Teachers' Experiences Implementing a School Wellness Initiative in Anchorage, AK: A Qualitative Study.

BACKGROUND: Teachers are uniquely poised to support students' healthy eating habits and physical activity. However, research is needed to examine the successes and challenges teachers face when implementing a school wellness initiative. The purpose of this study was to examine teachers' experiences implementing and managing a pilot school wellness initiative where students had longer lunch and recess, and more physical activity throughout the day. STATISTICAL ANALYSIS: Using a grounded theory approach, transcripts were analyzed qualitatively using principles of content analysis to identify themes and domains. Application of the codes and interrater reliability were conducted with a trained research assistant. METHODS: Focus groups were conducted to understand the challenging and successful experiences of teachers as they implemented and managed a school wellness initiative. The participants were teachers (N = 39) from six purposively selected elementary schools participating in a school wellness initiative. Focus groups were conducted in-person at participating schools. RESULTS: Teachers observed calmer students who ate more lunch with longer lunch periods. In addition, teachers observed improved focus in the classroom and fewer behavior issues with more physical activity opportunities. Successful strategies included reversing lunch and recess and implementing physical activity into daily lessons. However, some teachers had difficulty managing the extra time in the cafeteria and scheduling physical activity throughout the day, particularly in schools where administrators were not as supportive of the initiative. In the schools with greater administrative buy-in and support, teachers had easier, more positive experiences implementing the wellness initiative. CONCLUSIONS: School wellness initiatives in which teachers play a large role have the potential to support teachers and students. This study found that teachers value student health and understand students need to be nourished to learn, but teachers' experiences suggest they need support and buy-in from their administrators to be successful.

A Mixed-Methods Evaluation of a School Wellness Initiative: An Examination of Longer Lunch Periods and More Physical Activity Opportunities.

BACKGROUND: There are currently no national standards for lunch period lengths or physical activity in schools. Research is needed to better understand the impact of school initiatives that improve policies related to lunch and movement opportunities on student outcomes. Additionally, best practices are necessary to support schools that are considering initiatives that address these factors. OBJECTIVE: This study examined the impact of implementing longer lunch periods, recess, and other movement opportunities on student outcomes and best practices for implementation. DESIGN: A mixed-methods study including surveys and semistructured interviews and focus groups conducted during the 2019-2020 school year. PARTICIPANTS/SETTING: Surveys (n = 5107) from students in grades 3 and 4 attending 19 pilot and 11 matched control elementary schools and interviews/focus groups among principals, cafeteria managers, teachers, and parents in a representative subsample (n = 6) of pilot schools in Anchorage Alaska. MAIN OUTCOME MEASURES: Students' self-reported hunger levels and mood and perceptions and supportive strategies from school principals, cafeteria staff, teachers, and parents were examined. STATISTICAL ANALYSES PERFORMED: Mixed-model analysis of variance accounting for student demographics with students as a random effect (students nested within schools) were used to examine differences in hunger and mood. For interviews/focus groups, responses were analyzed qualitatively using principles of content analysis. RESULTS: Longer lunch periods were associated with significantly reduced hunger at the end of lunch period and significantly increased self-reported happiness in the cafeteria. Based on interviews/focus groups with school staff and parents, the initiative was generally perceived positively with reported benefits including reductions in disciplinary issues and improvements in student focus, social and emotional learning, and overall student happiness and well-being. Several supportive strategies were identified. CONCLUSIONS: Initiatives that increase lunch period lengths and physical activity opportunities have the potential to reduce students' hunger levels and improve focus and behaviors in the classroom. Schools should consider similar initiatives that incorporate the suggested strategies to potentially improve outcomes among students.

Complementary and alternative medicine use among persons with multiple chronic conditions: results from the 2012 National Health Interview Survey.

BACKGROUND: Although a quarter of Americans are estimated to have multiple chronic conditions, information on the impact of chronic disease dyads and triads on use of complementary and alternative medicine (CAM) is scarce. The purpose of this study is to: 1) estimate the prevalence and odds of CAM use among participants with hypercholesterolemia, hypertension, diabetes, and obesity; and 2) examine the effects of chronic condition dyads and triads on the use of CAM modalities, specifically manipulative and body-based methods, biological treatments, mind-body interventions, energy therapies, and alternative medical systems. METHODS: Data were obtained from the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement. Statistical analyses were restricted to persons with self-reported hypercholesterolemia, hypertension, diabetes, or obesity (n = 15,463). RESULTS: Approximately 37.2% of the participants had just one of the four chronic conditions, while 62.4% self-reported multiple comorbidities. CAM use among participants was as follows (p < 0.001): hypercholesterolemia (31.5%), hypertension (28.3%), diabetes (25.0%), and obesity (10.8%). All combinations of disease dyads and triads were consistently and significantly associated with the use of mind-body interventions (2-4%, p < 0.001). Two sets of three dyads were associated with use of manipulative methods (23-27%, p < 0.05) and energy therapies (0.2-0.3%, p < 0.05). Use of biological treatments (0.04%, p < 0.05) and alternative systems (3%, p < 0.05) were each significant for one dyad. One triad was significant for use of manipulative methods (27%, p < 0.001). CONCLUSIONS: These findings point to future directions for research and have practical implications for family practitioners treating multimorbid patients.

Complementary and Alternative Medicine Use by Normal Weight, Overweight, and Obese Patients with Arthritis or Other Musculoskeletal Diseases.

OBJECTIVES: The Centers for Disease Control and Prevention estimates that 50 million Americans have been diagnosed with arthritis and other musculoskeletal diseases. The purpose of the current study was to (1) estimate the prevalence of overall complementary and alternative medicine (CAM) use and (2) examine the role of body mass index (BMI) on CAM use among normal weight, overweight, and obese persons with chronic lower back pain, chronic neck pain, chronic/rheumatoid arthritis, or musculoskeletal diseases, while controlling for other covariates. DESIGN: Cross-sectional design using secondary data for 9724 adults from the 2007 National Health Interview Survey. Data were weighted and analyzed by using Stata 12 for Windows (Stata Corp., College Station, TX). Descriptive, bivariate, and multivariate logistic regression statistics were computed. PARTICIPANTS: The participants were randomly surveyed from U.S. households. OUTCOME MEASURES: CAM use was measured as reported use of any modality within the five National Center for Complementary and Integrative Health domains. RESULTS: CAM use was statistically significantly associated with female sex; race/ethnicity; having chronic neck pain, lower back pain, or chronic/rheumatoid arthritis; having limitations due to chronic disease; and geographic region (p < 0.05). Factors significantly associated with decreased odds of CAM use included age 50-64 years, income categorized as "other/missing," and having musculoskeletal diseases. Stratification by body mass index suggested increased odds of CAM use among normal/underweight persons with chronic neck pain but decreased odds for those with chronic musculoskeletal diseases. For overweight patients, increased odds of CAM use were significant for chronic lower back pain, musculoskeletal diseases, and chronic/rheumatoid arthritis. CONCLUSIONS: Musculoskeletal diseases and arthritis represent important public health problems with economic implications for the well-being of individuals and society. Identifying CAM use trends by patient weight can be used to improve strategies to increase awareness and access to CAM as part of comprehensive and cost-effective approaches for the management and treatment of these conditions.

Internet use and misuse. Preliminary findings from a new assessment instrument.

The internet is an affordable and easily accessible technology that has many potential applications to psychology. Interactive technologies engage users psychologically and may facilitate adaptive and maladaptive behaviors. This research explored the Internet-use patterns, psychological characteristics, and negative consequences associated with online activities of 393 college students using the Internet Use Survey (IUS), a self-report instrument designed to administer online. Results indicated that participants spent an average of 3.3 total hours per day on the Internet during the past 12 months and used the medium for multiple purposes. Although participants reported the occurrence of some potentially negative consequences related to Internet use, the prevalence rates for most problematic behaviors were generally low. Exploratory principal component analysis of the IUS subscale that attempts to measure Internet-related impairment revealed four factors: absorption, negative consequences, disrupted sleep, and deception. All of these factors were then significantly related to a measure of boredom proneness. This research supports the necessity for multidimensional assessment (e.g., frequency and context) of Internet usage to enhance our understanding of how this new technology interfaces with users psychologically and behaviorally.