Combined action observation and mental imagery versus neuromuscular electrical stimulation as novel therapeutics during short-term knee immobilization.

Limb immobilization causes rapid declines in muscle strength and mass. Given the role of the nervous system in immobilization-induced weakness, targeted interventions may be able to preserve muscle strength, but not mass, and vice versa. The purpose of this study was to assess the effects of two distinct interventions during 1 week of knee joint immobilization on muscle strength (isometric and concentric isokinetic peak torque), mass (bioimpedance spectroscopy and ultrasonography), and neuromuscular function (transcranial magnetic stimulation and interpolated twitch technique). Thirty-nine healthy, college-aged adults (21 males, 18 females) were randomized into one of four groups: immobilization only (n = 9), immobilization + action observation/mental imagery (AOMI) (n = 10), immobilization + neuromuscular electrical stimulation (NMES) (n = 12), or control group (n = 8). The AOMI group performed daily video observation and mental imagery of knee extensions. The NMES group performed twice daily stimulation of the quadriceps femoris. Based on observed effect sizes, it appears that AOMI shows promise as a means of preserving voluntary strength, which may be modulated by neural adaptations. Strength increased from PRE to POST in the AOMI group, with +7.2% (Cohen's d = 1.018) increase in concentric isokinetic peak torque at 30°/s. However, NMES did not preserve muscle mass. Though preliminary, our findings highlight the specific nature of clinical interventions and suggest that muscle strength can be independently targeted during rehabilitation. This study was prospectively registered: ClinicalTrials.gov NCT05072652.

Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic.

Youth with autism spectrum disorder (ASD) demonstrate unhealthy eating behaviors and dietary patterns compared to their neurotypical counterparts. Given the increased risk of unhealthy weight gain and the onset of the COVID-19 pandemic, modified nutrition programs in this population are warranted. The authors independently conducted two virtual pilot interventions during COVID-19 that offered feasible and acceptable alternatives to in-person delivery, providing unique opportunities for participant engagement and family involvement. Future virtual nutrition education programs for adolescents with ASD may include visual and verbal aids through Zoom, more parent/family integration, and accommodations for those with varying ASD severity levels.

Feasibility of parents promoting fruit-infused water to reduce preschool children's sugar-sweetened beverage consumption.

Background: Increasing water and decreasing sugar-sweetened beverage (SSB) consumption in preschoolers provide a strategy to reduce lifelong obesity risks. Aim: To determine feasibility/acceptability and examine preliminary findings of an innovative intervention for preschooler parents to promote fruit-infused water (FIW) to decrease SSB intake. Methods: Fourteen parents of preschoolers completed a pre-intervention survey, attended a presentation with a FIW demonstration/taste-testing, received pitchers/strainers, cutting boards, and FIW recipes/instructions, and received 8 supportive text messages over one month. Feasibility/acceptability was determined from analyzing parents' responses about participating. Descriptive statistics were conducted to analyze pre-/post-intervention survey data. Results: Three themes emerged: "Healthy Option Alternative"; "Feasible to Make FIW at Home"; and "Benefits for Parents". Preliminary findings from ten parents completing both pre-/post-intervention surveys indicated a decrease in preschoolers' total SSB amount/kcal intake, and an increase in parent self-efficacy and FIW knowledge/consumption. Conclusion: Preliminary findings provide valuable feasibility/acceptability information to guide a larger future study.

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

PURPOSE: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset. METHODS: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status. RESULTS/FINDINGS: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively. CONCLUSIONS: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.

Effects of an 8-Week Judo Program on Behaviors in Children with Autism Spectrum Disorder: A Mixed-Methods Approach.

Prior studies suggest that a combination of physical activity and mind-body exercises, often seen in martial arts, may attenuate negative behaviors in youth with Autism Spectrum Disorder (ASD). Therefore, the aim of this study was to examine the effects of an 8-week judo program on behavioral factors in children with ASD, using a mixed-methods approach. A total of 25 children (ages 8-17), diagnosed with ASD, participated in an 8-week judo program (1 × week). Parents of participants were given the Aberrant Behavior Checklist (ABC) to compare the severity of ASD-related behavior at baseline and at the end of the program. A subset of parents (n = 9) participated in semi-structured interviews that focused on their child's behaviors during the judo program. Non-parametric paired t-tests were conducted to compare differences in the ABC scores from at baseline and at the end of the program. Interviews were coded independently by two trained researchers and categorized into behavioral themes. Participants attended an average of 7.04 ± 1.06 classes (out of 8 sessions). There were no significant changes in ABC scores, however, parent interviews revealed that 78% of parents observed improvements in both social skills and self-esteem as a result of the judo program. Despite no significant differences in ABC scores pre and post-judo, data from parent interviews indicate improvements in self-esteem and social skills. Future studies should further examine the effects of judo in a larger sample of youth with ASD, and include control conditions (e.g. no-exercise group) for comparison purposes.

The influence of friends and psychosocial factors on physical activity and screen time behavior in adolescents: a mixed-methods analysis.

(1) Determine the association between adolescent moderate-to-vigorous physical activity (MVPA) and screen time with their nominated friends' behaviors and (2) explore potential mechanisms of friends' social influences on MVPA and screen time. Participants consisted of 152 adolescents (mean age: 14.5 years, 53 % female, 50 % high school, 80 % Caucasian). MVPA was measured with an Actigraph GT3X+ accelerometer. Demographic and psychosocial variables were assessed via questionnaires. Participants nominated up to 5 friends who completed MVPA and screen time questionnaires. A subset of adolescents (n = 108) participated in focus groups that examined potential mechanism of friends' influence on MVPA and screen time. Multiple regression analysis examined the association of demographic, psychological, and nominated friend variables with participants' MVPA and screen time. NVivo 10.0 was used to analyze qualitative data. Greater levels of friends' MVPA was associated with greater levels of MVPA in both males (p < .0001) and females (p < .0001). Greater levels of friends' screen time was associated with greater levels of screen time in males (p = .04) while psychosocial variables, such as increased screen time enjoyment, were associated with increased screen time in females (p = .01). School level was not associated with either MVPA or screen time. Focus group data indicated that friends positively influenced participants' MVPA through engaging in activity with participants, verbal encouragement, and modeling of MVPA. All participants preferred to be active with friends rather than alone, however, females preferred activity with a close friend while males preferred to be active with a group. Enjoyment of MVPA was the most cited reason for engaging in MVPA with friends. The majority of participants reported friends not having an influence on screen time. Adolescents with active friends are more likely to be physically active and spend less time engaging in screen-based behaviors. Interventions to increase MVPA in youth could be designed to include the recruitment of friends to increase enjoyment of MVPA.

Comparison of the Effects of Stable and Dynamic Furniture on Physical Activity and Learning in Children.

We compared the effects of traditional (stable) and non-traditional (dynamic) school furniture on children's physical activity (PA), energy expenditure (EE), information retention, and math skills. Participants were 12 students (8.3 years, 58 % boys) in grades 1-5. Participants wore an Actigraph GT3X+ accelerometer (to assess PA), and an Oxycon Mobile indirect calorimetry device (to assess EE) for 40 min (20 min for each session). Each session consisted of a nutrition lecture, multiple choice questions related to the lecture, and grade-appropriate math problems. We used paired t tests to examine differences between the stable and dynamic furniture conditions. Average activity counts were significantly greater in the dynamic than the stable furniture condition (40.82 vs. 9.81, p < 0.05). We found no significant differences between conditions for average oxygen uptake (p = 0.34), percentage of nutrition questions (p = 0.5), or math problems (p = 0.93) answered correctly. Movement was significantly greater in the dynamic than the stable furniture condition, and did not impede information acquisition or concentration. Future studies should compare the long-term effects of traditional and dynamic furniture on health and academic outcomes in schools and other settings.

Sitting Less for Success: Reducing Sedentary Behaviors to Increase Kindergarten Achievement.

BACKGROUND: Physical activity (PA) improves outcomes, but disadvantaged children typically experience more sedentary behavior (SB). This study explored movement, executive function (EF) health, and academic achievement (AA) for economically disadvantaged kindergarteners. METHODS: Children in 2 classrooms (n = 16; n = 7) wore wrist-based accelerometers to assess PA/SB during the school day. Independent t-tests and analysis of variance analyzed mean group differences in PA/SB and EF/AA, and correlations explored AA and EF associations. RESULTS: The movement-based class spent significantly less time in SB compared to the contemporary class (t = 2.552, g = 1.115), made greater reading (t = -2.611) and math (t = .967) gains, and had better EF (t = .012). There were significant negative correlations between SB and math (r = -.534) and reading (r = -.592), but no significant relationships with EF. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools should consider methods to decrease time spent in SB at lower-SES schools, which is financially feasible and less time-consuming than programs to increase PA. CONCLUSION: Decreased SB time was associated with better AA. More research is needed to determine whether interventions to decrease time spent in SB at school improve academic outcomes in disadvantaged children.

Effects of a family judo program on sleep quality in youth with Autism Spectrum Disorder.

OBJECTIVE: The purpose of this study was to examine the effects of a family-based judo program on sleep quality in youth diagnosed with Autism Spectrum Disorder (ASD). METHODS: Eighteen youth (13.17 years ± 3.76, 78% male) diagnosed with ASD participated in a 14-week family judo program. Sleep quality was assessed using the Actigraph GT9X accelerometer pre- and post-judo intervention. Non-parametric paired t-tests were conducted to examine changes in sleep quality variables. RESULTS: There was a significant increase in sleep efficiency (p = .05), and a significant decrease in both sleep latency (p = .001) and wake after sleep onset (p = .02) following participation in the judo program. There were no changes in sleep duration observed in this sample (p = .83). CONCLUSION: Participation in a family judo program may improve sleep quality in youth with ASD. More research is necessary to understand the mechanisms by which judo may improve sleep quality in youth with ASD.

The physical and psychosocial benefits of a family judo program for parents of children with Autism Spectrum Disorder: A pilot study.

BACKGROUND: Parents of children with Autism Spectrum Disorder (ASD) tend to have high levels of stress and poor health habits. There is a lack of interventions that focus on improving health outcomes in parents of children with ASD. OBJECTIVE: To examine the physical and psychosocial effects of a family-based judo program on parents of children diagnosed with ASD. METHODS: This study utilized a pre-post single group design. Eighteen parent-child dyads participated in a 14-week judo program for families of children with ASD. Judo sessions were held once a week for 45 min. Parents wore wrist accelerometers to assess physical activity/sleep quality, and completed surveys regarding self-reported stress levels pre- and post-judo. Parents also completed open-ended questions regarding their experience in the program. Paired sample t-tests were conducted to examine changes in stress, physical activity, and sleep quality from pre-to post-program. RESULTS: Both a decrease in parental stress (47.77 vs. 41.61, p < 0.01) and an increase in minutes per day of physical activity (35.49 vs 45.94, p = 0.002) were observed from baseline to post-program. Fourteen of the 18 parents (78 %) reported at least one psychosocial benefit (e.g. increased self-confidence) or physical health benefit (e.g. increased physical activity) from participation in the program. CONCLUSIONS: A family judo program may provide health benefits, such as reducing stress levels and increasing physical activity in parents of children with ASD. Further research involving larger sample sizes is necessary to better determine the effects of judo on both parents and their children with ASD.

Sex differences in muscle-quality recovery following one week of knee joint immobilization and subsequent retraining.

This manuscript represents the second phase of a clinical trial designed to examine the effects of knee joint immobilization and retraining on muscle strength and mass. In Phase 2, we examined sex differences in the recovery of multiple indices of muscle quality after a resistance training-based rehabilitation program. Following 1 week of immobilization, 27 participants (16 males, 11 females) exhibiting weakness underwent twice weekly resistance training sessions designed to re-strengthen their left knee. Unilateral retraining sessions utilizing leg press, extension, and curl exercises were conducted until participants could reproduce their pre-immobilization knee extension isometric maximal voluntary contraction (MVC) peak torque. Post-immobilization, both sexes demonstrated impaired MVC peak torque (males = -10.8%, females = -15.2%), specific torque (-9.8% vs. -13.1%), echo intensity of the vastus lateralis (+6.9% vs. +5.9%) and rectus femoris (+5.9% vs. +2.1), and extracellular water/intracellular water ratio (+7.8% vs. +9.0%). The number of retraining sessions for peak torque to return to baseline for males (median = 1, mean = 2.13) versus females (median = 2, mean = 2.91) was not significantly different, though the disparity in recovery times may be clinically relevant. Following retraining, specific torque was the only muscle-quality indicator that improved along with MVC peak torque (males = 20.1%, females = 22.4%). Our findings indicate that measures of muscle quality demonstrate divergent recovery rates following immobilization, with muscle mass lagging behind improvements in strength. Greater immobilization-induced strength loss among females suggests that sex-specific rehabilitation efforts may be justified.

The role of psychosocial factors in the decision to enroll in physical education courses at the state college level.

OBJECTIVE: Physical education (PE) courses may provide young adults with opportunities to become active, however, enrollment in college PE courses remains low. PARTICIPANTS: This study examined psychosocial factors related to PE enrollment in a sample of 177 college students (29.4% completed a PE course). METHODS: Participants completed an online survey that inquired about demographic information, college PE enrollment, exercise self-efficacy, and several open-ended questions regarding their enrollment decisions. RESULTS: There were no differences in self-efficacy scores between PE completers and non-completers. PE completers had more positive previous experiences with PE (43.7% vs 19.3%, p < .01) while non-completers had more negative PE experiences (33% vs 12.5%, p = .03). PE completers felt that self-improvement (51.5% vs 21.3%, p < .01) was most important regarding decisions to enroll in a PE course, while non-completers were concerned with PE courses counting toward their degree (29.2% vs 9.1%, p = .02). CONCLUSIONS: These findings can help inform those involved in teaching and administration of PE courses at the state college level. Future research should further investigate how past PE experiences shape students' feelings toward PE.

An urban versus rural comparison of obesity between youth with and without autism spectrum disorder.

To examine obesity prevalence in youth with autism spectrum disorder (ASD) and neurotypical (NT) youth living in rural and urban areas. Data is from the 2019 National Survey of Children's Health, a national dataset that collected information on child health and well-being. Overweight/obesity status was based on parent/caregiver report of child height and weight. Urban and rural status was determined by whether children lived in/near a city. Chi-square tests were conducted to examine differences in obesity prevalence in youth with ASD and NT youth living in rural and urban areas. Overall, 43.9% of youth with ASD were overweight/obese compared to 30.6% of NT youth (p < 0.001). There was a significantly higher proportion of NT youth living in rural areas (36.44%) who were overweight/obese compared to urban NT youth (30.35%, p = 0.002). There were no significant differences in the proportion of overweight/obese youth with ASD living in rural areas (44.02%) compared to urban areas (44.44%, p = 0.96). Urban residence reduced the odds of overweight/obese compared to rural residence among NT youth (aOR = 0.77, 95%CI = 0.66-0.90) but urban/rural residence was not a significant factor in models for ASD youth (aOR = 1.25, 95%CI = 0.63-2.48). In contrast to NT youth, there were no differences in levels of overweight/obesity in youth with ASD living in rural areas compared to urban areas. Further research on how sociodemographic factors and geographic location affect obesity in youth with ASD is warranted.

The impact of health education on physical activity correlates in college students.

Objective To examine the effects of a 15-week, conceptually based university health/wellness course on moderate-to-vigorous physical activity (MVPA) levels, psychosocial factors, and health-related fitness knowledge (HRFK). Participants: 125 undergraduates enrolled during spring 2016 semester. Methods: Participants completed pre- and post-course surveys with questions on MVPA levels, exercise self-efficacy (SE), exercise motivation, and HRFK. Wilcoxon rank sum tests examined changes in SE, motivation, and HFRK. A multiple regression analysis examined associations among HRFK, psychosocial factors, and MVPA. Results: HRFK and MVPA increased from baseline to post-course assessment (p<.01). An increase in SE was associated with an increase in MVPA (p < 0.0001). Conclusions: Enrollment in a conceptually based health/wellness course may increase MVPA and HRFK in college students. Although the increase in SE post-course was not significant, it was associated with an increase in MVPA. These results support adoption of health/wellness programming to attenuate decreases in MVPA typically observed in college students.

Health behaviors, psychosocial factors, and academic engagement in youth with autism spectrum disorder: A latent class analysis.

The purpose of this study was to identify behavioral and health-related profiles of children with autism spectrum disorder (ASD), based on the 2016 National Survey of Children's Health. A sample of 894 children with ASD (weighted sample N = 768,181) were included in the analysis. All data were parent-reported and included measures on current diagnosis of ASD, general child health, weight status, physical activity (PA), screen time (ST), sleep duration, academic engagement, and social engagement. Latent class analysis, estimated with Mplus v. 8.4, was used to identify latent profiles of children with ASD. A three-profile solution was the best fitting model, per model fit criteria. Children in profile 1 had overall more positive attributes (better health and weight, PA, more engaged in school, little difficulty in making friends, and modest ST) relative to children in either profiles 2 or 3. Children in profile 2 had distinctly increased ST and more difficulty in making friends when compared with children in either other profile. A greater proportion of children in profiles 2 and 3 were receiving behavioral treatment compared to profile 1; however, no differences were observed among profiles according to ASD severity, medication status, or additional health conditions. Studies should examine causal mechanisms among health behaviors, academic achievement, and social engagement in youth with ASD.

The relationship between dietary inflammatory potential and cancer outcomes among cancer survivors: A systematic review and meta-analysis of cohort studies.

Cancer remains the second leading cause of death globally. Chronic inflammatory environments promote the growth of tumors, and the intake of certain food items can increase systemic inflammation. This study examined the relationship between the inflammatory potential of diet, measured by the Dietary Inflammatory Index (DII), and recurrence, all-cause, and cancer-specific mortality among cancer survivors. Web of Science, Medline, CINHAL, and PsycINFO databases were searched in April 2022. Two independent reviewers screened all searches. Of the 1,443 studies, 13 studies involving 14,920 cancer survivors passed all the screening stages. Three studies reported cancer recurrence, 12 reported all-cause mortality, and six reported cancer-specific mortality. Seven studies calculated DII from pre-diagnosis diets, five from post-diagnosis diets, and one from both pre-and post-diagnosis diets. A random-effects model meta-analysis showed that high DII was not associated with an increased risk of recurrence (HR = 1.09, 95 % CI = 0.77, 1.54, n = 4) and all-cause (HR = 1.08, 95 % CI = 0.99, 1.19, n = 14) and cancer-specific mortality (H = 1.07, 95 % CI = 0.92, 1.25, n = 6). Analysis by the timing of dietary assessment showed that only post-diagnosis DII was associated with an increased risk of all-cause mortality (HR = 1.34, 95 % CI = 1.05, 1.72, n = 6) by 34 %; however, cancer type did not modify these associations. The quality of the study assessed using the Newcastle Ottawa Scale indicated all but one studies were good. The risk of all-cause mortality among cancer survivors could be reduced by consuming more anti-inflammatory diets after cancer diagnosis.

Feasibility of a Remote-based Nutrition Education and Culinary Skills Program for Young Adults With Autism Spectrum Disorder.

OBJECTIVE: To evaluate the feasibility of a remote-based nutrition education and culinary skills program for young adults with autism spectrum disorder (ASD). METHODS: Thirteen young adults with ASD (26.6 ± 4.4 years; 77% male) participated in a remote-based nutrition program twice a week over 12 weeks. Principles of Social Cognitive Theory were used to develop the curriculum, which focused on nutrition education and meal preparation. Feasibility was assessed through attendance records, retention rates, duration/frequency of participant engagement, session notes, and participant interviews. RESULTS: The program had a 13% refusal rate and a 7% attrition rate. Participants had a session attendance rate of 83%. Session notes revealed that the remote format offered several methods of participant communication and captured evidence of family support. Interview themes included increased nutrition-related knowledge, self-efficacy, and behavioral capability. CONCLUSIONS AND IMPLICATIONS: The remote-based nutrition program met feasibility benchmarks for adherence and retention and was well-accepted by participants. A remote-based format for nutrition interventions can reach a wider range of young adults with ASD; however, input from the target population should be considered in the development of the program.

Brief Report: Feasibility and Acceptability of a Remote-Based Nutrition Education Program for Adolescents with Autism Spectrum Disorder: A COVID-19 Pilot Study.

To examine the feasibility and acceptability of a remote-based nutrition education program during COVID-19 for adolescents with autism spectrum disorder (ASD). Ten adolescents with ASD participated in a 4-week nutrition education program utilizing Zoom software during COVID-19. Topics included shopping for healthy food, and food preparation safety measures. Attendance was collected for each session. Participants, parents, and the classroom teacher completed post-program surveys and interviews. The course attendance rate was 97%. Every adolescent reported they would participate in similar future programs, and the teacher/parents felt the program was a positive experience for the participants. The remote-based nutrition education program appeared to be feasible and acceptable to participants. Future research should focus on program efficacy.

Preliminary Evidence of Children's Weight Gain From 5 Months of Home Quarantine During the COVID-19 Pandemic.

Purpose. Preventive measures to curtail the spread of the Coronavirus Disease 2019 (COVID-19)-such as home quarantine, closure of schools/programs-are necessary, yet the impact of these restrictions on children's weight status is unknown. The purpose of this case report was to investigate changes in children's body mass index (BMI) and zBMI during COVID-19 quarantine. Methods. Children had their heights and weights recorded early March 2020 (pre-COVID-19) and 5 months later (early August 2020). Paired sample t tests examined changes in BMI and zBMI from baseline to follow-up. Results. Twenty-nine children (62% female; mean age 9.3 years; 27.5% with overweight or obesity) provided height and weight data at both time points. There was a significant difference in pre-COVID-19 BMI (mean [M] = 20.1, standard deviation [SD] = 6.0) and follow-up BMI (M = 20.7, SD = 6.4); t (57) = -3.8, P < .001, and pre-COVID-19 zBMI (M = 0.8, SD = 0.9) and follow-up zBMI (M = 0.9, SD = 0.9); t (57) = -3.1, P = .003. Five of the 29 children moved from normal weight to overweight (n = 4) or obese (n = 1) during 5 months of quarantine. Conclusions. Preliminary evidence shows most children increased their BMI and zBMI values from pre-COVID-19 assessment to the follow-up assessment, 5 months later. These initial findings identify potential incidental negative health consequences of children as a result of COVID-19 preventative measures such as home quarantine.

Angina Outcomes in Secondhand Smokers: Results from the National Health and Nutrition Examination Survey 2007-2018.

Objective The aim of the study is to examine the relationship between secondhand smoke (SHS) and angina using the National Health and Nutrition Examination Survey database over a 12-year period. Methods Self-reported smoking status and cotinine levels were used to identify exposure groups (smokers, nonsmokers, and secondhand smokers), and medical history of angina was also collected via a self-report survey. The association between exposure to SHS and angina was analyzed using odd ratios with 95% confidence intervals calculated using two logistic regression models. Results The study found that when aggregating data from all 12 years, secondhand smokers are 42.9% significantly more likely to report having experienced angina, while smokers were 97.7% significantly more likely to report having angina compared with nonsmokers. Conclusions This study is the first of its kind to examine data from a national database over a 12-year period to determine an association between SHS and angina outcomes, thus highlighting the importance of reducing SHS exposure to improve cardiovascular health.