Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer.

Importance: Fertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population's fertility perceptions and their alignment with objective infertility risk are scant. Objective: To assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception. Design, Setting, and Participants: This retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022. Exposures: Participants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review. Main Outcomes and Measures: Participants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk. Results: This study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation. Conclusions and Relevance: In this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.

HPV Vaccine Misperceptions Among Hispanics/Latinos in Southern California.

BACKGROUND: Cervical and other vaccine-preventable HPV-associated cancers disproportionately impact Hispanic/Latinos in the USA. HPV vaccine uptake may be impacted by community agreement with common HPV vaccine misperceptions. It is unknown whether Hispanics/Latinos have a greater agreement with these misperceptions relative to non-Hispanic whites. METHODS: HPV vaccine misperceptions were assessed through a 12-item Likert scale included in a population health assessment mailed to households in the southwest United States. Linear regression models assessed the association between identifying as Hispanic/Latino and summed misperception score. RESULTS: Among the 407 individuals in the analytic sample, 111 (27.3%) were Hispanic/Latino and 296 (72.7%) were non-Hispanic white. On average, Hispanics/Latinos had a 3.03-point higher HPV vaccine misperception sum score relative to non-Hispanic whites, indicating greater agreement with misperceptions (95% confidence interval: 1.16-4.88; p < 0.01). DISCUSSION: Culturally relevant interventions are needed to address HPV vaccine misperceptions among Hispanics/Latinos as part of efforts toward HPV-associated cancer health equity.

Factors predicting parent engagement in a family-based childhood obesity prevention and control program.

BACKGROUND: Family-based interventions are efficacious at preventing and controlling childhood overweight and obesity; however, implementation is often hindered by low parent engagement. The purpose of this study was to evaluate predictors of parent engagement in a family-based childhood obesity prevention and control intervention. METHODS: Predictors were assessed in a clinic-based community health worker (CHW)-led Family Wellness Program consisting of in-person educational workshops attended by parents and children. This program was part of a larger effort known as the Childhood Obesity Research Demonstration projects. Participants included 128 adult caretakers of children ages 2-11 (98% female). Predictors of parent engagement (e.g., anthropometric, sociodemographic, psychosocial variables) were assessed prior to the intervention. Attendance at intervention activities was recorded by the CHW. Zero-inflated Poisson regression was used to determine predictors of non-attendance and degree of attendance. RESULTS: Parents' lower readiness to make behavioral and parenting changes related to their child's health was the sole predictor of non-attendance at planned intervention activities in adjusted models (OR = 0.41, p < .05). Higher levels of family functioning predicted degree of attendance (RR = 1.25, p < .01). CONCLUSIONS: To improve engagement in family-based childhood obesity prevention interventions, researchers should consider assessing and tailoring intervention strategies to align with the family's readiness to change and promote family functioning. TRIAL REGISTRATION: NCT02197390, 22/07/2014.

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study.

PURPOSE: Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors. METHODS: A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations. RESULTS: Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior. CONCLUSIONS: Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA. IMPLICATIONS FOR CANCER SURVIVORS: Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

The Promoting Equity in Stem Cell Genomics Survey.

Aim: This study aimed to determine knowledge and attitudes toward induced pluripotent stem cell technology and biobanking. Methods: A survey instrument was developed to determine individuals' knowledge of and attitudes toward these technologies. Results: Results from 276 ethnically diverse participants who took the online survey demonstrated significant associations (p ≤ 0. 05) in knowledge by ethnicity and race regarding properties of stem cells, different types of stem cells and previous sample donation behavior. Significantly more Whites 39% (n = 53) compared with Blacks or African-Americans 19.2% (n = 14) had previous knowledge of induced pluripotent stem cells (χ2 = 8.544; p = 0.003) Conclusion: Overall, White race was associated with greater knowledge about stem cells and biobanks and greater willingness to donate samples for future research.

Stem cell biobanks have few samples from minorities for genomic studies. We conducted an online survey to understand knowledge and attitudes toward stem cell biobanks and technologies. Overall, we learned that White race was associated with the greatest knowledge about stem cell biobanks and willingness to contribute tissue samples for biobanks. More education is required so that minorities are willing to contribute tissue samples toward stem cell biobanks. This will help researchers study the genomic bases of disease and pursue translational research toward addressing health inequities.

Association between pregnancy intention and preconception health behaviors.

BACKGROUND: Female adolescent and young adult (AYA) cancer survivors face higher infertility and pregnancy risks than peers with no cancer history. Preconception health behaviors such as physical activity (PA), tobacco smoking, and alcohol intake influence reproductive outcomes. In general populations, pregnancy intention is positively associated with healthy preconception behaviors, but it has not been studied among AYA survivors. The authors hypothesized that higher pregnancy intention would be associated with healthier behaviors, especially among AYA survivors with perceived infertility risk. METHODS: A cross-sectional analysis was conducted with data collected between 2013 and 2017 from 1071 female AYA survivors aged 18 to 39 years who had completed their primary cancer treatment and enrolled in an ovarian function study. Self-reported intention dimensions were measured as a pregnancy intention score (PIS) and trying now to become pregnant. Multivariable linear (PA), binary (smoking), and ordinal (alcohol use) logistic regressions were used to estimate associations between intentions and preconception behaviors, with adjustments made for demographic and cancer characteristics. Effect modification by perceived infertility risk was assessed. RESULTS: The mean PIS was 1.1 (SD, 0.77) on a 0 to 2 scale (2 = high intention), and 8.9% were attempting pregnancy now. A higher PIS was associated with increased PA (ß, 0.08; 95% CI, 0.11-1.04), whereas ambivalence in pregnancy intention was associated with lower alcohol consumption (odds ratio, 0.72; 95% CI, 0.55-0.95). Pregnancy intentions were not associated with smoking. Perceived infertility risk strengthened the relationship between PIS and PA (P < .05). CONCLUSIONS: Pregnancy intentions were associated with some healthier preconception behaviors in AYA survivors. Medical professionals caring for AYA survivors may consider pregnancy intention screening to guide conversations on preconception health.

Conceptualizing an Interdisciplinary Collective Impact Approach to Examine and Intervene in the Chronic Cycle of Homelessness.

Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region.

Educating the Next Generation of Undergraduate URM Cancer Scientists: Results and Lessons Learned from a Cancer Research Partnership Scholar Program.

To improve cancer disparities among under-represented minority (URM) populations, better representation of URM individuals in cancer research is needed. The San Diego State University and University of California San Diego Moores Cancer Center Partnership is addressing cancer disparities through an educational program targeting undergraduate URM students. The Partnership provides a paid intensive summer research internship enriched with year-round activities that include educational sessions, a journal club, mentorship, social activities, and poster sessions and presentations. Program evaluation through follow-up surveys, focus groups, and other formal and informal feedback, including advisory and program steering committees, are used to improve the program. Long-term follow-up among scholars (minimum of 10 years) provides data to evaluate the program's long-term impact on scholars' education and career path. Since 2016, 63 URM undergraduate students participated in the scholar program. At the year-2 follow-up (2016 cohort; n = 12), 50% had completed their Graduate Record Examination (GRE) and/or applied to graduate or medical school. Lessons learned during the course of the program led to implementation of changes to provide a better learning experience and increase overall program satisfaction. Updates were made to recruitment timeline, improvements of the recruitment processes, refinement of the program contracts and onboarding meetings, identification of essential program coordinator skills and responsibilities, adjustments to program components, and establishment of a well-mapped and scheduled evaluation plan. The Partnership identified best practices and lessons learned for implementing lab-based internship scholar programs in biomedical and public health fields that could be considered in other programs.

A Promotor-Led Pilot Study to Increase Colorectal Cancer Screening in Latinos: The Juntos Contra El Cáncer Program.

Background. Latinos have lower colorectal cancer (CRC) screening rates compared to other racial/ethnic groups in the United States, despite an overall increase in CRC screening over the past 10 years. To address this disparity, we implemented a promotor-led intervention to increase CRC screening test adherence in community-based settings, connecting community members with a partnering federally qualified health center. Purpose. To evaluate the Juntos Contra el Cáncer/Together Against Cancer (JUNTOS) intervention, by assessing pre-post changes in (1) CRC screening test adherence and (2) CRC knowledge and perceived barriers to CRC screening. We also assessed the feasibility and acceptability of program activities. Method. JUNTOS was a group-based intervention, delivered by promotores (community health workers), to promote CRC screening test adherence among Latino adults. The intervention consisted of a culturally tailored 2½-hour interactive workshop followed by an appointment scheduling assistance from a promotor. Workshop participants were Latino adults (males and females) aged 50 to 75 years who were not up-to-date with CRC screening guidelines. We conducted interviews before and 6 to 9 months after the workshop to assess program outcomes. Results. Of the 177 participants included, 118 reported completing the CRC screening test (66.7%) by 6 to 9 months postintervention. We observed baseline to 6- to 9-month increase in CRC knowledge and lower perceived barriers to obtaining CRC screening. Furthermore, the intervention was found to be feasible and acceptable. Conclusion. Results suggest that JUNTOS can be feasibly implemented in partnership with a federally qualified health center. The current study supports group-based CRC interventions in community and clinic settings.

Evaluating Research Centers in Minority Institutions: Framework, Metrics, Best Practices, and Challenges.

The NIH-funded Research Centers in Minority Institutions (RCMI) program is currently funding 18 academic institutions to strengthen the research environment and contribution to health disparities research. The purpose of this multiphase mixed-methods study was to establish a uniform evaluation framework for demonstrating the collective success of this research consortium. Methods included discussions of aims and logic models at the RCMI Evaluators' Workshop, a literature review to inform an evaluation conceptual framework, and a case study survey to obtain evaluation-related information and metrics. Ten RCMIs participated in the workshop and 14 submitted responses to the survey. The resultant RCMI Evaluation Conceptual Model presents a practical ongoing approach to document RCMIs' impacts on health disparities. Survey results identified 37 common metrics under four primary categories. Evaluation challenges were issues related to limited human resources, data collection, decision-making, defining metrics, cost-sharing, and revenue-generation. There is a need for further collaborative efforts across RCMI sites to engage program leadership and community stakeholders in addressing the identified evaluation challenges and measurement. Program leadership should be engaged to apply the Evaluation Conceptual Framework and common metrics to allow for valid inter-institutional comparisons and consortium-wide evaluations. Stakeholders could ensure evaluation metrics are used to facilitate community impacts.

A Statement of Commitment to Zero Tolerance of Harassment and Discrimination in Schools and Programs of Public Health.

The Association of Schools and Programs of Public Health convened a Task Force on Zero Tolerance of Harassment and Discrimination in 2019 to develop a policy statement and strategies for addressing harassment of all types in institutions offering public health education. We outline the premises and scholarly foundation for the development of the Statement of Commitment to Zero Tolerance of Harassment and Discrimination, the statement itself, and future plans for realizing the aspiration established in the statement. The development of this living document is predicated on the belief that it is the core responsibility of academic institutions to build the knowledge and that it is the responsibility of leaders, namely deans of schools of public health and directors of public health programs, to lead in building the shared knowledge and insist on the practices that create institutions for a better future free of harassment and discrimination. Our statement is informed by the knowledge that aggressions in the form of harassment and discrimination undermine the health and well-being of individuals, the public, and populations.

The search for the ejecting chair: a mixed-methods analysis of tool use in a sedentary behavior intervention.

Research is needed on interventions targeting sedentary behavior with appropriate behavior-change tools. The current study used convergent sequential mixed methods (QUAN + qual) to explore tool use during a edentary behavior intervention. Data came from a two-arm randomized sedentary behavior pilot intervention. Participants used a number of intervention tools (e.g., prompts and standing desks). Separate mixed-effects regression models explored associations between change in number of tools and frequency of tool use with two intervention targets: change in sitting time and number of sit-to-stand transitions overtime. Qualitative data explored participants' attitudes towards intervention tools. There was a significant relationship between change in total tool use and sitting time after adjusting for number of tools (ß = -12.86, p = .02), demonstrating that a one-unit increase in tool use was associated with an almost 13 min reduction in sitting time. In contrast, there was a significant positive association between change in number of tools and sitting time after adjusting for frequency of tool use (ß = 63.70, p = .001), indicating that increasing the number of tools without increasing frequency of tool use was associated with more sitting time. Twenty-four semistructured interviews were coded and a thematic analysis revealed four themes related to tool use: (a) prompts to disrupt behavior; (b) tools matching the goal; (c) tools for sit-to-stand were ineffective; and (d) tool use evolved over time. Participants who honed in on effective tools were more successful in reducing sitting time. Tools for participants to increase sit-to-stand transitions were largely ineffective. This study is registered at clincialtrials.gov. Identifier: NCT02544867.

Profiles of a Health Information-Seeking Population and the Current Digital Divide: Cross-Sectional Analysis of the 2015-2016 California Health Interview Survey.

BACKGROUND: Internet use for health information is important, given the rise of electronic health (eHealth) that integrates technology into health care. Despite the perceived widespread use of the internet, a persistent "digital divide" exists in which many individuals have ready access to the internet and others do not. To date, most published reports have compared characteristics of internet users seeking health information vs nonusers. However, there is little understanding of the differences between internet users seeking health information online and users who do not seek such information online. Understanding these differences could enable targeted outreach for health interventions and promotion of eHealth technologies. OBJECTIVE: This study aims to assess population-level characteristics associated with different types of internet use, particularly for seeking online health information. METHODS: The 2015-2016 California Health Interview Survey datasets were used for this study. Internet use was classified as never used the internet (Never use), ever used the internet but not to search for health information in the last 12 months (Use not for health), and ever used the internet and have used it to search for health information in the last 12 months (Use for health). Weighted multinomial logistic regression was used to assess sociodemographic and health characteristics associated with types of internet use. Findings are reported as odds ratios (ORs) with 95% CIs. RESULTS: Among 42,087 participants (weighted sample of 29,236,426), 19% reported Never Use of the internet, 27.9% reported Use not for health, and 53.1% reported Use for health. Compared to Never Use individuals, Use for health individuals were more likely to be younger (OR: 0.1, 95% CI 0.1-0.2 for ≥60 years vs <60 years), female (OR: 1.6, 95% CI 1.3-1.9 compared to males), and non-Hispanic white (OR: 0.54, 95% CI 0.4-0.7 for Latinos and OR: 0.2, 95% CI 0.2-0.4 for African Americans) and have a higher socioeconomic status (>400% of Federal Poverty Guidelines; OR: 1.3, 95% CI 1.4-2.4). Overall, characteristics for the Use not for health and Use for health groups were similar, except for those with lower levels of education and respondents not having visited a physician in the last year. For these two characteristics, the Use not for health group was more similar to the Never Use group. CONCLUSIONS: Our findings indicate that a digital divide characterized by sociodemographic and health information exists across three types of users. Our results are in line with those of previous studies on the divide, specifically with regard to disparities in use and access related to age, race/ethnicity, and socioeconomic status. Disparities in online health-seeking behavior may reflect existing disparities in health care access extending into a new era of health technology. These findings support the need for interventions to target internet access and health literacy among Never Use and Use not for health groups.

The My Body Knows When Program Increased Intuitive Eating Characteristics in a Military Population.

INTRODUCTION: The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode. MATERIALS AND METHODS: Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power). RESULTS: Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m2. There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (-0.4 ± 0.6 kg/m2; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; -0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; -0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects. CONCLUSIONS: The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain).

Participants' Perceptions on the Use of Wearable Devices to Reduce Sitting Time: Qualitative Analysis.

BACKGROUND: Recent epidemiological evidence indicates that, on average, people are sedentary for approximately 7.7 hours per day. There are deleterious effects of prolonged sedentary behavior that are separate from participation in physical activity and include increased risk of weight gain, cancer, metabolic syndrome, diabetes, and heart disease. Previous trials have used wearable devices to increase physical activity in studies; however, additional research is needed to fully understand how this technology can be used to reduce sitting time. OBJECTIVE: The purpose of this study was to explore the potential of wearable devices as an intervention tool in a larger sedentary behavior study through a general inductive and deductive analysis of focus group discussions. METHODS: We conducted four focus groups with 15 participants to discuss 7 different wearable devices with sedentary behavior capabilities. Participants recruited for the focus groups had previously participated in a pilot intervention targeting sedentary behavior over a 3-week period and were knowledgeable about the challenges of reducing sitting time. During the focus groups, participants commented on the wearability, functionality, and feedback mechanism of each device and then identified their two favorite and two least favorite devices. Finally, participants designed and described their ideal or dream wearable device. Two researchers, who have expertise analyzing qualitative data, coded and analyzed the data from the focus groups. A thematic analysis approach using Dedoose software (SocioCultural Research Consultants, LLC version 7.5.9) guided the organization of themes that reflected participants' perspectives. RESULTS: Analysis resulted in 14 codes that we grouped into themes. Three themes emerged from our data: (1) features of the device, (2) data the device collected, and (3) how data are displayed. CONCLUSIONS: Current wearable devices for increasing physical activity are insufficient to intervene on sitting time. This was especially evident when participants voted, as several participants reported using a "process of elimination" as opposed to choosing favorites because none of the devices were ideal for reducing sitting time. To overcome the limitations in current devices, future wearable devices designed to reduce sitting time should include the following features: waterproof, long battery life, accuracy in measuring sitting time, real time feedback on progress toward sitting reduction goals, and flexible options for prompts to take breaks from sitting.

A Qualitative Examination of Parent Engagement in a Family-Based Childhood Obesity Program.

Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.

International migration and dietary change in Mexican women from a social practice framework.

Migration from lower- and middle-income to high-income countries is associated with dietary change, and especially with the adoption of a modern, less healthy diet. In this article we analyze the dietary changes experienced by Mexican migrants, employing as a theoretical framework the concept of social practice. According to this framework, practices integrate material elements, meanings and competences that provide their conditions of possibility. Practices are shared by members of social groups, and interact with other competing or reinforcing practices. Between 2014 and 2015, we conducted semi-structured interviews with 27 women, international return migrants living in Tijuana, Mexico. The interview guide asked about history of migration and dietary change. We found three main areas of dietary change: from subsistence farming to ready meals, abundance vs. restriction, and adoption of new food items. The first one was associated with changes in food procurement and female work: when moving from rural to urban areas, participants substituted self-produced for purchased food; and as migrant women joined the labor force, consumption of ready meals increased. The second was the result of changes in income: participants of lower socioeconomic position modified the logic of food acquisition from restriction to abundance and back, depending on the available resources. The third change was relatively minor, with occasional consumption of new dishes or food items, and was associated with exposure to different cuisines and with learning how to cook them. Public health efforts to improve the migrants' diets should take into account the constitutive elements of dietary practices, instead of isolating individuals from their social contexts.

A Cluster Randomized Trial to Promote Healthy Menu Items for Children: The Kids' Choice Restaurant Program.

Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.