What Matters When Children Play: Influence of Social Cognitive Theory and Perceived Environment on Levels of Physical Activity Among Elementary-Aged Youth.

OBJECTIVES: Social Cognitive Theory (SCT) has often been used as a guide to predict and modify physical activity (PA) behavior. We assessed the ability of commonly investigated SCT variables and perceived school environment variables to predict PA among elementary students. We also examined differences in influences between Hispanic and non-Hispanic students. DESIGN: This analysis used baseline data collected from eight schools who participated in a four-year study of a combined school-day curriculum and environmental intervention. METHODS: Data were collected from 393 students. A 3-step linear regression was used to measure associations between PA level, SCT variables (self-efficacy, social support, enjoyment), and perceived environment variables (schoolyard structures, condition, equipment/supervision). Logistic regression assessed associations between variables and whether students met PA recommendations. RESULTS: School and sex explained 6% of the moderate-to-vigorous PA models' variation. SCT variables explained an additional 15% of the models' variation, with much of the model's predictive ability coming from self-efficacy and social support. Sex was more strongly associated with PA level among Hispanic students, while self-efficacy was more strongly associated among non-Hispanic students. Perceived environment variables contributed little to the models. CONCLUSIONS: Our findings add to the literature on the influences of PA among elementary-aged students. The differences seen in the influence of sex and self-efficacy among non-Hispanic and Hispanic students suggests these are areas where PA interventions could be tailored to improve efficacy. Additional research is needed to understand if different measures of perceived environment or perceptions at different ages may better predict PA.

Assessing Strengths, Challenges, and Equity Via Pragmatic Evaluation of a Social Care Program.

OBJECTIVE: Models of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. METHODS: Our evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families' resource need(s). RESULTS: Reach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). CONCLUSIONS: Maximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.

Cognitive-behavioral therapy and exercise training in adolescent females with elevated depression symptoms and at-risk for type 2 diabetes: Protocol for a randomized controlled trial.

BACKGROUND: Adolescent-onset type 2 diabetes (T2D) is a major public health concern of growing proportions. Prevention, therefore, is critical. Unfortunately, standard-of-care treatment for T2D prevention (e.g., exercise training) show insufficient effectiveness and do not address key modifiable barriers (e.g., depression symptoms) to exercise engagement. Depression symptoms are associated with both poorer physical fitness and greater insulin resistance, the key risk factor in adolescent-onset T2D. Thus, a targeted prevention approach that addresses depression symptoms in combination with exercise training may offer a novel approach to mitigating T2D risk. METHODS: This manuscript describes the design and study protocol for a multi-site, four-arm randomized controlled trial comparing the efficacy of group cognitive-behavioral therapy, group exercise training, and their combinations for the targeted prevention of worsening insulin resistance in N = 300 adolescent females at-risk for T2D with BMI ≥85th percentile and elevated depression symptoms. All four intervention arms will run in parallel and meet weekly for 1 h per week for 6-week to 6-week segments (12 weeks total). Outcomes are assessed at baseline, 6-week mid-treatment, 12-week follow-up, and 1-year follow-up. RESULTS: The primary outcome is insulin resistance. Key secondary outcomes include insulin sensitivity, cardiorespiratory fitness, physical activity, depression symptoms, and body measurements. CONCLUSION: Study findings will guide the ideal sequencing of two brief T2D prevention interventions for ameliorating the course of insulin resistance and lessening T2D risk in vulnerable adolescents. These interventions will likely be cost-effective and scalable for dissemination, having the potential for significant public health impact on communities at risk for T2D.

Recess environment and curriculum intervention on children's physical activity: IPLAY.

Understanding the impacts of the built environment on physical activity (PA) is essential to promoting children's PA. The purpose of this study was to investigate the effects of schoolyard renovations and a PA recess curriculum alone and in combination on children's PA. This was a 2 (learning landscape [LL] vs. non-LL) × 2 (curriculum intervention vs. no curriculum intervention) factorial design with random assignment to the curriculum intervention, and six elementary schools per condition. PA outcomes were assessed preprogram, mid-program, immediate postprogram, and one year postprogram. No meaningful intervention effects were found. Lack of an effect may be due to the brief dose of recess, the curriculum not being integrated within the schoolyard, the LL implementation occurring prior to the study, or the already high levels of PA. Potential avenues to promote PA include making recess longer, integrating recess into the school curricula, and developing recess PA curricula integrating schoolyards.

An assessment of schoolyard features and behavior patterns in children's utilization and physical activity.

BACKGROUND: Careful research that elucidates how behavior relates to design in the context of elementary school grounds can serve to guide cost-efficient design with the goal of encouraging physical activity (PA). This work explores patterns in children's PA behavior within playground spaces with the specific goal of guiding healthy playground design. METHODS: Data on children's utilization and PA behavior in 6 playgrounds divided into 106 observation zones were collected in 2005 and 2006 at Denver elementary school playgrounds using the System for Observing Play and Leisure Activity in Youth. Analyses of variance and t tests determined whether there were differences in utilization and behavior patterns across observations zones and between genders. RESULTS: This study provides evidence that children prefer to use certain types of playground zones and that they are more likely to practice moderate-to-vigorous physical activity (MVPA) in some zones. The authors observed statistically significant differences between genders. Boys were more likely to engage in MVPA in zones without equipment, girls were more likely to use zones with equipment. CONCLUSIONS: This work suggests that the inclusion or omission of specific playground features may have an impact on the way that children use the spaces.

A microgeographic analysis of physical activity behavior within elementary school grounds.

PURPOSE: There is little scholarship on physical activity among children within outdoor spaces and work is needed to advance the design of these spaces from "best practices" towards evidence-based design. This project examined how playground feature density relates to children's physical activity. DESIGN: We used the System for Observing Play and Leisure Activity to observe children's physical activity. SETTING: We observed children during school recess on 24 school grounds in the Denver metropolitan area of Colorado, in spring of 2010 and 2011. SUBJECTS: A total of 31,069 observations were made from an estimated 9900 children aged 5 to 12. These were aggregated and analyzed in 397 playground zones. MEASURES: We examined utilization, the number of children present in a particular activity zone during an observation, and the percentage of children engaged in moderate to vigorous physical activity as they relate to the density of constructed features on school playgrounds. ANALYSIS: Ordinary least-squares linear regression model assessed the relationship between playground feature density and the utilization and moderate to vigorous physical activity. RESULTS: Significant positive associations were observed between utilization and feature density among all children (ß = .20; p < .001) and a statistically significant but small association was observed between moderate to vigorous physical activity and feature density for girls (ß = .12; p = .013), but not for boys. CONCLUSION: This analysis contributes to evidence that design features of play spaces may influence children's behavior within school grounds.

Parent involvement is associated with early success in obesity treatment.

OBJECTIVE: The study examined the influence of parent involvement and family factors on body mass index (BMI) change in a pediatric obesity treatment program. METHODS: A total of 104 children and their caregivers were examined during a 12-week obesity intervention. Participants (mean age = 11.42 years; SD = 2.83) and their caregivers completed measures of family environment and depression prior to enrollment. Children's BMI and parental involvement were rated weekly during the intervention. Logistic regressions were conducted to examine the role of sociodemographic factors, family characteristics, and parent involvement on weight. RESULTS: Children with the lowest parent involvement were less likely to lose any weight or have clinically significant (>or=2 kg) weight loss. Demographics and family factors did not predict BMI change. Parent involvement related to ethnicity, absences and physical activity. CONCLUSIONS: Parental involvement may be helpful in identifying who is likely to do well in a weight loss program.