Development, Applications, and Refinement of the Family Nutrition and Physical Activity (FNPA) Child Obesity Prevention Screening.

Concerns regarding the continued high prevalence of childhood overweight and obesity have created a need for proactive approaches to behavior change. The Family Nutrition and Physical Activity (FNPA) screening tool was developed for research and clinical use to identify home environments and behaviors that could predispose youth to increased weight. FNPA scores have been shown to correlate with body mass index (BMI) percentiles in first-grade students and to predict unique variance in change in BMI percentiles from first to second grade. The FNPA has been used for family behavior counseling and is now a standard component of well-child visits throughout the Geisinger Health System in Pennsylvania. Parents complete the FNPA prior to annual visits, and providers can discuss areas of concern based on screening results. Children of parents who complete the FNPA have shown smaller increases in BMI z-scores over the following year than children of parents who did not complete the FNPA. The FNPA is also used to inform the arrangement of family-centered obesity treatment for children. Recently, the FNPA has undergone a systematic update to ensure its continued relevance and utility. The updated tool is provided, and current and future users can access more information about the tool at myfnpa.org.

Comparison of In-Person and Online Motivational Interviewing-Based Health Coaching.

Health coaching is a common approach for promoting lifestyle changes, but little is known about the effectiveness of different delivery methods. The purpose of this study was to evaluate the effectiveness of in-person versus online health coaching when used as part of a facilitated behavior change program. To increase translatability, the study used a naturalistic design that enabled participants to self-select the coaching delivery method (Group) as well as the target behavior (diet, physical activity, or weight management). Regardless of group, participants were provided with a behavior-based monitoring device and guided to use it by the health coach. A sample of 92 adults participated and 86 completed pre-post evaluations to assess behavior change strategies and posttest outcome measurements for their specific goal. Two-way (Group × Time) analyses of variance were used to evaluate changes in behavioral strategies. Intent-to-treat regression analyses were used to compare postintervention outcomes for groups. The in-person group had significantly higher Healthy Eating Index scores than the online group ( p < .05), but nonsignificant group differences were observed for those targeting physical activity or weight change ( p > .05). The results support the use of health coaching for promoting behavior change and suggest that online coaching may be equally effective as in-person methods.

Relationships between County Health Rankings and child overweight and obesity prevalence: a serial cross-sectional analysis.

BACKGROUND: The County Health Rankings (CHR) system provides health rankings for U.S. counties. These factors may have utility for evaluating and predicting health outcomes. This study examined the association between CHR factors and the prevalence of child overweight/obesity (OWOB) in the state of Pennsylvania over 3 years. METHODS: The prevalence of childhood OWOB was obtained for all Pennsylvania school districts for the 2009-10 through 2011-12 school years. Correlational and inferential statistical analyses were used to examine the associations between the prevalence of OWOB in grades K-6 (OWOB1) and 7-12 (OWOB2) and z-score for the overall CHR Health Factors rank, as well as for individual predictive factors (Health Behaviors, Clinical Care, Social and Economic Factors and Physical Environment). RESULTS: Low to moderate correlations (0.29-0.43) were found between OWOB1 and CHR factors. Weaker and less consistent correlations were found for adolescents. There was a significantly higher prevalence of OWOB in counties with poorer CHR scores. CONCLUSIONS: County-level adult indicators of health are significantly associated with levels of child obesity. Future studies should examine the relationship between CHR and other health outcomes.

A first look at perceived stress in southeastern university students during the COVID-19 pandemic.

Objective: Shelter-in-place and social distancing reduce the risk of infection spread, but evidence is appearing to support an unintentional spread of negative mental health effects. The aim of this study was to assess perceived stress in a sample of undergraduate students reflecting upon Spring 2020. Participants and methods: Undergraduate students (N = 312, 75% female, 88% white) completed an online survey assessing demographic information and stress assessed via Cohen's Perceived Stress Scale. Results: Student respondents averaged PSS scores of 21.31(7.54) with 82% of students classified as having moderate or high perceived stress. Females reported higher perceived stress scores compared to males (Z = 4.89, p < 0.01). Conclusions: With concerns about enrollment and financial viability of universities, funneling limited funds to student mental health services could be a utilization of universities' limited funds during Fall 2020.

The relationship between physical activity, stress, and resilience in sexual and gender minority college students.

OBJECTIVE: To assess the role of sexual orientation and gender identity in the relationship between physical activity (PA), stress and resilience. PARTICIPANTS: A nationally-representative sample of students (n = 91,718) from United States postsecondary institutions. METHODS: Students reported aerobic and strength training (ST) behaviors, stress, resilience, gender identity and sexual orientation. Moderated regressions examined the influence of gender identity and sexual orientation on the relationship between PA and stress or resilience. RESULTS: Men and heterosexual students reported higher PA and resilience and lower stress than did women, gender minorities, and sexual minorities. Significant moderation was found for women, queer students, bisexual students, trans women and lesbians in the various models. CONCLUSIONS: Gender minority and sexual minority students display poorer levels of PA and mental health than cisgender and heterosexual counterparts, but this relationship varies by identity group.

Gender differences in stress, resilience, and physical activity during the COVID-19 pandemic.

Objective: To evaluate gender differences in physical activity (PA), stress and resiliency during the COVID-19 pandemic. Participants: Students (n = 300) at a southeastern US university. Methods: Perceived Stress (PSS), Resiliency (BRS), Life Events (LEI), and PA were recorded via online survey in Summer 2020. PSS, BRS, LEI, and PA were compared between males and females. Two-way ANOVAs examined gender and frequency effects on PSS and BRS. Results: Females had lower BRS and higher PSS and LEI scores than males (all p < .001). PSS/BRS scores were more strongly correlated with PA in males. Significant gender × frequency interactions were found for PSS (vigorous, p = .03) and for BRS (moderate, p = .049). There was a significant main effect of frequency for PSS with strength training (p < .001). Conclusions: Results suggest that interventions may be particularly needed for females and those with low PA levels.

Changes in dual-task cognitive performance elicited by physical exertion vary with motor task.

Background: Integrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes. Purpose: Assess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol. Methods: 34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance. Results: There was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3-1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64). Conclusion: Participants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.

Physiological characteristics of National Collegiate Athletic Association Division I ice hockey players and their relation to game performance.

Previous ice hockey research has focused on physiological profiles and determinants of skating speed, but few studies have examined the association of preseason player evaluations with a measure of season-long performance. Understanding which tests are most predictive of player performance could help coaches organize practice and training more effectively. The purpose of this study was to describe physical characteristics and skill levels of 24 members of an NCAA Division I men's ice hockey team and relate them to game performance over the course of a season as measured by plus/minus (+/-) score. Subjects performed a battery of preseason tests including treadmill maximal aerobic capacity, body fat, leg press, push-ups, bench press, chin-ups, and sprinting ability both on and off ice. Pearson and Spearman correlations were used to examine correlations between preseason measures and +/- score. One coach also subjectively grouped the top and bottom 6 players, and analysis of variance was used to examine any differences in preseason measures and +/- score between these 2 groups. Leg press, chin-ups, bench press, and repeat sprint performance were significantly correlated with +/- score (r = 0.554, 0.462, 0.499, and -0.568, respectively). Teams with limited time and resources may choose to perform these tests to evaluate player potential efficiently. Only +/- score differed between top and bottom players suggesting that +/- accurately reflected the coach's perception of player success in this sample.

Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults' Activity Levels: Randomized Intervention.

BACKGROUND: While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. OBJECTIVE: This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. METHODS: A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. RESULTS: Regression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=-.49, P=.01) and lack of previous experience with pedometers (beta=-.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). CONCLUSIONS: This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT03837366; https://clinicaltrials.gov/ct2/show/NCT03837366.

Construct Validity of an Obesity Risk Screening Tool in Two Age Groups.

Home environment influences child health, but the impact varies as children move into adolescence. The Family Nutrition and Physical Activity (FNPA) screening tool has been used to evaluate home environments, but studies have not compared the utility of the tool in different age groups. The purpose of this study was to examine the efficacy of the FNPA tool in first and tenth grade samples. Parents of first grade (n = 250) and tenth grade (n = 99) students completed the FNPA and results were linked to body mass index (BMI) data. FNPA scores were examined by gender, income, race, and school-level socioeconomic status (SES). Correlations examined associations between FNPA scores and several BMI indicators. Logistic and linear regression analyses evaluated the construct validity of the FNPA in both groups. Mean FNPA score differed by age group, by SES in both age groups, and by race in the first grade sample only. Correlations between FNPA score and BMI indicators were higher in the first grade sample, but SES was significantly associated with BMI only in tenth graders. The FNPA has stronger utility in younger children, while school SES is a stronger predictor of adolescent weight status.

Comparative effectiveness of guided weight loss and physical activity monitoring for weight loss and metabolic risks: A pilot study.

Many consumer-based physical activity monitors (PAMs) are available but it is not clear how to use them to most effectively promote weight loss. The purpose of this pilot study was to compare the effectiveness of a personal PAM, a guided weight loss program (GWL), and the combination of these approaches on weight loss and metabolic risk. Participants completed the study in two cohorts: Fall 2010 and Spring 2011. A sample of 72 obese individuals in the Ames, IA area were randomized to one of 3 conditions: 1) (GWL, N = 31), 2) PAM, N = 29, or 3) a combination group (PAM + GWL, N = 29). Weight and metabolic syndrome score (MetS), computed from waist circumference (WC), BMI, blood pressure (BP), and lipids were assessed at baseline and following an 8-week intervention. Weight was also assessed four months later. Two-way (Group × Time) ANOVAs examined intervention effects and maintenance. Effect sizes were used to compare magnitude of improvements among groups. During the intervention, all groups demonstrated significant improvements in weight and MetS (mean weight loss = 4.16 kg, p < 0.001). Mean weight continued to decline modestly during follow-up, with average weight loss of 4.82 kg from baseline (p < 0.01). There were no group differences for weight loss but the PAM + GWL group had significantly larger changes in MetS score (d = 0.06-0.77). The use of PAM resulted in significant improvements in weight and MetS that were maintained across a four-month follow-up. Evidence suggests that the addition of GWL contributed to enhanced metabolic outcomes.

Effects of Enhancing School-Based Body Mass Index Screening Reports with Parent Education on Report Utility and Parental Intent To Modify Obesity Risk Factors.

BACKGROUND: School-based body mass index screenings (SBMIS) have been controversial. We aimed to determine if parents would indicate improved utility with SBMIS when the report included parent education and whether parental intent to modify obesity risk factors would vary with report type or child weight. METHODS: A cluster-controlled trial was conducted with 31 elementary schools randomized to distribute a standard SBMIS report or the standard report plus education (SBMIS+). A random subsample of parents completed a mailed survey (731 SBMIS, 738 SBMIS+). Using a two-stage cluster sampling design, logistic regression models with school-level random effect were used to assess differences between conditions and by weight category. RESULTS: Parents in the SBMIS+ condition vs. the standard condition were more likely to indicate that the report provided useful information (not significant) and an intent to help their child get enough sleep (p < 0.001). Parents of children who were overweight or obese were less likely than parents of children who were not to indicate that the report provided useful information about their child's weight status (p < 0.001) or access to resources (p < 0.05). However, these parents were more likely to plan a visit to healthcare provider (p < 0.001) and to intend to limit sugar-sweetened beverages (p < 0.05). CONCLUSIONS: Parental education can enhance the utility of the SBMIS report and parental intention to modify at least one obesity risk factor. SBMIS reports prompted parents of children with overweight and obesity to seek clinical care and limit sugar-sweetened drinks.

Energy Cost of Children's Structured and Unstructured Games.

BACKGROUND: Limited data are available on energy cost of common children's games using measured oxygen consumption. METHODS: Children (10.6 ± 2.9 years; N = 37; 26 male, 9 female) performed a selection of structured (bowling, juggling, obstacle course, relays, active kickball) and unstructured (basketball, catch, tennis, clothespin tag, soccer) activities for 5 to 30 minutes. Resting metabolic rate (RMR) was calculated using Schofield's age- and sex-specific equation. Children wore a portable metabolic unit, which measured expired gases to obtain oxygen consumption (VO2), youth METs (relative VO2/child's calculated RMR), and activity energy expenditure (kcal/kg/min). Descriptive statistics were used to summarize data. RESULTS: Relative VO2 ranged from 16.8 ± 4.6 ml/kg/min (bowling) to 32.2 ± 6.8 ml/kg/min (obstacle course). Obstacle course, relays, active kickball, soccer, and clothespin tag elicited vigorous intensity (>6 METs), the remainder elicited moderate intensity (3-6 METs). CONCLUSIONS: This article contributes energy expenditure data for the update and expansion of the youth compendium.

Factors associated with parent concern for child weight and parenting behaviors.

BACKGROUND: A parent's perception about their child's overweight status is an important precursor or determinant of preventative actions. Acknowledgment of, and concern for, overweight may be moderated by the parent's own weight status whereas engaging in healthy behaviors at home may promote healthy weight status. It is hypothesized that normal weight parents are more likely to engage in healthy behaviors and acknowledge overweight in their own children whereas heavier parents may report more concern about child weight. METHODS: A total of 1745 parents of first- through fifth-grade students completed a questionnaire assessing reactions to a school BMI report and perceptions about BMI issues. Specific items included perceptions of child's weight status, concern for child weight status, and preventive practices. Parents also provided information about their own weight status. Relationships between measured child weight, perceived child weight, parent weight, parent concern, and healthy behaviors were examined. RESULTS: Overweight parents were more likely to identify overweight in their child and report concern about their child's weight. Concern was higher for parents of overweight children than of normal weight children. Normal weight parents and parents of normal weight children reported more healthy behaviors. CONCLUSIONS: Results support the hypothesis that normal weight parents are more likely to engage in healthy behaviors and that overweight parents are more likely to report concern about child weight. However, overweight parents are also more likely to acknowledge overweight status in their own child. Future research should examine links between parent concern and actual pursuit of weight management assistance.

The relationship among HRpeak, RERpeak, and VO2peak during treadmill testing in girls.

Clear criteria for maximal oxygen consumption (VO2max) determination in youth are not available, and no studies have examined this issue in girls. Our purpose was to determine whether different peak heart rate (HRpeak) and peak respiratory exchange ratio (RERpeak) cut points affect girls' (N = 453; M age = 13.3 years, SD = .1) VO2max during a maximal treadmill test. A multivariate analysis of variance revealed VO2max (ml kg(-1) min(-1) differed significantly among HRpeak, 180-189 b min(-1) = 34 (SD = .8), 190-194 bmin(-1) = 35 (SD = .9), 195-199 b min(-1) = 38 (SD = .8), 200-204 b min(-1) = 40 ml kg1 x min(-1) (SD = .8), and > or = 205 bmin(-1) = 42 ml kg1 x min(-1) (SD = .7) but not RERpeak. In studies where evidence of a VO2 plateau was examined, peak oxygen consumption (VO2peak) did not differ between plateau and no-plateau groups. Although our results suggest the association between lower VO2peak and lower peak heart rate is a true cardiovascular limit to aerobic energy production, we cannot rule out participant effort.