Prevalence and risk factors of post-acute sequelae of COVID-19 among United States Veterans.

PURPOSE: To better understand Post-Acute Sequelae of COVID-19 (PASC) in the Veteran population, this study aims to determine the prevalence of PASC and identify risk factors associated with its development. METHODS: This retrospective cohort study included 363,825 Veterans that tested positive for COVID-19 between February 1, 2020, and September 30, 2022. The primary outcome was the development of PASC 30-180 days following an acute infection with SARS-CoV-2. Multivariate logistic regression was utilized to examine factors associated with PASC. RESULTS: Of the 363,825 Veterans included in the analysis, 164,315 (45%) displayed symptoms of PASC. The Veterans in this analysis were predominantly male, non-Hispanic White, under the age of 65 years old, and lived in an urban residence. The strongest predictors for PASC included Non-Hispanic Black or African American race compared to Non-Hispanic White race (aOR=1.14), being between the ages of 50 and 64 compared to ages 50 and below (aOR=1.80), diabetes (aOR=8.46), and severe acute infection (aOR=1.42). CONCLUSION: Results demonstrate potential health inequities for vulnerable individuals, as well as increased risk for individuals with pre-existing comorbidities. The prevalence of PASC provides estimates for future health care utilization. The risk factors identified can aid public health interventions to reduce the burden of PASC.

The Social, Demographic, and Clinical Predictors of COVID-19 Severity: a Model-based Analysis of United States Veterans.

PURPOSE: This study aims to identify the contributions of individual and community social determinants of health (SDOH), demographic, and clinical factors in COVID-19 disease severity through a model-based analysis. METHODS: This national cross-sectional study focused on hospitalization among those tested for COVID-19 and use of intensive care, analyzing data on 220,848 Veterans tested between February 20, 2020 and October 20, 2021. Multiple logistic regression models were constructed using backwards elimination. The predictive value of each model was assessed with a c-statistic. RESULTS: Those hospitalized were older, more likely to be male, of Black or Asian race, have an income less than $39,999, live in an urban residence, and have medical comorbidities. The strongest predictors for hospitalization included Gini inequality index, race, income, heart failure, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). For intensive care, Asian race, rural residence, COPD, and CKD were the strongest predictors. C-statistics were c = 0.749 for hospitalization and c = 0.582 for ICU admission. CONCLUSIONS: A combination of clinical, demographic, individual and community SDOH factors predict COVID-19 hospitalization with good predictive ability and can inform risk stratification, discharge planning, and public health interventions. Racial disparities were not explained by social or clinical factors. Intensive care models had low discriminative power and may be better explained by other characteristics.

Neighborhood and Household Environment as Contributors to Racial Disparities in Sleep Duration among U.S. Adolescents.

Objective: Racial disparities in adolescent sleep duration have been documented, but pathways driving these disparities are not well understood. This study examined whether neighborhood and household environments explained racial disparities in adolescent sleep duration. Methods: Participants came from Waves I and II of Add Health (n=13,019). Self-reported short sleep duration was defined as less than the recommended amount for age (<9 hours for 6-12 years, <8 hours for 13-18 years, and <7 hours for 18-64 years). Neighborhood factors included neighborhood socioeconomic disadvantage, perceived safety and social cohesion. Household factors included living in a single parent household and household socioeconomic status (HSES). Structural equation modeling was used to assess mediation of the neighborhood and household environment in the association between race/ethnicity and short sleep duration. Results: Only HSES mediated racial disparities, explaining non-Hispanic (NH) African American-NH White (11.6%), NH American Indian-NH White (9.9%), and Latinx-NH White (42.4%) differences. Unexpectedly, higher HSES was positively associated with short sleep duration. Conclusion: Household SES may be an important pathway explaining racial disparities in adolescent sleep duration. Future studies should examine mechanisms linking household SES to sleep and identify buffers for racial/ethnic minority adolescents against the detrimental impacts that living in a higher household SES may have on sleep.

Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey.

BACKGROUND: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities' knowledge of equity along digital health use patterns. OBJECTIVE: This study aims to identify the social determinants of digital health tool adoption in Georgia. METHODS: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. RESULTS: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. CONCLUSIONS: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions.

Nutrition Policies, Practices, and Environments in Low-Income Georgia Elementary Schools, United States, 2015-2017.

BACKGROUND: A nutritious diet can prevent obesity and chronic disease and improve academic performance, yet many children have energy-dense, nutrient-poor diets. The objective of this study was to assess nutrition policies, practices, and environments in Georgia Supplemental Nutrition Assistance Program Education (SNAP-Ed) elementary schools and compare them across school-level demographic characteristics. METHODS: We distributed a cross-sectional online survey to administrators, grade level chairs, and nutrition managers from 113 Georgia SNAP-Ed elementary schools during 2015-2017. Logistic regression, one-way ANOVA, and Tukey's tests were performed to assess differences by free and reduced-price lunch eligibility and percentage black. Fisher's exact and Rao-Scott chi-square tests were performed to assess differences by school size and geography. RESULTS: The majority of schools established wellness policies and committees, provided nutrition education, and offered fresh fruits and/or vegetables daily. Fewer schools had policies limiting sugar-sweetened foods within classrooms or had established a school garden. There were minimal significant differences in survey responses across school-level demographics. CONCLUSIONS: Georgia SNAP-Ed elementary schools are providing healthy nutrition settings for their students in a number of areas, and can further improve by establishing more comprehensive wellness policies, a committee to enforce them, and engaging children in hands-on nutrition education activities.

Physical Activity Opportunities and Academic Outcomes of Fourth Grade Elementary School Students in Georgia.

BACKGROUND: Physical activity at schools is an important component in combatting childhood obesity. Studies have shown that physical activity at school is positively associated with academic outcomes. The purpose of this study is to examine associations between opportunity of physical activity time at school and academic outcomes. METHODS: This statewide, cross-sectional study utilized 2 data sources from the Georgia Department of Education and Georgia Shape in 860 schools. Multivariable linear regression analysis assessed the impact of the amount of physical activity time at school and standardized test scores, controlling for aerobic capacity, BMI, race, gender, school size, geographic category, and SES. RESULTS: Time of physical activity opportunity at school was not significantly associated with Mathematics or Reading CRCT scores (p = .94, p = .31, respectively). SES had the greatest impact on test scores, where higher SES schools had higher standardized test scores (p < .01 for all tests scores). CONCLUSION: Time of physical activity opportunities at school was not significantly associated with standardized test scores. SES appears to be the most important factor in academic outcomes. Time spent in PA at school does not negatively affect academic outcomes and should be utilized to prevent/reduce childhood overweight and obesity.

Obesity and understudied minority children: existing challenges and opportunities in epidemiology.

BACKGROUND: Obesity is a major public health concern in the United States and should be addressed as early as possible, in childhood. Disparities exist in obesity prevalence and its associated comorbidities by racial/ethnic group, however less is known about the smaller racial/ethnic subclasses that are often aggregated and assumed to be homogeneously at risk. As the racial and ethnic composition of the US shifts towards greater diversity, it is important that epidemiologic research addresses these new challenges. MAIN BODY: In this short communication, we focus on Asian American children given that subgroups are historically understudied and emerging evidence among adults suggest heterogeneous associations for both obesity and cardio-metabolic outcomes. Existing limitations in this research area include: (1) identifying the appropriate measurement of adiposity in Asian American children; (2) determining high-risk cutoffs for intervention; and (3) developing strategies to ensure study robustness. CONCLUSION: Data disaggregation is a necessary approach to understand potentially heterogeneous associations in childhood obesity and cardio-metabolic risk, but epidemiologic investigators must address these challenges. Ultimately, successful strategies could help better identify high risk subgroups, target interventions, and effectively reduce the burden of obesity among American youth.

Elementary school physical activity opportunities and physical fitness of students: A statewide cross-sectional study of schools.

BACKGROUND: Using a cross-sectional design, we assessed the relationship between the time schools provide for physical activity and the proportion of students achieving a healthy aerobic capacity or body mass index. METHODS: In 2013-2014, physical education and grade-level teachers from 905 of 1,244 Georgia elementary schools provided survey data about the frequency and duration of physical activity opportunities offered before, during, and after school. Log-binomial models related the weekly physical activity minutes provided by schools to the proportion of children in the FitnessGram healthy fitness zone for aerobic capacity or body mass index while adjusting for school characteristics and demographics. RESULTS: During-school physical activity time was not associated with student fitness, but schools with before-school physical activity programs had a moderately higher prevalence of healthy aerobic capacity (prevalence ratio among girls: 1.06; 99% confidence interval: 1.00-1.13; prevalence ratio among boys: 1.03; 99% confidence interval: 0.99-1.08). Each additional 30 minutes of recess per week was associated with no more than a 3%-higher proportion of students with healthy body mass indexes (prevalence ratio among girls: 1.01; 99% confidence interval: 1.00-1.03; prevalence ratio among boys: 1.01; 99% confidence interval: 0.99-1.03). CONCLUSIONS: The amount of physical activity time provided by schools is not strongly associated with school-aggregated student fitness. Future studies should be designed to assess the importance of school-based physical activity time on student fitness, relative to physical activity type and quality.

Racial disparities and sleep among preschool aged children: a systematic review.

Sleep disorders and sleep insufficiency are common among preschool-aged children. Studies among school-aged children show disordered sleep is often more prevalent among racial minority groups. The primary aim of this systematic review was to critically appraise empirical data to elucidate the relationship between race and key sleep variables among children aged 2 to 5 years old. By systematically searching PubMed, Web of Science, and EBSCO databases, we identified empirical research articles conducted in the United States that investigate this relationship. We searched for variables relevant to (1) insufficient sleep duration, (2) poor sleep quality, (3) irregular timing of sleep, including sleep/wake problems and irregular bedtime onset and wake times (4) and sleep/circadian disorders. Nine studies satisfied the criteria for inclusion: five investigated nocturnal sleep duration, five investigated bedtime-related variables, four investigated daytime sleep (napping), three investigated total sleep, two investigated sleep quality, and one investigated wake times. Four studies specifically addressed racial and demographic differences in sleep variables as the primary aim, while the remaining five contained analyses addressing racial and demographic differences in sleep as secondary aims. Non-Hispanic white, white, or European-American race was used as the reference category in all studies. The results provided consistent evidence that white, non-Hispanic children were more likely to go to bed earlier and more regularly, have longer nocturnal sleep, and nap less than most racial and ethnic minorities. Combined, this literature presents a compelling narrative implicating race as an important factor in sleep patterns among a preschool age population.

Feasibility of a Multicomponent Program to Promote Physical Activity and Nutrition in Georgia Low-Income Early Care and Education Settings.

BACKGROUND: This article describes the process and intermediate outcomes from a program implemented in 65 Early Care and Education (ECE) centers serving low-income families throughout Georgia during the 2014-2017 school years. METHODS: The HealthMPowers' Empowering Healthy Choices in Schools, Homes, and Communities ECE program was based on the organization's previously successful elementary school program and aligns with current early childhood nutrition and physical activity recommendations. Participating centers worked with HealthMPowers for up to 3 years. A team from each center led changes by conducting annual self-assessments, creating and implementing improvement plans, and implementing nutrition and physical activity programs using educational resources and environmental cues. A monitoring and evaluation plan provided ongoing feedback to HealthMPowers and centers. Family and staff surveys provided insights into behaviors of children, families, and staff. Process measures included specific benchmarks (e.g., center leadership team formation, improvement plan implementation). Annual self-assessment results served as intermediate outcome measures. RESULTS: As of 2017, 65 centers had enrolled in the program. All centers formed a health team and completed the baseline self-assessment and most implemented an improvement plan (88%). At the 1-year follow-up self-assessment, centers reported improvements from baseline including never offering food incentives for good behavior (75%-86%), conducting taste testing at least once a month (61%-79%), and rarely/never serving sugar-sweetened beverages (93%-96%). CONCLUSIONS: Initial process measures from a multicomponent health promotion program in ECE were promising. An integrated continuous improvement approach to working with child care settings is feasible and likely effective.

Racial/ethnic sleep disparities in US school-aged children and adolescents: a review of the literature.

Sleep is essential for optimal health, well-being, and cognitive functioning, and yet nationwide, youth are not obtaining consistent, adequate, or high-quality sleep. In fact, more than two-thirds of US adolescents are sleeping less than 8 hours nightly on school nights. Racial and ethnic minority children and adolescents are at an increased risk of having shorter sleep duration and poorer sleep quality than their white peers. In this review, we critically examined and compared results from 23 studies that have investigated racial/ethnic sleep disparities in American school-aged children and adolescents ages 6-19 years. We found that White youth generally had more sufficient sleep than minority youth, Hispanics had more than Blacks, and there was inconclusive evidence for Asians and other minorities. Recommendations for researchers include the following: (1) explore underlying causes of the disparities of these subpopulations, with a particular interest in identifying modifiable causes; (2) examine factors that may be impacted by racial/ethnic sleep disparities; (3) use a multidimensional approach to measuring sleep disparities; and (4) examine how beliefs about sleep are patterned by race/ethnicity. Understanding sleep disparities can inform interventions, policies, and educational programs to minimize sleep disparities and their impact on health, psychological, and educational outcomes.

Socioeconomic and Racial/Ethnic Disparities in Physical Activity Environments in Georgia Elementary Schools.

PURPOSE: This study aimed to characterize physical activity (PA) environments in Georgia public elementary schools and to identify socioeconomic status (SES) and racial/ethnic disparities in PA environments. DESIGN: A school setting PA survey was launched in 2013 to 2014 as a cross-sectional online survey assessing PA environment factors, including facility access and school PA practices, staff PA opportunities, parental involvement in school PA, and out-of-school PA opportunities. SETTING: All 1333 Georgia public elementary schools were recruited. PARTICIPANTS: A total of 1083 schools (81.2%) responded. Survey respondents included school administrators, physical education (PE) teachers, and grade-level chairs. MEASURES: Physical activity environment factors were assessed via an online questionnaire adapted from school PA surveys and articles. ANALYSIS: The chi-square and Fisher exact analyses were conducted to examine the reporting of PA environment factors overall and by school SES, as measured by free/reduced lunch rate, and/or racial/ethnic composition. RESULTS: Overall, many PA environment factors were widely prevalent (ie, gym [99%] or field [79%] access), although some factors such as some PA-related programs (ie, a structured walk/bike program [11%]) were less widely reported. Disparities in school PA environment factors were largely patterned by SES, though they varied for some factors by racial/ethnic composition and across SES within racial/ethnic composition categories. For example, lower SES schools were less likely to report access to blacktops and tracks ( p-value < .0001), and higher SES schools were less likely to report access to playgrounds ( p-value = .0076). Lower SES schools were also less likely to report "always/often" giving access to PE/PA equipment during recess ( p-value < .01). Lower SES and majority nonwhite schools were less likely to report having joint use agreements with community agencies ( p-value < .0001). CONCLUSION: This study highlights SES and racial/ethnic disparities in PA environments in Georgia public elementary schools.

Home environments, physical activity, and energy expenditure among low-income overweight and obese women.

Ecologic models of physical activity identify multiple environmental domains that influence activity levels, including the home. This study examined aspects of the home environment associated with objective measures of physical activity in overweight and obese women. Study participants were recruited through three federally qualified health centers in rural southwest Georgia as part of a randomized controlled trial of a home-environment-focused weight gain prevention intervention. Data collected from February 2011 to December 2012 were from 301 participants who completed baseline interviews and wore accelerometers for 7 days. Most were African American (83.4%) and obese (50.5%) or morbidly obese with body mass index ≥40 (35.6%). Mean age was 50.6 years. Participants were highly sedentary, with 7.9 hours of non-sedentary time per week, primarily in light activity. In a multivariate model, exercise equipment (p = .03), family support (p = .02), and full-time employment (p = .03) were positively associated with non-sedentary time, whereas age (p = .003), living in a more rural area (p = .03), and having an exercise space (p = .01) were negatively associated. Home environments may be promising targets for programs aimed at increasing activity levels among overweight and obese women.

Prenatal and Postnatal Fruit and Vegetable Intake Among US Women: Associations with WIC Participation.

Objective Evaluate variation in fruit and vegetable intake by Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and poverty status among pregnant, and postpartum women participating in the Infant Feeding Practice Study II (IFPSII). Methods IFPSII (2005-2007) followed US women from third trimester through 1 year postpartum through mailed questionnaires measuring income, WIC participation, breastfeeding; and dietary history questionnaires (DHQ) assessing prenatal/postnatal fruit and vegetable consumption. Poverty measurements used U.S. Census Bureau Federal Poverty thresholds to calculate percent of poverty index ratio (PIR) corresponding to WIC's financial eligibility (≤185 % PIR). Comparison groups: WIC recipients; WIC eligible (≤185 % PIR), but non-recipients; and women not financially WIC eligible (>185 % PIR). IFPSII participants who completed at least one DHQ were included. Intake variation among WIC/poverty groups was assessed by Kruskal-Wallis tests and between groups by Mann-Whitney Wilcoxon tests and logistic regression. Mann-Whitney Wilcoxon tests examined postnatal intake by breastfeeding. Results Prenatal vegetable intake significantly varied by WIC/poverty groups (p = 0.04) with WIC recipients reporting significantly higher intake than women not financially WIC eligible (p = 0.02); association remained significant adjusting for confounders [odds ratio 0.66 (95 % confidence interval: 0.49-0.90)]. Prenatal fruit and postnatal consumption did not significantly differ by WIC/poverty groups. Postnatal intake was significantly higher among breastfeeding than non-breastfeeding women (fruit: p < 0.0001; vegetable: p = 0.006). Conclusions for Practice Most intakes did not significantly differ by WIC/poverty groups and thus prompts research on WIC recipient's dietary behaviors, reasons for non-participation in WIC, and the influence of the recent changes to the WIC food package.

Agreement between the Perceived and Actual Fruit and Vegetable Nutrition Environments among Low-Income Urban Women.

The food environment is described by two measures: store-level (actual) and individual-level (perceived). Understanding the relationship between actual and perceived fruit and vegetable (F&V) nutrition environments is important as their association may influence F&V purchases and consumption. The study objective was to assess agreement between perceived and actual environment measures of availability, quality, and affordability/price for fresh and canned/frozen F&V. African American WIC recipients (n=84) self-reported perceptions corresponding to chain food stores (n=13) which were then assessed by surveyors. Nearly 80% of participants had positive perceptions of stores' F&V availability, quality, and affordability. Store assessments indicated high F&V availability and quality and lowest prices for canned varieties. Kappa statistics, sensitivity, and specificity calculated agreement between perceived and actual measures. Results indicated slight to fair agreements. Agreements were highest for quality measures (kappa=0.25 (95% CI:0.08-0.42), p=.008). Research implications include promoting nutrition education and resident interviewing to understand F&V expectations.

Exploring the Impact of the New WIC Food Package on Low-Fat Milk Consumption Among WIC Recipients: A Pilot Study.

OBJECTIVE: To examine if the mothers and their eldest child participating in WIC would accept the 2009 new Women, Infants, and Children (WIC) program package and drink more low-fat milk. METHODS: Mothers and their eldest child at two Atlanta WIC clinics were recruited. Data were collected at baseline (before the new WIC package), at one week and four weeks. RESULTS: The percentage of children consuming low-fat milk significantly increased: 41.3% at baseline, 58.8% at week one, and 79.5% at week four (p<.001). After four weeks, the mothers reported increased child's consumption of low-fat milk vs. whole milk (AOR = 7.36; CI: 1.44-37.52). Mothers' consumption of low-fat milk did not significantly change after introduction of the new package. CONCLUSIONS: Policy changes for WIC vouchers were implemented to encourage mothers to reduce fat calories in dairy products for them and their children. This represents a powerful, low-resource intervention to change health behaviors among low-income families.

The relationship between income and oral health among people with intellectual disabilities: a global perspective.

BACKGROUND: The scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities. METHODS: Eighty-two thousand five hundred and seventy Special Olympics athletes were screened and eligible for inclusion in this study. The main exposure (income status) and selected oral health signs and symptoms (missing teeth, untreated decay, injury, gingivitis, and mouth pain) were used to conduct a cross-sectional analysis. Prevalence odds ratios were obtained through logistic regression. RESULTS: Study participants from low-income countries experienced adverse health outcomes at a lower rate than expected. Study participants from upper middle, lower middle, and low-income countries had higher odds of mouth pain and untreated decay, yet lower odds of missing teeth, injury, and gingivitis, than participants from high-income countries. Overall, a great number of individuals from every income group required maintenance or urgent care. CONCLUSION: Oral health problems are not exclusive to low-income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high-income countries may be attributed to the high proportion of participants from the United States, which is considered a high-income country but has large income disparities. Health-determining circumstances in low-income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes.

Obesity is associated with an increase in pharmaceutical expenses among university employees.

OBJECTIVE: To examine costs associated with obesity in an employee population and factors associated with increased costs. METHODS: We used data from the Physical Activity and Life Style (PALS) study, a randomized prospective design evaluating three interventions to increase physical activity among physically inactive nonfaculty university employees (n = 454). The primary exposure variable, obesity (measured by body mass index), was obtained from the in-person baseline survey. Covariates were obtained from the baseline survey and included demographic characteristics and health status. Data from the baseline survey was linked with administrative data to determine pharmaceutical, inpatient, outpatient, and total health care costs for three years. Average monthly expenditures for obese and nonobese individuals were compared using t-tests and a two-part multivariate regression model adjusted for demographic and socioeconomic characteristics and health behaviors. RESULTS: Although in-patient and outpatient expenses were not associated with obesity, pharmaceutical expenditures were $408 or 87.2% higher per year ($468 versus $876) for obese individuals than for nonobese individuals, which reflected poorer health behaviors and health status of obese adults. CONCLUSION: Awareness of the costs associated with obesity among employees can stimulate employers to make the investment in providing employer-sponsored wellness and health improvement programs to address obesity.

A holistic school-based intervention for improving health-related knowledge, body composition, and fitness in elementary school students: an evaluation of the HealthMPowers program.

BACKGROUND: Over the past 30 years, obesity in the United States has increased twofold in children and threefold in adolescents. In Georgia, nearly 17% of children aged 10 - 17 are obese. In response to the high prevalence of child obesity in Georgia and the potential deleterious consequences that this can have, HealthMPowers was founded in 1999 with the goal of preventing childhood obesity by improving health-enhancing behaviors in elementary schools, utilizing a holistic three-year program. This study measures the effectiveness of the HealthMPowers program in improving the school environment, student knowledge, behavior, cardiovascular fitness levels, and Body Mass Index (BMI). METHODS: The present analysis utilizes data from 40 schools that worked with HealthMPowers over the course of the 2012 - 2013 school year (including schools at each of the three years of the intervention period) and provided information on demographics, student knowledge and behaviors, BMI, performance on the PACER test of aerobic capacity, and school practices and policies (measured via school self-assessment with the HealthMPowers-developed instrument "Continuous Improvement Tracking Tool" or CITT), measured at the beginning and end of each school year. Paired two-sample T tests were used to compare continuous variables (e.g., student knowledge scores, BMI-for-age Z scores), while chi-squared tests were used to assess categorical variables (e.g., trichotomized PACER performance). RESULTS: Students across all grades and cohorts demonstrated improvements in knowledge and self-reported behaviors, with particularly significant improvements for third-graders in schools in the second year of the HealthMPowers program (p < 0.0001). Similarly, decreases were observed in BMI-for-Age Z scores for this cohort (and others) across grades and gender, with the most significant decreases for students overweight or obese at baseline (p < 0.0005). Students also showed significant increases in performance on the PACER test across grades and cohorts (p < 0.0001). Lastly, schools tended to improve their practices over time, as measured via the CITT instrument. CONCLUSIONS: The present report demonstrates the effectiveness of the HealthMPowers program in producing positive change in school policies and practices, student knowledge and behaviors, and student fitness and BMI, supporting the use of holistic interventions to address childhood obesity.

Impact of personal preference and motivation on fruit and vegetable consumption of WIC-participating mothers and children in Atlanta, GA.

OBJECTIVE: To determine the effect of psychosocial and sociodemographic factors on consumption of fruits and vegetables (F&V) for women and children participating in the Atlanta Special Supplemental Nutrition Program for Women, Infants, and Children. METHODS: Participants (n = 249) were selected from 2 Atlanta Special Supplemental Nutrition Program for Women, Infants, and Children agencies. Data from this analysis were collected from in-person interviews. The dichotomous dependent variable was whether participants met recommended intakes for F&V. Independent variables were personal preference and motivation factors of F&V consumption, and sociodemographic factors. Bivariate analysis determined significant factors to include in logistic models. RESULTS: Only 27.7% of mothers and 44.2% of their oldest child consumed > 5 servings of F&V daily. Not knowing how to prepare F&Vs and spoilage of F&V before eating them were significantly related to F&V consumption of mothers. CONCLUSIONS AND IMPLICATIONS: Food storage and preparation resulted in significant differences in meeting criteria for F&V consumption. Future initiatives should include cooking classes and emphasize food preparation techniques.