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.

Skipping breakfast and its association with sociodemographic characteristics, night eating syndrome, and sleep quality among university students in Bangladesh.

INTRODUCTION: Skipping breakfast has become more common, and it can significantly affect a person's health, performance, mood, and other physiological and psychological factors. In Bangladesh, university students often encounter unhealthy dietary habits, which raises questions about why many university students choose to skip breakfast. The purpose of this study was to investigate the prevalence of skipping breakfast among university students in Bangladesh and explore the contributing factors. METHODS: Patuakhali Science and Technology University, Bangladesh was the location of this cross-sectional study. Breakfast consumption was measured with the single-question item, "How often do you eat breakfast?" (Almost every day, sometimes, rarely, or never). Skipping breakfast was classified as respondents selecting sometimes, rarely, or never having breakfast. Sociodemographic, behavioral, and sleep-related data were collected as key predictor variables. Multiple logistic regression models identified factors associated with skipping breakfast. RESULTS: The prevalence of skipping breakfast among study participants (N = 502, 51.6% female and mean age 21.31 years) was 63.5%. Female students were more likely to skip breakfast compared to male students (adjusted odds ratio, AOR = 1.65, 95% CI: 1.06-2.55). Smoker participants had a higher likelihood of skipping breakfast compared to non-smokers (AOR = 3.92, 95% CI: 1.57-9.78). Students with night eating syndrome had a higher likelihood of skipping breakfast compared to their counterparts (AOR = 1.84, 95% CI: 1.06-3.22). Students with poor sleep quality were three times more likely to skip breakfast than their counterparts (AOR = 2.95, 95% CI: 1.93-4.51). Overweight/obese students were less likely to skip breakfast compared to their counterparts (AOR = 0.40, 95% CI: 0.20-0.82). CONCLUSION: This study highlights a high prevalence of skipping breakfast among university students in Bangladesh. Specifically, students who are females, smokers, poor sleepers and who have night eating syndrome are more likely to skip breakfast compared to their counterparts. These findings underscore a need for targeted interventions and educational programs to promote healthy breakfast habits. Addressing these modifiable risk factors can have a positive impact on students' nutritional practices and their health and wellbeing.

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.

Investing in the Future: A Premedical Surgical Elective for Undergraduate Students.

BACKGROUND: Research has shown that providing surgical exposure and mentorship before clerkship can bolster interest and cultivate quality surgical residents. However, most studies have focused exclusively on programs for 1st and 2nd year medical students. The purpose of this study is to describe a novel undergraduate premedical surgical elective (PMSE) and the interests and perceptions of PMSE participants of the surgical field. METHODS: Undergraduate students applied for a semester long PMSE that included surgical shadowing, mentorship, a research component, attendance at seminars, and hands-on workshops. Post-PMSE completion, participants were invited to complete an online survey about their perceptions of pursuing a career in surgery and their specialties of interest. RESULTS: Thirty-six PMSE participants completed the survey (21 females and 15 males). More than half (57%) of female respondents expressed interest in a surgical career. Most respondents (78%) agreed or strongly agreed that they are confident in their ability to become a surgeon. A lower proportion of female respondents (33%) believed the atmosphere of the surgical field to be inclusive than males (53%). Males accumulated significantly more surgical shadowing hours than females (P < .05). DISCUSSION: Findings from this study describe a novel PMSE at a large undergraduate institution. Survey data of PMSE participants revealed a high proportion of female respondents would like to pursue a career in surgery and reported confidence in achieving this. However, females perceived the field to be less inclusive than male respondents. Improving inclusivity may require increased focus and attention by PMSEs and surgical education programs.

Internet addiction, depressive symptoms, and anxiety symptoms are associated with the risk of eating disorders among university students in Bangladesh.

The risk of developing an eating disorder among university students is higher than the general population in Bangladesh. Since psychiatric disorders (such as depression and anxiety) and addictive behaviors (e.g., internet addiction) predominantly exist among university students in the country, these may increase their vulnerability to developing an eating disorder. The association of internet addiction, depression, and anxiety with the risk of eating disorders among Bangladeshi university students is relatively unknown; therefore, this study investigates the association. This study was a cross-sectional design. Students (N = 700) from two public universities in Bangladesh completed the Patient Health Questionnaire (PHQ-9) scale, the Generalized Anxiety Disorder (GAD-7) tool, and Orman's Internet Addiction Survey (OIAS) to measure exposure variables. Eating Attitudes Test-26 (EAT-26) assessed the outcome variable. Multivariable logistic regression analysis showed that internet addiction [adjusted odds ratio (aOR) for moderate addiction = 2.15 and severe addiction = 3.95], depressive (aOR 3.04), and anxiety (aOR 2.06) symptoms were associated with an increased risk of eating disorder among study participants. Future longitudinal studies on university students are recommended to gain a better understanding about the causal factors of eating disorder to support intervention initiatives and strategies by public health practitioners and policy experts.

Prevalence and predictors of binge eating disorder symptoms among a sample of university students in Bangladesh: A cross-sectional survey.

Background and Aims: There is a dearth of information about binge eating disorder (BED) among Bangladeshi university students, who may be more susceptible to BED due to the rise in unhealthy lifestyles and food habits. Therefore, the purpose of this study was to assess the prevalence and associated factors of BED symptoms among Bangladeshi university students. Methods: Students (N = 525) from three public universities in Bangladesh participated in this cross-sectional study between November 2022 and March 2023. Face-to-face interviews were conducted using a structured paper-based questionnaire that included two validated survey tools; the binge eating disorder screener and the patient health questionnaire-9. To identify the factors associated with BED symptoms, multiple logistic regression analysis was conducted, with sociodemographic and behavioral information (e.g., age, sex, smoking status, etc.) considered as covariates. Results: The prevalence of BED symptoms among participants (mean age 21.28 years, 50.3% male and 49.7% female) was 20.6%. Male students had a 2.28 times higher likelihood of having BED symptoms compared to female counterparts (adjusted odds ratio [AOR] = 2.28; 95% CI: 1.33-3.89). Older students (AOR = 3.56, 95% CI: 1.80-7.05), students who were overweight or obese (AOR = 3.32, 95% CI: 1.87-5.89), and students reporting higher depressive symptoms (AOR = 2.69, 95% CI: 1.66-4.35) were at greater risk for developing BED compared to their respective counterparts. Conclusions: This study provides new insights into the prevalence of BED symptoms and its contributing factors among Bangladeshi students. Approximately 1-in-5 university students reported having BED symptoms. University students who are older, overweight, or obese, and who report depressive symptoms may be at greatest risk. Future longitudinal studies are needed to determine the causal factors underlying BED. Findings from this study can assist policymakers and public health professionals in developing effective and targeted strategies to mitigate the risks associated with BED among Bangladeshi university students.

Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot.

BACKGROUND: The use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties. METHODS: Teams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size. RESULTS: TECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention. CONCLUSIONS: A gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support). TRIAL REGISTRATION: Clinicaltrials.gov ( NCT03509129 , April 26, 2018).

Exposure to secondhand smoke is associated with poor sleep quality among non-smoking university students in Bangladesh: a cross-sectional survey.

Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an under-investigated area of the country's public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students.

Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction.

BACKGROUND: Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. OBJECTIVE: To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). METHOD: Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. RESULTS: Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26). CONCLUSION AND RELEVANCE: Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.

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.

Free Summer Day Camp to Address Childhood Obesity: Is There Demand?

Children from low-income households, and who are overweight or obese (OWOB), are at risk of accelerated weight gain during summer. Summer day camps (SDCs) have the potential to mitigate accelerated weight gain during summer as these settings can positively influence children's obesogenic behaviors (i.e., increase physical activity); however, barriers exist to attending, most notably cost. Little is known on whether low-income caregivers of children with OWOB would be interested in having their child attend SDC for free. Caregivers (n = 109, 82% mother respondents, >75% Medicaid and Minority Household) with a child attending pediatric endocrinology clinics completed a one-page survey to explore demand. Approximately 66% of respondents expressed interest for their child to attend SDC for free. Providing free SDC for children with OWOB and from low-income households is a possible strategy to tackle childhood obesity during summer.

Determinants of health care seeking behavior for childhood infectious diseases and malnutrition: A slum-based survey from Bangladesh.

This study aimed to explore the magnitude and determinants of health care seeking behaviors for common infectious disease and malnutrition among Bangladeshi under-five children living in slum areas. A cross-sectional study of 300 children-caregiver dyads was conducted in an urban slum of Bangladesh. Data were collected via a structured questionnaire with accompanying anthropometric assessments of children administered by research staff. Multiple logistic regression was employed to identify associated factors of health care seeking behaviors. Only 44.7% and 13.0% of respondents sought care for childhood infectious diseases and malnutrition, respectively. Being a male child, 2-5 years old, having ≤5 family members, monthly family income >125$, and living in close proximity to a health facility were found to be potential determinants of health care seeking behavior for childhood infectious diseases. Mother/caregivers with poor nutritional information knowledge and who had a child 2-5 years old reported engaging in less care seeking behaviors regarding their child's malnutrition compared to their counterparts. Caregivers of children under the age of 5 years old reported low participation in health care seeking behaviors in relation to childhood infectious disease and malnutrition. Families living in slums require additional support targeting health and nutritional educational programs.

Accuracy and Precision of Opportunistic Measures of Body Composition from the Tanita DC-430U.

Background: It is essential to quantify the accuracy and precision of bioelectrical impedance (BIA)-estimated percent body fat (%BF) to better interpret community-based research findings that utilize opportunistic measures. Methods: Study 1 measured the accuracy of a new dual-frequency foot-to-foot BIA device (Tanita DC-430U) compared with dual-energy X-ray absorptiometry (DXA) among healthy elementary school-aged children (N = 50). Study 2 examined the precision of BIA %BF estimates within and between days among children and adults (N = 38). Results: Regarding accuracy, Tanita DC-430U underestimated %BF by 8.0 percentage points compared with DXA (20.6% vs. 28.5%), but correctly ranked children in terms of %BF. Differences in %BF between BIA and DXA were driven by lower BIA-estimated fat mass (7.8 kg vs. 9.9 kg, p < 0.05) and higher BIA-estimated fat-free mass (25.3 kg vs. 24.1 kg, p < 0.05). The absolute agreement between BIA and DXA for estimated %BF was moderate (concordance correlation coefficients = 0.53). Regarding precision, measures taken at the same time, but on different days (root mean square standard deviation [RMSD] = 0.42-0.74) were more precise than the measures taken at different times within a single day (RMSD = 1.04-1.10). Conclusion: The Tanita DC-430U substantially underestimated %BF compared with DXA, highlighting the need to assess accuracy of new BIA devices when they are introduced to the market. Opportunistic measures of %BF estimates were most precise when taken at consistent times and in the morning, but may be utilized throughout the day with an understanding of within- and between-day variability.

Association between Nutrition Literacy and Bangladeshi Adults' Healthy Eating Behaviors: Evidence from the Nutrition Literacy Study 2021.

This study investigated the association between healthy eating behaviors and nutrition literacy in a sample of Bangladeshi adults. A cross-sectional survey was conducted among 400 adults from two districts of Bangladesh (Dhaka and Chattogram). Data were generated by in-person interviews using a structured questionnaire. The Nutrition Literacy Scale and National Dietary Guidelines for Bangladesh were used to assess nutrition literacy and healthy eating behaviors, respectively. Multiple linear regression models were used to observe the association. The mean score for healthy eating behavior was 21.8 (SD = 4.8, Range: 5−33) on a scale of 34. A moderate positive correlation was found between nutrition literacy and healthy eating behavior of participants (r = 0.28, p < 0.001). The adjusted regression model showed that a 1 unit increase in nutrition literacy reflected an increase in the healthy eating behavior score of participants by 0.22 units (ß = 0.223, p < 0.001). Findings showed an association between nutrition literacy and eating behaviors in Bangladeshi adults. Future research could be carried out to establish a causal relationship that may help inform the necessity of educational interventions for Bangladeshi adults to assist with meeting national nutrition-related targets.

COVID-19 mitigation strategies: A natural experiment highlighting the importance of structure in the prevention and treatment of childhood obesity.

Societal restrictions due to the Coronavirus Disease 2019 (COVID-19), such as the closure of schools, childcare centers, and community programs, were implemented to prevent the spread of the disease and to protect the health and well-being of the population. These mitigation efforts drastically interrupted the day-to-day environments of children and adolescents and influenced how they spent the majority of their waking hours. Evidence shows on days when children and adolescents are in "structured" settings, such as school or other extracurricular programs or day camps, their obesogenic behaviors (i.e., sleep, physical activity, diet, and screen/media time) are more favorable than on days with less structure (e.g., summer days, weekends). Although obesity is driven by complex interactions between environmental, behavioral, biological, and genetic factors, COVID-19 pandemic closures emphasized the importance of daily structure. This short communication used a tertiary examination of the literature to show how societal restrictions and mitigation strategies resulted in significant increases in childhood and adolescent obesity on a global scale and highlights the importance of key underlying principles of the Structured Days Hypothesis (SDH). Closure of schools and other structured programs as a result of COVID-19 exposed youth to prolonged periods of less-structured environments as youth spent considerably more time at home than normal. Societal restrictions and mitigation strategies as a result of COVID-19 inadvertently demonstrated the importance of structure in shaping children's health behaviors and weight-related outcomes. Public health practitioners and researchers should consider this framework in the development of interventions to prevent and treat obesity in youth.

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.

The Association Between Bangladeshi Adults' Demographics, Personal Beliefs, and Nutrition Literacy: Evidence From a Cross-Sectional Survey.

Background: Poverty and health illiteracy, combined with inappropriate systems to track disease and infection rates, contribute to children-and-mothers' poor adherence to nutrient-rich foods intake in Bangladesh. Although risk factors for child and pregnant women malnutrition have been explored, the relationship between Bangladeshi adults' nutrition literacy and their demographics and personal beliefs remains unknown. The purpose of this study was to examine the association between adults' nutrition literacy, demographics and personal beliefs in a large sample of Bangladeshi adults. Methods: Four hundred adults from two districts (Dhaka and Chattogram) of Bangladesh participated in a cross-sectional survey. Data were collected by interviews using a structured questionnaire containing the Nutrition Literacy Scale. Multiple linear regression models were employed to analyze associations between nutrition literacy and related factors. Results: The mean nutrition literacy score was 21.6 (SD: 3.7; range: 11-32) on a scale of 32. Multiple linear regression revealed that being a businessman (ß = 1.66, p = 0.013) or private employee (ß = 1.08, p = 0.030), having a higher family income (ß = 1.17, p = 0.009), and a higher educational level were positively associated with higher nutrition literacy scores compared to their counterparts. Participants who had ever completed a nutrition-related course (ß = 4.95, p < 0.001), and who perceived themselves as having a need for accessing nutrition-related information were positively associated with the higher nutrition literacy compared to their counterparts. Conclusion: Findings from this study suggest the need for an integrated response plan involving educational interventions and accessible dietary plans targeting adult populations to enhance their nutritional literacy.

Healthy Summer Learners: An explanatory mixed methods study and process evaluation.

Healthy Summer Learners (HSL), a novel, 6-week summer program for 2-4th grade children from low-income families in the Southeastern United States, aimed to prevent accelerated summer BMI gain and academic learning loss by providing healthy meals and snacks, 15 min of nutrition education, 3 h of physical activity opportunities and 3.5 h of reading instruction daily. This three-armed pilot quasi-experimental study used a repeated measure within- and between-participant design to compare HSL, to an active comparator-21st Century Summer Learning Program (21 C), and no-treatment control. A mixed-methods process evaluation was employed to evaluate program implementation and provide insight for future program development. Though the program was well received, student attendance was lower than anticipated and full program fidelity was not achieved. During interviews, both parents and teachers noted that the bussing schedule was inconsistent, making attendance difficult for some families. These process evaluation findings may help explain why no statistically significant group-by-time interactions at 3- or 12-month follow up were found for the primary outcomes of zBMI or MAP reading score. Future iterations of HSL should seek to extend program hours, lengthen program duration, and explore ways to lower projected cost of attendance.

Examining adolescents' obesogenic behaviors on structured days: a systematic review and meta-analysis.

BACKGROUND: The structured days hypothesis posits that 'structured days' (i.e., days with pre-planned, segmented, and adult-supervised environments) reduce youth obesogenic behaviors. Structured days may be especially important for adolescents', as adolescence (12-19 years) is a period of developmental milestones and increased autonomy. Therefore, the objective of this systematic review and meta-analysis is to evaluate the relationship between structured days and adolescents' obesogenic behaviors (i.e., physical activity, diet, screen time, and/or sleep). METHODS: From February to April of 2020, four databases (i.e., Embase, PubMed, Web of Science, and PsychINfo) were searched for cross-sectional, longitudinal, and intervention (i.e., baseline data only) studies reporting obesogenic behaviors on more structured versus less structured days (i.e., weekday versus weekend or school year versus summer/holiday). RESULTS: A total of 42,878 unique titles and abstracts were screened with 2767 full-text articles retrieved. After review of full-text articles, 296 studies were identified (sleep k = 147, physical activity k = 88, screen time k = 81, diet k = 8). Most studies were conducted in North America, Europe & Central Asia, or East Asia & the Pacific used self-report measures and compared school days to weekend days. Meta-analyses indicated that adolescents' physical activity (standardized mean difference [SMD] = -0.25 [95%CI - 0.48, -0.03]) and screen time (SMD = -0.48 [95%CI - 0.66, -0.29]) were less healthy on less structured days. Differences did not reach statistical significance for sleep (SMD = -0.23 [95%CI - 0.48, 0.02]) and diet (SMD = -0.13 [95%CI - 0.77, 0.51]), however, sleep timing (SMD = -1.05 [95%CI - 1.31, -0.79]) and diet quantity (SMD = -0.29 [95%CI - 0.35, -0.23]) were less healthy on less structured days. The review identified studies with large heterogeneity. CONCLUSIONS: Findings indicate that adolescents' physical activity, screen time, sleep timing, and diet quantity are less healthy on less structured days. Interventions for adolescents to prevent and treat obesity may be more successful if they are designed to target times that are less structured.