterns and Indicators of Disease Risk among University Students.

The transition from adolescence to adulthood is a unique period during which lifelong dietary habits are shaped. Dietary patterns (DPs) among young adults attending college have not been adequately described, and associations between DPs and indicators of disease risk are not well understood in this age group. Dietary data were collected from undergraduates participating in the Tufts Longitudinal Health Study (TLHS; 1998-2007) by Food Frequency Questionnaire (FFQ; n = 1323). DPs were derived using principal components analysis with varimax rotation. Scree plots; eigenvalues; factor loadings; and previous studies were used to determine and label the DPs retained. Cross-sectional relationships between DP scores and anthropometric measures (percent body fat (PBF) and (BMI) and lipid biomarkers (total; HDL and LDL cholesterol; and triglycerides) were assessed with multivariable regression models; adjusted for demographics; physical activity; smoking; intention to gain/lose weight; and total energy intake. Effect modification by sex was tested. Three DPs were identified: Prudent; Western; and Alcohol. Greater adherence to the Prudent DP was associated with favorable anthropometric outcomes. The Alcohol DP was associated with a favorable lipid profile. Associations between the Western DP and blood lipids differed by sex; with unfavorable impact observed only among males. Our findings add to the literature linking DPs in young adults with measurable adiposity and cardiometabolic outcomes; suggesting that improving nutrition among college students could reduce chronic disease risk.

Validation of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire.

BACKGROUND: Recent research has highlighted the potential for out-of-school-time (OST) environments to impact children's energy balance. Expanding upon this evidence requires validated measures to assess nutrition and physical activity (PA) environments across large samples of OST programs. The aim of this study was to assess the criterion validity of the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire (OST-SBPA), an online questionnaire designed to measure OST nutrition and PA environments by program leaders' reports. METHODS: The study consisted of two samples of OST programs (total n=65). Objective data across program meetings were compared to program leaders' reports of usual snack, beverage, and PA offerings. All 65 programs provided snack and beverage data; PA data were available from 31 programs. Validity was assessed using percent agreement, Cohen's kappa, and Spearman's correlations. RESULTS: All OST-SBPA items demonstrated agreement above 60% when dichotomized (e.g., none/some versus most/all of the time for frequency items). Most OST-SBPA items were significantly correlated with objective data, including how often fresh and processed fruits and vegetables, salty snacks, sweet snacks, protein snacks, milk, juice, and sweetened beverages were offered and four PA measures (r=0.43-0.78; p<0.01), whereas one item, the frequency that water was offered, was not (r=0.13; p=0.37). The water item demonstrated validity once water from water fountains was recoded and not considered a program-provided beverage. CONCLUSIONS: These findings fill a gap in the literature through the validation of a brief questionnaire that can be used to assess OST nutrition and PA environments. The current results support the use of the OST-SBPA in studies aiming to assess and impact these environments.

Demographic, Physiologic, and Psychosocial Correlates of Physical Activity in Structured Exercise and Sports Among Low-Income, Overweight Children.

OBJECTIVE: To describe correlates of physical activity (PA) in structured exercise and structured sports sessions among low-income, overweight children participating in a community-based PA program. METHODS: A total of 93 children (55% male; 91% Hispanic) aged 8-14 years were included. Participants wore pedometers in a sample of 10 of 59 total sessions offered; mean steps per minute were calculated for structured exercise and sports sessions. Separate multivariable regression models tested associations between steps per minute in exercise and sports sessions and 5 potential correlates: baseline body mass index z-score, aerobic fitness (Progressive Aerobic Cardiorespiratory Endurance Run laps), perceived athletic competence (Harter self-perception profile), sex, and age. RESULTS: Only age (ß = -2.9; P = .02) significantly predicted steps per minute in exercise sessions. Age (ß = -4.3; P = .007), fitness (ß = 0.45; P = .03), and male sex (ß = 8.7; P = .02) significantly predicted steps per minute in sports. CONCLUSION AND IMPLICATIONS: In structured exercise and sports, perceived competence may not influence overweight and obese children's PA. However, girls and older or less fit children may engage less actively, especially in sports.

Food and physical activity environments: an energy balance approach for research and practice.

Increases in the prevalence of overweight and obesity are a function of chronic, population-level energy imbalance, whereby energy intakes exceed energy expenditures. Although sometimes viewed in isolation, energy intakes and expenditures in fact exist in a dynamic interplay: energy intakes may influence energy expenditures and vice versa. Obesogenic environments that promote positive energy balance play a central role in the obesity epidemic, and reducing obesity prevalence will require re-engineering environments to promote both healthy eating and physical activity. There may be untapped synergies in addressing both sides of the energy balance equation in environmentally focused obesity interventions, yet food/beverage and physical activity environments are often addressed separately. The field needs design, evaluation, and analytic methods that support this approach. This paper provides a rationale for an energy balance approach and reviews and describes research and practitioner work that has taken this approach to obesity prevention at the environmental and policy levels. Future directions in research, practice, and policy include moving obesity prevention toward a systems approach that brings both nutrition and physical activity into interdisciplinary training, funding mechanisms, and clinical and policy recommendations/guidelines.

Exploring New Relationships Between Physical Activity Volume and Intensity and Cardiometabolic Risk in U.S. Adolescents.

BACKGROUND: Associations between physical activity (PA) intensity and volume and adolescents' cardiometabolic health have research, policy, and practice implications. This study compares associations between cardiometabolic risk factors and 1) moderate-to-vigorous PA (MVPA) minutes versus total PA volume (accelerometer-derived total activity counts, TAC) and 2) light PA volume (counts at light intensity, L-TAC) versus moderate-to-vigorous PA volume (counts at moderate-to-vigorous intensity, MV-TAC). METHODS: 2105 adolescents from 2003- 2006 NHANES were included. Independent variables were MVPA minutes, TAC, L-TAC, and MV-TAC. Regression models tested associations between PA variables and continuous metabolic risk index (CMRI), waist circumference, systolic and diastolic blood pressure, HDL, insulin, and triglycerides. RESULTS: TAC demonstrated a slightly stronger inverse association with CMRI (P = .004) than did MVPA (P = .013). TAC and MVPA were both associated with systolic and diastolic pressure, HDL, and insulin; associations were similar or slightly stronger for TAC. L-TAC and MV-TAC were both associated with CMRI and HDL. Only L-TAC was associated with diastolic pressure. Only MV-TAC was associated with waist circumference, systolic pressure, and insulin. CONCLUSIONS: Compared with MVPA minutes, TAC demonstrates similar or slightly stronger associations with cardiometabolic risk factors. L-TAC and MV-TAC appear similarly associated with adolescents' clustered risk but differently associated with individual risk factors.

Baseline Socio-demographic characteristics and self-reported diet and physical activity shifts among recent immigrants participating in the randomized controlled lifestyle intervention: "Live Well".

The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes.