Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020.

BACKGROUND: The COVID-19 pandemic has further exposed inequities in our society, demonstrated by disproportionate COVID-19 infection rate and mortality in communities of color and low-income communities. One key area of inequity that has yet to be explored is disparities based on preferred language. METHODS: We conducted a retrospective cohort study of 164,368 adults tested for COVID-19 in a large healthcare system across Washington, Oregon, and California from March - July 2020. Using electronic health records, we constructed multi-level models that estimated the odds of testing positive for COVID-19 by preferred language, adjusting for age, race/ethnicity, and social factors. We further investigated interaction between preferred language and both race/ethnicity and state. Analysis was performed from October-December 2020. RESULTS: Those whose preferred language was not English had higher odds of having a COVID-19 positive test (OR 3.07, p < 0.001); this association remained significant after adjusting for age, race/ethnicity, and social factors. We found significant interaction between language and race/ethnicity and language and state, but the odds of COVID-19 test positivity remained greater for those whose preferred language was not English compared to those whose preferred language was English within each race/ethnicity and state. CONCLUSIONS: People whose preferred language is not English are at greater risk of testing positive for COVID-19 regardless of age, race/ethnicity, geography, or social factors - demonstrating a significant inequity. Research demonstrates that our public health and healthcare systems are centered on English speakers, creating structural and systemic barriers to health. Addressing these barriers are long overdue and urgent for COVID-19 prevention.

"You Only Teach PE and It Doesn't Really Matter": Middle School PE Teachers' Perspectives on Intervention Efforts to Increase Physical Activity.

Physical education (PE) is a frequent site of public health intervention to promote physical activity (PA); however, intervention research frequently overlooks the perspective of PE teachers. The purpose of this qualitative study was to explore teachers' experiences with and perceptions of a PA curriculum intervention. Six findings within three categories were identified and described in detail. In-depth one-on-one semistructured interviews were conducted with nine PE teachers from eight middle schools in Los Angeles. Feeling underappreciated and having a "muddled mission" within PE were driving factors in teacher morale and practice. Teachers had positive experiences with the curriculum, but significant barriers remained and limited the potential for PA during PE classes. PE teachers are pulled in multiple directions and perceive a lack of necessary support systems to achieve student health goals. Interventions aimed at leveraging PE as a site of PA promotion must incorporate the perspectives of PE teachers.

Physical Activity Correlates in Middle School Adolescents: Perceived Benefits and Barriers and Their Determinants.

The purpose of this study was to examine the determinants of benefits and barriers and their relationship with physical activity (PA) among predominantly Latino middle school students. Data were collected in a cross-sectional survey of 4,773 seventh-grade students recruited from a large, urban school district in Los Angeles. Hierarchical logistic regression models were used to assess determinants of benefits and barriers as well as their association with self-reported PA. Differences in benefits and barriers were observed by gender, ethnicity, and body size. Barriers were negatively correlated with all three PA outcomes while benefits were positively associated with exercising at least 60 min daily. A deeper understanding of benefits and barriers can facilitate the development of interventions and collaborative efforts among physical education teachers, school nurses, and administrators to implement comprehensive approaches that encourage students' participation in PA inside and outside of the classroom.

The Impact of Food Insecurity on the Home Emotional Environment Among Low-Income Mothers of Young Children.

Objectives Household stressors, such as food insecurity, contribute to the home emotional environment and negatively affect child development. Little research on this topic has been conducted among very young children. This study aimed to examine the relationship between food insecurity and the home emotional environment, as well the extent to which the relationship may be mediated by maternal symptoms of depression. Frequency of praise, affection, and discipline of young children by mothers were examined as markers of the home emotional environment. Methods Data were collected in a cross-sectional study of mothers of children under the age of five (N = 4231). Logistic regression was used to assess the relationship between level of food security and frequency of praise and discipline of children. Mediation analysis using the KHB method was conducted to test whether maternal mental health mediated the relationship between food insecurity and each outcome. Results Low and very low food security were significantly associated with higher odds of disciplining children with high frequency. Controlling for all covariates, frequency of praise was not significantly associated with level of household food insecurity. Differences in praise and discipline frequency were found by language of interview, maternal education, and employment. Conclusions for Practice Parent-child interactions, specifically related to discipline, are related to food insecurity. Further research should consider cultural patterns and mechanisms behind the relationship between food insecurity and the home environment. Household stressors begin affecting children at young ages, and early intervention is essential to prevent further negative sequelae as children grow older.

Consistency of Moderate to Vigorous Physical Activity in Middle School Physical Education.

This study assessed the consistency of moderate to vigorous physical activity (MVPA) in a sample of middle school physical education lessons. Random intercept hierarchical linear regressions were employed to model the relationship between consistency of MVPA and independent variables, including lesson and teacher characteristics. Larger classes spent significantly more time in consistent MVPA in the absence of controlling for teacher characteristics. A significant interaction between class size and teacher experience suggests that experience may play a beneficial role in larger classes, and overall class size does not have to be a barrier to achieving high levels of MVPA.

Engagement in meaningful activities post suicide loss: A scoping review protocol.

RATIONALE: Each day, more than 10 Canadians die by suicide. Each suicide leaves entire communities to manage the traumatic aftermath of this loss. Individuals bereaved by suicide loss are at a higher risk of experiencing negative mental health outcomes. Current research suggests that engagement in meaningful activities may be an avenue to protecting mental health. It is important to understand if this is also the case for those experiencing bereavement post suicide loss. To date, there has not been a synthesis of the literature examining suicide loss and the nature and extent of engagement in meaningful activities post loss. OBJECTIVES: 1) To describe the nature and extent of the peer-reviewed suicide loss and bereavement literature related to engagement in meaningful activities; and 2) to identify facilitators and barriers that may impact engagement in meaningful activities post loss. METHODS: This paper describes a scoping review protocol that will be completed using stages identified by Arksey and O'Malley and updated by Levac and colleagues. Joanna Briggs Institute framework will also guide this review. Four electronic databases will be searched for suicide bereavement/loss concepts. Two reviewers will apply inclusion and exclusion criteria to identify articles discussing engagement in meaningful activities of everyday living post loss. Data will be descriptively summarized and analyzed using inductive content analysis. Results will be reported following PRISMA Extension for Scoping Reviews. EXPECTED RESULTS: A descriptive summary and conceptual map describing the current state of the peer-reviewed literature will be constructed. CONCLUSION: Experiencing a suicide loss increases the risk of negative mental health outcomes. A synthesis of literature is required to map the current available evidence related to suicide bereavement and engagement in meaningful activities, with potential implications for improving supports and services for those bereaved. This protocol is register with Open Science Framework Registries (10.17605/OSF.IO/M2NES).

Bias-Based Bullying in California Schools: The Impact of the 2016 Election Cycle.

The purpose of this study is to examine the trends in bias-based bullying between 2013 and 2019 among California youth overall and by type of bias-based bullying and explore the extent to which Trump's announcement of his candidacy for U.S. President in June 2015 impacted these bullying outcomes. We pooled the student-level survey data from multiple waves of the California Healthy Kids Survey. The final study sample included 2,817,487 middle- and high-school students (48.3% female, 47.9% male, and 3.7% not reported). We examined five specific types of bias-based bullying and any bias-based bullying overall. We employed logistic regression and calculated odds ratios to compare differences in the odds of bias-based bullying before and after Trump announced his candidacy for U.S. President. Between 2013 and 2019, approximately one in four students reported experiencing at least one type of bias-based bullying, based on race, ethnicity, or national origin being the most commonly reported. Trump's announcement for candidacy was inconsistently associated with differences in the odds of bias-based bullying. Counties in which a higher proportion of the electorate voted for Trump had slightly higher odds of bullying for any bias-based bullying and for all specific types of bias-based bullying. Findings highlight the need for a commitment to protecting students from bullying regardless of their identity. Public health and education researchers and practitioners should draw on our growing understanding of the different dimensions of bullying in designing, implementing, and evaluating intervention approaches that address bias-based bullying, a particularly important cause given the growing polarization in the United States and the increasing salience of identity in the lead-up to and since the 2016 and 2020 elections.

Innovation and Competency Development in Occupational Therapy Fieldwork During the COVID-19 Pandemic.

Background: Occupational therapy clinical education was disrupted because of the COVID-19 pandemic. This introduced both challenges and opportunities in clinical fieldwork education and created a naturalistic opportunity to study the innovations that occurred. Purpose: To identify and describe fieldwork education innovations that occurred during the COVID-19 pandemic and understand how these clinical learning contexts impacted competency development in occupational therapy learners. Method: A qualitative multi-case study methodology was used. The participants (N = 28) were occupational therapy learners and preceptors who self-identified as having participated in an innovative fieldwork placement during the pandemic either as a preceptor or learner. Data were collected via in-depth interviews and analyzed to identify cases of innovation. Within and across case analyses were conducted to describe innovations and competencies addressed. Findings: Three cases of fieldwork innovations were identified: (a) Virtual Care; (b) Intrapreneurship; and (c) Administration. The commonly addressed competency domains across the cases were OT Expertise, Excellence in Practice, and Communication and Collaboration. The competency domain, culture, equity, and justice, was only addressed in the virtual care case. Conclusion: Our findings indicate that innovative fieldwork placements can support competency development in occupational therapy; however, this development is complex and contextually based.

Mammogram perceptions, communication, and gaps in care among individuals with non-English language preference in Oregon and Washington states.

This study examined perceptions of and communication about mammography as drivers of gaps in screening among individuals with non-English language preference (NELP). A survey was fielded in fall 2021 in five languages (Cantonese, English, Russian, Spanish, or Vietnamese) to individuals identified using electronic medical records in Oregon and Washington. The analytic sample consisted of 420 respondents with a median age of 61; approximately 45% of respondents identified as Asian, 37% as Hispanic, Latino, or Spanish origin, and 18% as some other race, ethnicity, or origin. Logistic regression models examined associations between screening and perception and communication items. Individuals who believed mammograms are unnecessary when healthy (aRR = 0.72 [0.57, 0.91]) or absent symptoms (aRR = 0.85 [0.72, 1.00]) were less likely to report a mammogram within the past two years (i.e., be current). Having a provider recommend (aRR = 1.27 [1.09, 1.47]) and discuss mammography (aRR = 1.18 [1.05, 1.32]) were associated with a higher likelihood of being current. Few respondents received written or verbal information in their preferred language (35% and 28.3%, respectively). Financial and logistical support, including language services were most frequently identified as types of support needed to obtain a mammogram. Overall, misperceptions about mammography may act as a barrier but communication may act as a facilitator for individuals with NELP. Provider-patient communication could be an effective way to encourage mammography. Culturally-responsive health promotion materials and provider communication, available in patients' preferred language, are needed to combat misperceptions and support ongoing, on-time mammography for NELP patients.

Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers.

BACKGROUND AND OBJECTIVES: Black preterm infants are more likely to die than White preterm infants within the same NICU. Racism may lead to disparate quality of NICU care contributing to disparities in preterm infant health outcomes. The objective of our study was to understand Black mothers' perspectives of the impact of racism on the quality of care for Black preterm infants in the NICU and what might be done to address it. METHODS: Using qualitative research methods, we conducted in-depth, semistructured interviews with 20 Black mothers of preterm infants in a single Level IV NICU 6 to 18 months after hospital discharge regarding experiences with disparate quality of NICU care. We developed themes iteratively and conducted interviews until thematic saturation was reached. RESULTS: The majority of mothers believed that racism impacted the quality of NICU care and described examples of racism in the NICU at structural, institutional, and interpersonal levels. Mothers also provided ideas for interventions that would decrease racism and improve quality of NICU care for Black families, including increased Black representation, increased peer support, and improved staff education and training. CONCLUSIONS: Black mothers of preterm infants experienced racism during NICU hospitalization that impacted the quality of care they received. Interventional studies directed toward mitigating these racial disparities may focus on addressing racism during the NICU period and should include input from Black stakeholders at all stages of design, implementation, and analysis.

Exploring the Relationship Between MyPlate Knowledge, Perceived Diet Quality, and Healthy Eating Behaviors Among Adolescents.

PURPOSE: MyPlate is the current dietary guidance icon meant to communicate healthy eating patterns. The purpose of this study is to evaluate knowledge of MyPlate nutrition education messages among middle school students and its association with dietary intake and perceived diet quality. DESIGN: Secondary analysis of cross-sectional data. SETTINGS: Survey of eighth-grade students from 16 middle schools in California. SUBJECTS: A total of 3521 eighth-grade students. MEASURES: MyPlate knowledge was assessed with 3 questions asking how much of the plate in a typical meal should be (1) fruits and vegetables, (2) grains, and (3) proteins. A brief food frequency questionnaire measured intake of fruits, vegetables, sweets, salty snacks, fast-food, and sugar-sweetened beverages (SSBs) over the past 7 days. Students self-rated their diet quality as poor, fair, good, or excellent. ANALYSIS: Hierarchical logistic regression models controlling for gender, ethnicity, and socioeconomic status. RESULTS: Only 11% of students answered all MyPlate questions correctly. MyPlate knowledge was associated with 65% higher odds of not consuming SSBs, but 46% lower odds of not consuming sweets. MyPlate knowledge was not associated with adolescents' perceived diet quality or intake of salty snacks, fruits, or vegetables. CONCLUSION: Knowledge of nutrition education messages communicated by the MyPlate dietary guidance icon is limited among adolescents. The association between MyPlate knowledge and lower consumption of SSBs is encouraging, given the strong association between SSBs and childhood obesity.

Strategies for Effective Collaboration with Middle School Physical Education Teachers: An Application of School-Engaged Research.

BACKGROUND: Increasing the capacity of teachers to deliver physical education (PE) lessons that are high in moderate to vigorous physical activity (PA) is one strategy to increase the amount of exercise students receive during school. However, traditional research approaches have not directly engaged the school community as equitable partners in the intervention design process. The purpose of this article is to describe the process, outputs, and lessons learned from a school-engaged research study, which incorporates the unique needs of schools-in terms of structure, accountability measures, and array of stakeholders into the research process and design. METHODS: This article describes lessons learned from Project SHAPE, a PA intervention that used principles of school-engaged research to guide program planning, recruitment, implementation, and data dissemination. RESULTS: The study team successfully partnered with 16 schools and enrolled 55 teachers and surveyed 4,773 students. CONCLUSIONS: Efforts to improve PE programs can benefit from a school-engaged research approach that directly involves teachers, fosters mutually beneficial relationships, and integrates the schools' perspective in the research process.

Evaluation of an Intervention to Increase Physical Activity in Low-Income, Urban Middle Schools.

BACKGROUND: Physical education (PE) can provide opportunities to engage in daily moderate-to-vigorous physical activity (MVPA), but MVPA levels in many classes are low. This study examines MVPA during middle school PE lessons before and after receiving the SPARK (Sports, Play, and Active Recreation for Kids) program. METHODS: Sixteen schools were enrolled in the study. PE teachers at eight schools received the intervention. PE lessons at all schools (N = 561) were observed over 2 years. Hierarchical linear regression models examined the effect of the intervention on the amount and consistency of MVPA and sedentary behavior. RESULTS: An average of 13.7% of observed class time was spent in MVPA (approximately 5 minutes of a 60-minute class), compared to 27.5% of time spent sedentary. There was no evidence that the curriculum resulted in increased MVPA or consistent MVPA, or that it decreased sedentary behavior. Findings also suggested that contextual factors may contribute to physical activity levels in PE. CONCLUSIONS: Mixed evaluation findings of the SPARK middle school curriculum demonstrate that an out-of-the-box curriculum does not have the same results in all contexts. Implications for school health are described based upon findings. Further research is needed to identify effective strategies to increase MVPA for adolescents both in and outside of PE.

The Effects of a 2-Year Middle School Physical Education Program on Physical Activity and Its Determinants.

Purpose: This study examines the effects of the middle school SPARK physical education (PE) curriculum on predisposing, enabling, and reinforcing factors for physical activity (PA) as well as self-reported PA in a predominantly low-income, Latinx student population in Los Angeles, CA. Methods: Data were collected from 3763 students of seventh and eighth grades at 2 time points at the 16 middle schools enrolled in the study. Hierarchical logistic regression models were used to assess intervention effects on PA attitudes, PE enjoyment, FitnessGram passing, daily PA, and muscle-strengthening PA, controlling for demographic variables. Results: Although there was no detectable intervention effect on increasing the number of students exercising 60 minutes per day, there was a negative intervention effect detected for muscle-strengthening exercises. A significant positive intervention effect was detected for both PE enjoyment and FitnessGram passing. Deeper analysis of these findings revealed that the positive effect on PE enjoyment occurred only among male students. Conclusion: The SPARK curriculum had mixed effects on students' PA behavior as well as predisposing, enabling, and reinforcing factors for PA. Incorporating student perspectives into the evaluation of intervention efforts to promote PA can facilitate a better understanding of the ways in which these efforts influence PA behaviors and its determinants.

Use of Mind-Body Therapies Among Young Adults Aged 18-24 Years: Findings From the 2012 National Health Interview Survey.

PURPOSE: To investigate the prevalence, patterns, and satisfaction of use of mind-body therapies (MBTs) in a nationally representative sample of young adults (ages 18-24 years). METHODS: Young adults interviewed in the 2012 National Health Interview Survey were analyzed (n = 3,286). Individual types (e.g., mindfulness) and a combined measure of use of any MBT were assessed. Reasons for and satisfaction with use was also investigated. Design-based F tests and logistic regression were used; all analyses were weighted and stratified by gender. RESULTS: Overall, 14.6% of young adults used MBT in the past year (9.6% of men and 19.1% of women, p < .001). Among men, higher levels of education, greater numbers of health conditions, and healthy behaviors were associated with greater odds of MBT use. Among women, Latina and black women had lower odds of use (vs. white). Higher education, greater mental distress, and greater numbers of health conditions and healthy behaviors were associated with greater odds of use. While both men and women reported stress reduction and general wellness as top reasons for use, men also reported the use to improve athletic performance. CONCLUSIONS: Young adulthood is a critical period in the life course when individuals are establishing lifestyle and health behaviors that can be enduring. Because stress is a persistent problem, and many MBTs can be helpful with management of stress and anxiety, young adult may be underutilizing these modalities. Public health and educational strategies for greater engagement in MBT among young adults are warranted.

Correlates of Social Support and its Association With Physical Activity Among Young Adolescents.

BACKGROUND: A substantial proportion of adolescents, particularly girls and minority youth, fail to meet daily physical activity (PA) recommendations. Social support contributes to adolescent PA, but studies examining this relationship have yielded inconsistent results and rarely focus on diverse, urban populations. AIMS: This study examines the correlates of support for PA from family and friends and its relationship with PA outcomes among young adolescents. METHODS: Data were collected in a cross-sectional survey of 4,773 middle school students. Social support from family and friends was separately measured using the Sallis Support for Exercise Scales. Hierarchical logistic regression models were used to assess correlates of high support and the relationship between support and self-reported PA. RESULTS: Approximately one quarter of students reported being active for at least an hour each day. 31.7% of students reported high family support for PA, while 17.8% reported high friend support. Differences in perceptions of support by gender, ethnicity, and language emerged. Support from family and friends were both consistently strong predictors of all three PA outcomes measured. DISCUSSION: Findings highlight the need for multilevel interventions targeting both psychosocial influences on behavior in addition to addressing the physical environment. Given low rates of friend support for PA, there appears to be an opportunity to increase PA levels through promotion of supportive behaviors among peers. CONCLUSION: Support for PA from family and friends is a key contributor to increased PA among adolescents. Further research is needed to further understand the mechanisms by which these factors influence PA.

Nutrition Campaign Knowledge and Dietary Behavior in Middle School Students.

BACKGROUND: Federal nutrition campaigns are designed to make dietary recommendations accessible but have not been extensively evaluated. This paper explores whether knowledge of nutrition campaigns is associated with dietary behavior among young adolescents. METHODS: Cross-sectional survey data were collected from 4,773 middle school students in Southern California. Hierarchical logistic regression models were used to assess the association between dietary behaviors and nutrition campaign knowledge, controlling for gender and ethnicity. RESULTS: Knowledge of the Fruit & Veggies-More Matters campaign was associated with increased odds of high fruit and vegetable consumption, knowledge of the MyPlate campaign was associated with neither, and both were associated with increased odds of not consuming soda. CONCLUSION: Overall, low percentages of students demonstrated knowledge of nutrition campaigns, and knowledge was associated with some dietary behaviors. More research is needed to examine the impact of nutrition campaigns while also accounting for other psychosocial and environmental factors that may affect soda, fruit, and vegetable consumption.