Sleep Duration, Mental Health, and Increased Difficulty Doing Schoolwork Among High School Students During the COVID-19 Pandemic.

We estimated the prevalence of short sleep duration (<8 h/average school night) among high school students (grades 9-12) during the COVID-19 pandemic by using data from the Adolescent Behaviors and Experiences Survey (January-June 2021; N = 7,705). An adjusted logistic regression model predicted prevalence ratios for more difficulty doing schoolwork during the pandemic compared with before the pandemic. Most (76.5%) students experienced short sleep duration, and two-thirds perceived more difficulty doing schoolwork. Students who slept less than 7 hours per school night or experienced poor mental health were more likely to report increased difficulty doing schoolwork. Addressing students' sleep duration could complement efforts to bolster their mental health and learning.

Prevalence of children walking to school and related barriers-United States, 2017.

Children and adolescents can engage in an active lifestyle by walking to school; however, several barriers may limit this behavior. This study estimates the prevalence of walking to school and related barriers as reported by U.S. parents. Data from the 2017 SummerStyles, a Web-based survey conducted on a nationwide sample of U.S. adults, were analyzed in 2017. Parents of children aged 5-18 years (n = 1137) were asked whether their youngest child walked to or from school during a usual school week and what barriers make this difficult. Frequencies are presented overall and by parent characteristics. About 1 in 6 parents (16.5%) reported their youngest child walks to or from school at least once during a usual week. Prevalence differed by parental race/ethnicity, marital status, region, and distance from school. The most common barrier was living too far away (51.3%), followed by traffic-related danger (46.2%), weather (16.6%), "other" barrier (14.7%), crime (11.3%), and school policy (4.7%). The frequency at which parents reported certain barriers varied by their child's walking status, distance to school, age of youngest child, race/ethnicity, education level, household income, and metropolitan statistical area status. However, the relative ranking of barriers did not differ by these characteristics. Prevalence of walking to school is low in the U.S., and living too far away and traffic-related danger are common barriers reported by parents. Implementing Safe Routes to School programs and other initiatives that utilize strategies to overcome locally-relevant barriers could help increase the prevalence of children walking to school.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Maternal employment, acculturation, and time spent in food-related behaviors among Hispanic mothers in the United States. Evidence from the American Time Use Survey.

Employment is a major factor underlying im/migration patterns. Unfortunately, lower diet quality and higher rates of obesity appear to be unintended consequences of moving to the US. Changes in food preparation practices may be a factor underlying dietary acculturation. The relationships between employment, acculturation, and food-related time use in Hispanic families have received relatively little attention. We used cross-sectional data collected from Hispanic mothers (ages 18-65) with at least one child <13 years old participating in the 2003-2011 American Time Use Survey (n = 3622) to estimate the relationship between employment, acculturation (US-born vs. im/migrant), and time spent in food preparation and family dinner. Regression models were estimated separately for the employed and the non-working and were adjusted for Hispanic origin group, socio-demographic and household characteristics. Working an eight-hour day was associated with spending 38 fewer minutes in food preparation (-38.0 ± SE 4.8, p < 001). Although being US-born was associated with spending fewer minutes in food preparation, this relationship varied by origin group. Acculturation did not appear to modify the relationship between hours worked and time spent in food preparation or family dinner. Mothers who worked late hours spent less time eating the evening meal with their families (-9.8 ± SE 1.3). Although an eight-hour workday was associated with a significant reduction in food preparation time, an unexpected result is that, for working mothers, additional time spent in paid work is not associated with the duration of family dinner later that day.

Healthy kids out of school: using mixed methods to develop principles for promoting healthy eating and physical activity in out-of-school settings in the United States.

INTRODUCTION: Widespread practices supporting availability of healthful foods, beverages, and physical activity in out-of-school-time (OST) settings would further obesity prevention efforts. The objective of this article was to describe principles to guide policy development in support of healthy eating and physical activity practices in out-of-school settings to promote obesity prevention. METHODS: The Institute of Medicine's L.E.A.D. framework (Locate Evidence, Evaluate it, Assemble it, and Inform Decisions) was used to identify practices relevant to children's healthful eating in most OST settings: 1) locate and evaluate information from a national survey of children's perceptions of healthful-food access; published research, reports, policies and guidelines; and roundtables with OST organizations' administrators; 2) assemble information to prioritize actionable practices; and 3) inform programmatic direction. RESULTS: Three evidence-informed guiding principles for short-duration OST resulted: 1) drink right: choose water instead of sugar-sweetened beverages; 2) move more: boost movement and physical activity in all programs; and 3) snack smart: fuel up on fruits and vegetables. CONCLUSION: Healthy Kids Out of School was launched to support the dissemination and implementation of these guiding principles in short-duration OST settings, complementing efforts in other OST settings to shift norms around eating and physical activity.

Opportunities in the Extended Day: Approaches for Promoting Physical Activity and Healthy Eating During Out-of-School Time.

BACKGROUND: This systematic review aims to identify out-of-school time (OST) interventions (eg, programming, policies) that increased opportunities for physical activity (PA) and healthy eating and/or improved youth PA and dietary behaviors. METHODS: We searched for articles within systematic reviews that met our criteria (2010-2018) and for individual articles (2010-2020). Reviewer pairs screened articles, double-extracted data, assessed risk of bias (RoB), and achieved consensus. We included 71 articles (55 studies, 60 intervention arms). RESULTS: Health (n = 3) and nutrition education (n = 7) interventions showed promising results, but most used weak designs and had high RoB. PA-focused interventions (n = 23) were largely consistent in improving fitness and moderate to vigorous PA during programming. Programmatic interventions that improved both PA and nutrition outcomes engaged family or community members (n = 4/13). Most organizational policy interventions improved the nutrition environment and student PA during OST. CONCLUSIONS: Organization-level policy and programmatic interventions can improve environmental supports and youth behaviors during OST programming, complementing school-day efforts to address student PA and dietary intake. To maximize their potential impact, OST programs need to be accessible to families. Administrators can consider actions to reduce participation barriers.

Coordinated Approach: Comprehensive Policy and Action Planning.

BACKGROUND: Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States. METHODS: A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition. RESULTS: We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors. IMPLICATIONS: Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes. CONCLUSIONS: Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.

A Whole School, Whole Community, Whole Child Approach to Support Student Physical Activity and Nutrition: Introduction/Methods.

BACKGROUND: We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles. METHODS: A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies. FINDINGS: Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings. CONCLUSIONS: This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity.

Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students - Youth Risk Behavior Survey, United States, 2021.

The fall of 2021 was the first school semester to begin with widespread in-person learning since the COVID-19 pandemic began. Understanding dietary and physical activity behaviors of adolescents during this time can provide insight into potential health equity gaps and programmatic needs in schools and communities. This report uses data from the 2021 national Youth Risk Behavior Survey conducted among a nationally representative sample of U.S. public and private school students in grades 9-12 to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. In addition, 2-year comparisons (2019 versus 2021) of these behaviors were examined. In 2021, daily consumption of fruits, vegetables, and breakfast during the past 7 days remained low and decreased overall with specific disparities by sex and race and ethnicity from 2019 to 2021. The overall prevalence of students attending physical education classes daily, exercising to strengthen muscles on ≥3 days/week (i.e., met the guideline for muscle-strengthening activity), and playing on at least one sports team decreased from 2019 to 2021; whereas being physically active for ≥60 minutes/day on all 7 days (i.e., met the guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines remained low but did not change. These findings underscore the need for strategies to increase healthy dietary and physical activity behaviors both in the recovery phase of COVID-19 and longer term.

Food Insecurity and Its Association With Alcohol and Other Substance Use Among High School Students in the United States.

BACKGROUND: Studies show that food insecurity is associated with adverse health behaviors for children and adults. However, published data among adolescents are limited. The objective of this study was to examine the association between food insecurity and substance use behaviors among US high school students. METHODS: Data from the 2017 Youth Risk Behavior Survey in 10 states were combined to examine the association between household food insecurity and adolescent use of alcohol, marijuana, prescription opioid misuse, and illicit drugs using logistic regression. RESULTS: Among surveyed respondents, 12.3% of high school students reported experiencing food insecurity. In unadjusted analyses, the prevalence of substance use was higher among students with food insecurity compared to food secure students: current binge drinking (16.2% vs 11.5%), current marijuana use (24.0% vs 16.2%), lifetime prescription opioid misuse (21.3% vs 12.6%), and lifetime use of illicit drugs (12.3% vs 5.0%) (all p < .05). In adjusted models, food insecurity was associated with lifetime prescription opioid misuse and lifetime use of illicit drugs (aPR 1.38 and 1.70, respectively). CONCLUSION: Students with food insecurity are a potential group at a higher rise of substance misuse and may benefit from prevention programs designed to address their needs.

Improving active travel to school and its surveillance: an overlooked opportunity in health promotion and chronic disease prevention.

Increasing active travel to school (ATS) could reduce the deficit in youth physical activity participation; however, surveillance of ATS is limited. Given that ATS contributes to our understanding of children's physical activity patterns nationwide, is influenced by local contexts and state laws, and occurs within communities, surveillance could be informative at the national, state, and local levels. Following a National Collaborative on Childhood Obesity Research workshop, this commentary offers insights into strengthening surveillance and data collection of ATS behavior as well as ATS environmental, policy, and program supports.

BMI Reporting and Accuracy of Child's Weight Perception.

OBJECTIVES: To estimate whether school-based body mass index (BMI) reports impacted the accuracy of children's self-reported weight category, for children overall and within subgroups. METHODS: We analyzed existing data from the Fit Study, a randomized controlled trial of a BMI screening and reporting intervention conducted in California from 2014 to 2017. The sample included 4690 children in 27 schools randomized to receive BMI reports and 4975 children in 27 controls schools that received BMI screening only. To estimate how BMI reporting affected accuracy, we fit multinomial logistic regression models to our data. We calculated average marginal effects, which capture the change in probability that children more accurately reported their weight category because of BMI reporting. RESULTS: We detected no impact of BMI reporting on children's self-reported weight accuracy. Exploratory subgroup analyses show that for Black children, exposure to 1 round of BMI reporting was associated with a 10.0 percentage point increase in the probability of accurately reporting their weight category (95% confidence interval [CI]: 2.6 to 17.4). Two rounds of reporting were associated with an increase in the probability of accuracy for Asian children (6.6 percentage points; 95% CI: 0.4 to 12.8), 5th graders (11.1 percentage points; 95% CI: 1.6 to 20.5), and those with BMI <5th percentile (17.1 percentage points; 95% CI: 2.7 to 31.6). CONCLUSIONS: BMI reporting has limited efficacy in increasing children's weight perception accuracy. Although exploratory analyses show that specific subpopulations became more accurate, future prospective studies should be designed to confirm these results.

Dietary and Physical Activity Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices <1 time/day; 40.7% had eaten vegetables <1 time/day; and 16.7% had not eaten breakfast on all 7 days. Moreover, although 57.4% of students had played on ≥1 sports team during the 12 months before the survey, less than half of students had been physically active for ≥60 minutes/day on all 7 days (23.2%), had exercised to strengthen or tone their muscles on ≥3 days/week (49.5%), had met both aerobic and muscle-strengthening physical activity guidelines (16.5%), or had attended physical education classes on all 5 days in an average school week (25.9%). Trend data indicate limited progress in shifting dietary and physical activity behaviors. That is, with the exception of decreases in the percentage of students who had consumed soda ≥1 time/day (2009: 29.2%; 2019: 15.1%), sports drinks ≥1 time/day (2015: 13.8%; 2019: 10.6%), and <3 glasses/day of plain water (2015: 50.5%; 2019: 44.6%), high school students' dietary and physical activity behaviors have not improved and, in certain cases, have worsened. These findings support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices.

Prevalence and Types of School-Based Out-of-School Time Programs at Elementary Schools and Implications for Student Nutrition and Physical Activity.

BACKGROUND: Out-of-school time (OST) programs are an important setting for supporting student health and academic achievement. This study describes the prevalence and characteristics of school-based OST programs, which can inform efforts to promote healthy behaviors in this setting. METHODS: A nationally representative sample of public elementary schools (N = 640) completed surveys in 2013-2014. Administrators reported on OST programs and policies at their school. Multivariable logistic regression models estimated the prevalence of school-based OST programs, adjusting for school characteristics. Among schools with OST programs (N = 475), chi-square tests identified school characteristics associated with having an OST policy about physical activity or nutrition. RESULTS: Three fourths of elementary schools (75.6%) had a full- or partial-year school-based OST program, with 30.8% having both. Full- and partial-year programs were significantly less prevalent in rural and township areas versus urban settings. Only 27.5% of schools with OST programs reported having physical activity and/or nutrition policies. CONCLUSIONS: Most US elementary schools have an on-site OST program, but disparities in access exist, and most lack policies or awareness of existing policies regarding physical activity and nutrition. To maximize OST programs' potential benefits, strategies are needed to increase access to programs and physical activity and/or nutrition policy adoption.

District Policies and Practices Vary in Their Association With Adolescents' Consumption of Milk and 100% Fruit Juice.

PURPOSE: Researchers previously examined the relationship between school beverage policies and sugar-sweetened beverage (SSB) consumption. This study addressed a research gap by examining cross-sectional associations between district-level policies and practices and U.S. high school students' consumption of milk and 100% fruit juice. METHODS: Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked for 12 large urban school districts. Outcome variables were daily milk consumption (≥1 glass/day) and 100% fruit juice consumption (≥1 time/day). Exposure variables were five district policies (i.e., restrict SSB sales, maintain closed campuses, offer/sell healthful alternatives, restrict promotional products, and require nutrition education). Logistic regression models estimated the odds of consuming milk or 100% fruit juice daily, conditional on the policies and adjusting for sex, race/ethnicity, grade level, weight status, and district free/reduced-price lunch eligibility (n = 23,173). RESULTS: Students in districts that required/recommended restricting the times of SSB sales had 55% higher (adjusted odds ratio [AOR], 1.55; 95% confidence interval [CI], 1.28-1.87) odds of consuming ≥1 glass/day of milk than students in districts without this policy. Closed campus policies were associated with lower odds of consuming milk (AOR, .72; 95% CI, .63-.82) and higher odds of consuming juice (AOR, 1.27; 95% CI, 1.07-1.50). Policies requiring/recommending that districts offer/sell healthful alternatives were associated with lower odds of consuming 100% fruit juice daily. CONCLUSIONS: Results suggest that restricting SSB sales may support adolescents' milk consumption. Future studies should assess whether the implementation of federal standards that further restrict SSB sales in school leads to increased milk consumption.

The critical role of communications in a multilevel obesity-prevention intervention: Lessons learned for alcohol educators.

OBJECTIVE: Multilevel interventions to prevent underage drinking are more effective than individual-level strategies, and messaging campaigns are key to such approaches. Recognizing the benefits of translating best practices across public health domains, this paper details the communications campaign from Shape Up Somerville (SUS), an exemplar for multilevel community-based approaches to address pediatric obesity, highlighting lessons learned for alcohol educators. METHODS: All elements of SUS, including the communications strategy, were developed collaboratively with local partners. Communication initiatives included community-engaged brand development to unify diverse intervention components; school-based communications to promote new opportunities for healthy eating and physical activity; and media partnerships to promote healthy behaviors community-wide. RESULTS: The overall SUS intervention was effective in reducing prevalence of overweight/obesity among first- to third-graders in Somerville relative to control communities. Process evaluation showed that communications successfully reached diverse community segments and raised awareness of and receptivity to changes. CONCLUSIONS AND PRACTICE IMPLICATIONS: Communications campaigns are essential components of multilevel interventions addressing public health challenges including obesity and underage drinking. Such communications should be developed collaboratively with the target audience and stakeholders, designed to engage community members at multiple levels through multiple channels within a systems framework, and sustained through local partnerships.

Sodium Intake among US School-Aged Children: National Health and Nutrition Examination Survey, 2011-2012.

BACKGROUND: Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children. OBJECTIVE: To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children. DESIGN: Cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING: A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall. MAIN OUTCOME MEASURES: Population proportions of sodium intake from major food categories, places, and eating occasions. STATISTICAL ANALYSES PERFORMED: Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups. RESULTS: Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565±120 mg), lowest among girls (2,919±74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children's sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children's sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast. CONCLUSIONS: With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren's sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply.

Occupational Physical Activity and Weight-Related Outcomes in Immigrant Mothers.

INTRODUCTION: New immigrants are likely to be employed in occupations that provide physical activity; however, these positions may place workers at risk for adverse health outcomes. Relationships between occupational physical activity (OPA); weight-related behaviors; obesity; and depression remain underexplored among recent immigrants. METHODS: Participants (N=385) were Brazilian, Haitian, and Latino mothers enrolled in a community-based participatory research lifestyle intervention among immigrant mothers (<10 years in U.S.). Baseline BMI was calculated using objectively measured height and weight. Self-reported baseline data included sociodemographics; physical activity (Pregnancy Physical Activity Questionnaire); depressive symptoms (Center for Epidemiological Studies-Depression Scale); and prepared food purchasing frequency. Logistic regression models estimated the odds of obesity (BMI ≥30.0); high depressive symptoms (score ≥16); and purchasing prepared foods (≥1 times/week) by OPA quartile. Models adjusted for covariates, including household composition, origin group, maternal age, education, household income, and recruitment year (2010, 2011). Data were analyzed in 2013. RESULTS: Employed participants (49%) primarily worked as domestic workers, nursing assistants, and food service staff. In adjusted models, women in the highest OPA quartile versus lowest had 65% lower obesity odds (95% CI=0.16, 0.76) and approximately twice the odds of presenting high depressive symptoms (2.01, 95% CI=1.02, 4.27) and purchasing takeout food (1.85, 95% CI=0.90, 3.90), which was attenuated after adjusting for income and education (unadjusted OR=1.98, 95% CI=1.10, 3.52). CONCLUSIONS: OPA contributes to energy expenditure and may protect against obesity among new immigrant mothers; however, it is also associated with high depressive symptoms. Implications for physical and psychosocial well-being are mixed.