Use of the Nutrition Environment Measures Survey: A Systematic Review.

INTRODUCTION: The Nutrition Environment Measurement Survey (NEMS) measures were developed to assess the consumer food environment in stores and restaurants. NEMS tools have been widely used in research and adapted for diverse settings and populations in the 15 years since they were created. This systematic review examines the use and adaptations of these measures and what can be learned from published studies using NEMS tools. METHODS: A comprehensive search of bibliographic databases was conducted from 2007 to September 2021, supplemented by backward searches and communications with authors, to identify research articles using NEMS tools. Data on purpose, key findings, sample characteristics, NEMS characteristics, and modifications were abstracted. Articles were categorized on the basis of study goals, NEMS tool(s) used, variables measured, and common themes. RESULTS: A total of 190 articles from 18 countries were identified. Most studies (69.5%, n=123) used a modified version of NEMS tools. There were 23 intervention studies that used measures from NEMS tools or adaptations as outcomes, moderators, or process assessments. A total of 41% (n=78) of the articles evaluated inter-rater reliability, and 17% (n=33) evaluated test-retest reliability. DISCUSSION: NEMS measures have played an important role in the growth of research on food environments and have helped researchers to explore the relationships among healthy food availability, demographic variables, eating behaviors, health outcomes, and intervention-driven changes in food environments. The food environment is constantly changing, so NEMS measures should continue to evolve. Researchers should document data quality of modifications and use in new settings.

Earlier bedtimes and more sleep displace sedentary behavior but not moderate-to-vigorous physical activity in adolescents.

OBJECTIVES: Correlational models suggest increased cardiometabolic risk when sleep replaces moderate-to-vigorous (but not sedentary or light) physical activity. This study tested which activity ranges are impacted by experimentally altering adolescents' bedtime. METHOD: Adolescents completed a 3-week within-subjects crossover experiment with 5 nights of late bedtimes and 5 nights early bedtimes (6.5- and 9.5-hours sleep opportunity, respectively). Experimental condition order was randomized. Waketimes were held constant throughout to mimic school start times. Sleep and physical activity occurred in the natural environments, with lab appointments following each 5-day condition. Waist-worn accelerometers measured physical activity and sedentary behavior. Wrist-worn actigraphs confirmed sleep condition adherence. Wilcoxon tests and linear mixed effects models compared waking activity levels between conditions and across time. RESULTS: Ninety healthy adolescents (14-17 years) completed the study. When in the early (vs. late) bedtime condition, adolescents fell asleep 1.96 hours earlier (SD = 1.08, d = 1.82, p < .0001) and slept 1.49 hours more (SD = 1.01, d = 1.74, p < .0001). They spent 1.68 and 0.32 fewer hours in sedentary behavior (SD = 1.67, d = 1.0, p < .0001) and light physical activity (SD = 0.87, d = 0.37, p = .0005), respectively. This pattern was reflected in increased proportion of waking hours spent in sedentary and light activity. Absolute and proportion of moderate-to-vigorous physical activity did not differ between conditions (d = 0.02, p = .89; d = 0.14, p = .05, respectively). CONCLUSIONS: Inducing earlier bedtimes (allowing for healthy sleep opportunity) did not affect moderate-to-vigorous physical activity. Alternatively, later bedtimes (allowing for ≤ 6.5 hours of sleep opportunity, mimicking common adolescent school night sleep) increased sedentary behavior. Results are reassuring for the benefits of earlier bedtimes.

Strategic Priorities for Physical Activity Surveillance in the United States.

PURPOSE: Develop strategic priorities to guide future physical activity surveillance in the United States. METHODS: The Centers for Disease Control and Prevention and the American College of Sports Medicine convened a scientific roundtable of physical activity and measurement experts. Participants summarized the current state of aerobic physical activity surveillance for adults, focusing on practice and research needs in three areas: 1) behavior, 2) human movement, and 3) community supports. Needs and challenges for each area were identified. At the conclusion of the meeting, experts identified one overarching strategy and five strategic priorities to guide future surveillance. RESULTS: The identified overarching strategy was to develop a national plan for physical activity surveillance similar to the U.S. National Physical Activity Plan for promotion. The purpose of the plan would be to enhance coordination and collaboration within and between sectors, such as transportation and public health, and to address specific strategic priorities identified at the roundtable. These strategic priorities were used 1) to identify and prioritize physical activity constructs; 2) to assess the psychometric properties of instruments for physical activity surveillance; 3) to provide training and technical assistance for those collecting, analyzing, or interpreting surveillance data; 4) to explore accessing data from alternative sources; and 5) to improve communication, translation, and dissemination about estimates of physical activity from surveillance systems. CONCLUSION: This roundtable provided strategic priorities for physical activity surveillance in the United States. A first step is to develop a national plan for physical activity surveillance that would provide an operating framework from which to execute these priorities.

A randomized clinical trial comparing delivery of behavioral pediatric obesity treatment using standard and enhanced motivational approaches.

OBJECTIVE: To examine the efficacy of an adjunct motivational and autonomy-enhancing intervention (self-directed) for behavioral family-based pediatric obesity relative to the standard prescription of uniform behavioral skills use and interventionist goal assignment (prescribed). METHODS: In this randomized clinical trial, 72 overweight/obese children and their parents/caregivers were assigned to either self-directed or prescribed intervention for 20 weeks, with approaches diverging after week 5. Anthropometric measurements from child and participating parent at baseline, posttreatment, and 3-month, 6-month, 1-year, and 2-year follow-ups were evaluated for change (n = 59 in follow-up analyses). RESULTS: The approaches demonstrated similar child body mass index (BMI) z-score and parent BMI change from baseline to posttreatment and throughout follow-up, with child and parent weight status lower than baseline at 2 years after treatment cessation. CONCLUSIONS: An adjunct motivational and autonomy-enhancing approach to behavioral family-based pediatric obesity treatment is a viable alternative to the standard intervention approach.

Societal values and policies may curtail preschool children's physical activity in child care centers.

BACKGROUND AND OBJECTIVES: Three-fourths of US preschool-age children are in child care centers. Children are primarily sedentary in these settings, and are not meeting recommended levels of physical activity. Our objective was to identify potential barriers to children's physical activity in child care centers. METHODS: Nine focus groups with 49 child care providers (55% African American) were assembled from 34 centers (inner-city, suburban, Head Start, and Montessori) in Cincinnati, Ohio. Three coders independently analyzed verbatim transcripts for themes. Data analysis and interpretation of findings were verified through triangulation of methods. RESULTS: We identified 3 main barriers to children's physical activity in child care: (1) injury concerns, (2) financial, and (3) a focus on "academics." Stricter licensing codes intended to reduce children's injuries on playgrounds rendered playgrounds less physically challenging and interesting. In addition, some parents concerned about potential injury, requested staff to restrict playground participation for their children. Small operating margins of most child care centers limited their ability to install abundant playground equipment. Child care providers felt pressure from state mandates and parents to focus on academics at the expense of gross motor play. Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity. CONCLUSIONS: Societal priorities for young children--safety and school readiness--may be hindering children's physical development. In designing environments that optimally promote children's health and development, child advocates should think holistically about potential unintended consequences of policies.