Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study.

BACKGROUND: COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. METHODS: The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. CONCLUSION: Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.

Perceptions of Parental Support for Physical Activity and Healthy Eating among School-age Children During COVID-19 pandemic.

Family routines play a key role in promoting child health behaviors. This study 1) describes changes in children's perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explores how sex, age, and pandemic-related economic stressors relate to changes. Children's perceptions of family routines were assessed using four subscales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Linear mixed models assessed changes in perceptions and associated factors (child age and sex; caregiver(s) job loss during pandemic). Children (N=277) were aged 9.3-15.5y at pandemic onset (March 2020), dichotomized by median age (12.1y) as younger and older. Children's perceptions of PA-policies (pre-pandemic mean=15.4) and Diet-policies (pre-pandemic mean=26.3) increased significantly from pre- to early (b=1.2 and 2.3, respectively) and mid-pandemic (b=1.0 and 1.2, respectively). Diet-rules (pre-pandemic mean=10.8) decreased significantly from pre- to early (b=-1.1) and mid-pandemic (b=-2.0), with no PA-Diet-role-model changes. Younger children had a greater increase in perceived PA-policies and Diet-policies across the pandemic. Females (59.9%) had a greater decrease in perceived Diet-rules across the pandemic and less increase in Diet-policies and PA-Diet-role-model from pre- to early pandemic. Children whose caregiver(s) lost employment (51.8%) perceived a greater increase in PA-policies. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules for diet during the pandemic. Future research is needed to understand how changes in family routines relate to PA and healthy eating behaviors.

Challenges and Opportunities for Equity in US School Meal Programs: A Scoping Review of Qualitative Literature Regarding the COVID-19 Emergency.

The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families' needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity.

Overview and understanding of mental health and psychosocial support in Afghanistan.

More than four decades of war in Afghanistan has been both a main driver for poor mental health, and a barrier to the development of crucial mental health services. A study conducted by BMC Psychiatry in 2021, across eight regions in Afghanistan, found staggering levels of depressive and anxiety disorders among the general population. Almost one-half of those interviewed (47.12%) reported having high levels of distress in the last month, and almost 40% (39.44%) reported experiencing impairment to their lives due to poor mental health. Yet, despite the common experiences of much of the population, mental health is a hugely stigmatized topic of discussion in Afghanistan, due to a myriad of cultural, religious, socioeconomic and environmental factors. And now, under the de-facto Taliban government, mental health has been deprioritized in the face of a crumbling economy and acute levels of poverty, all but forgotten. This paper sought to review the impact and change to mental health services under the de-facto government, and to provide the reader with greater awareness into the current situation in Afghanistan and equip them with insight into how to respond to the mental health needs of Afghans.

Organizational trust, usability, and inclusivity are key implementation facilitators for a proposed assets-based mobile health intervention.

Assets-based interventions can address child health disparities by connecting families to existing community resources. Community collaboration when designing interventions may identify barriers and facilitators to implementation. The objective of this study was to identify crucial implementation considerations during the design phase of an asset-based intervention to address disparities in childhood obesity, Assets for Health. We conducted focus groups and semi-structured interviews with caregivers of children (<18 years) (N = 17) and representatives of community-based organizations (CBOs) which serve children and families (N = 20). Focus group and interview guides were developed based on constructs from the Consolidated Framework for Implementation Research. Data were analyzed using rapid qualitative analysis and matrices were used to identify common themes within and across groups of community members. Desired intervention characteristics included an easy-to-use list of community programs that could be filtered based on caregiver preferences and local community health workers to promote trust and engagement among Black and Hispanic/Latino families. Most community members felt an intervention with these characteristics could be advantageous versus existing alternatives. Key outer setting characteristics which were barriers to family engagement included families' financial insecurity and lack of access to transportation. The CBO implementation climate was supportive but there was concern that the intervention could increase staff workload beyond current capacity. Assessment of implementation determinants during the intervention design phase revealed important considerations for intervention development. Effective implementation of Assets for Health may depend on app design and usability, fostering organizational trust and minimizing the costs and staff workload of caregivers and CBOs, respectively.

The purpose of our work was to design a program to connect families with children to existing health-promoting resources in their communities (i.e., group exercise, food pantries, community gardens). We specifically wanted to capture the needs and preferences of parents with children and community-based organizations and determine the possible barriers to creating this program. Based on prior community listening sessions, the program, called Assets for Health, would consist of a mobile app which lists community resources and a community health worker to help connect families to these resources. We presented the idea for Assets for Health to a diverse group of parents and community-based organizations using focus groups and interviews to carefully capture their thoughts. We then analyzed what was said. This work showed that parents were struggling to find community programs that fit their needs and thought a program like Assets for Health could be helpful. Also organizations were struggling to show families that they could be trusted and that all families were welcome.

Physical Activity, Confidence, and Social Norms Associated With Teachers' Classroom Physical Activity Break Implementation.

Despite the benefits of classroom physical activity breaks on student health and academic outcomes, more research is needed to understand what factors may be associated with classroom physical activity break implementation, to bolster buy-in from school stakeholders and increase implementation. This quantitative study examined frequency of classroom physical activity break implementation in relation to (1) objectively measured teachers' physical activity and sedentary behaviors, (2) confidence for leading classroom physical activity breaks, (3) social norms (perceptions of other teachers' classroom physical activity break implementation), and (4) teacher- and school-level demographics. In total, 153 classroom teachers in 20 elementary and middle schools completed a survey including classroom physical activity break frequency, confidence, and social norms, one item each, dichotomized (1 = "most/all the time" OR "agree/strongly agree"). Accelerometry assessed total activity and daytime sedentary behavior. Analyses included multilevel binary logistic regression. Teachers were 90% female, 68% White, and 55% in elementary schools. Odds of implementing classroom physical activity breaks were lower among middle school teachers, 14 times greater among those with greater confidence, and over 17 times greater when teachers perceived others frequently implementing classroom physical activity breaks. Teacher activity was not associated with classroom physical activity break implementation. Future interventions to increase classroom physical activity break implementation should focus on increasing teachers' confidence to lead classroom physical activity breaks and creating more buy-in from classroom teachers to enhance each school's culture of health. By enhancing teacher confidence and social norms for implementing classroom physical activity breaks, we may increase school-based physical activity opportunities.

Geospatial Reach of the Maryland COVID-19 School Meals Response: Spring 2020.

OBJECTIVE: Examine characteristics of pandemic meal site (n = 602) location and meals served per site in Maryland, Spring 2020, following federal/state waivers for local meal site placement decision-making. METHODS: Using geographic information systems, we connected meal sites to census tract-level data and generated service areas from sites and distances from population-weighted census tract centroids to the closest pandemic meal site. Regression analysis determined associations of census tract pandemic meal site count and meals served per site with socioeconomic and demographic variables. RESULTS: Census tracts with more meal sites were urban (P < 0.001), food deserts (P < 0.001), and had higher percentages of children in poverty (P < 0.001). Sites serving fewer meals were in food deserts (P < 0.001) and areas with more children in poverty (P < 0.001). CONCLUSIONS AND IMPLICATIONS: Waivers allowing local meal site placement decision-making supported meal sites in high-need areas. Geospatial approaches could optimize site locations to ensure maximum reach to populations in need. Additional supports may be needed to ensure children in poverty areas receive meals distributed at these sites.

"Let's Use This Mess to Our Advantage": Calls to Action to Optimize School Nutrition Program beyond the Pandemic.

School nutrition programs mitigate food insecurity and promote healthy eating by offering consistent, nutritious meals to school-aged children in communities across the United States; however, stringent policy guidelines and contextual challenges often limit participation. During COVID-19 school closures, most school nutrition programs remained operational, adapting quickly and innovating to maximize reach. This study describes semi-structured interviews with 23 nutrition directors in North Carolina, which aimed to identify multi-level contextual factors that influenced implementation, as well as ways in which the innovations during COVID-19 could translate to permanent policy and practice change and improve program reach. Interviews were conducted during initial school closures (May-August 2020) and were deductively analyzed using the Social Ecological Model (SEM) and Consolidated Framework for Implementation Research (CFIR). Analysis elicited multiple relevant contextual factors: director characteristics (motivation, leadership style, experience), key implementation stakeholders (internal staff and external partners), inner setting (implementation climate, local leadership engagement, available resources, structural characteristics), and outer setting (state leadership engagement, external policies and incentives). Findings confirm the strength and resilience of program directors and staff, the importance of developing strategies to strengthen external partnerships and emergency preparedness, and strong support from directors for policies offering free meals to all children.

Patients' Experiences With Staphylococcus aureus and Gram-Negative Bacterial Bloodstream Infections: Results From Cognitive Interviews to Inform Assessment of Health-Related Quality of Life.

BACKGROUND: We previously conducted a concept elicitation study on the impact of Staphylococcus aureus and gram-negative bacterial bloodstream infections (SAB/GNB) on health-related quality of life (HRQoL) from the patient's perspective and found significant impacts on HRQoL, particularly in the physical and functional domains. Using this information and following guidance on the development of patient-reported outcome (PRO) measures, we determined which combination of measures and items (ie, specific questions) would be most appropriate in a survey assessing HRQoL in bloodstream infections. METHODS: We selected a variety of measures/items from the Patient-Reported Outcomes Measurement Information System (PROMIS) representing different domains. We purposefully sampled patients ~6-12 weeks post-SAB/GNB and conducted 2 rounds of cognitive interviews to refine the survey by exploring patients' understanding of items and answer selection as well as relevance for capturing HRQoL. RESULTS: We interviewed 17 SAB/GNB patients. Based on the first round of cognitive interviews (n = 10), we revised the survey. After round 2 of cognitive interviewing (n = 7), we finalized the survey to include 10 different PROMIS short forms/measures of the most salient HRQoL domains and 2 adapted questions (41 items total) that were found to adequately capture HRQoL. CONCLUSIONS: We developed a survey from well-established PRO measures that captures what matters most to SAB/GNB patients as they recover. This survey, uniquely tailored to bloodstream infections, can be used to assess these meaningful, important HRQoL outcomes in clinical trials and in patient care. Engaging patients is crucial to developing treatments for bloodstream infections.

Parent/Caregiver Views of the Effectiveness of Speech-Language Pathology for Children Born With Cleft Palate Delivered via Telemedicine During COVID-19.

PURPOSE: The purpose of this study was to describe and examine parent views of speech-language pathology (SLP) for children born with cleft palate delivered via telemedicine during the COVID-19 pandemic in the United Kingdom (UK). METHOD: Parents were asked whether they found this method of delivery "very effective," "somewhat effective," or "not at all effective." Free text was then invited. There were 212 responses. Ordinal chi-square, Kruskal-Wallis, or Fisher's exact tests examined associations between parent views of effectiveness and biological variables and socioeconomic status. Free text responses were analyzed using qualitative content analysis. RESULTS: One hundred and forty (66.0%) respondents reported that SLP delivered via telemedicine was "somewhat effective," 56 (26.4%) "very effective," and 16 (7.6%) "not at all effective." There was no evidence of an association between parent reported effectiveness and any of the explanatory variables. Parent-reported challenges impacting on effectiveness included technology issues and keeping their children engaged with sessions. Importantly, telemedicine was viewed as "better than nothing." CONCLUSIONS: Most parents reported that they felt SLP delivered via telemedicine during the first few months of the COVID-19 pandemic in the UK was at least "somewhat effective." It is important to interpret this in the context of there being no other method of service delivery during this time and that this study only represents families who were able to access SLP delivered via telemedicine. Further work is needed to identify which children with cleft palate might benefit from SLP delivered via telemedicine to inform postpandemic service provision.

Building a National Framework to Pair Scientists and Schools During a Global Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic forced the suspension of in-person education in schools serving students in kindergarten through 12th grade (K-12) across the United States. As time passed, teachers, students, and parents struggled with remote education. With limited guidance at the federal level, physicians and school leaders across the country collaborated to develop local solutions for schools. This article describes the lessons learned from the development of 4 academic-community partnerships and collaboration among these partnerships to provide national leadership on managing COVID-19 mitigation in the K-12 environment. In addition, we describe a pathway forward for using academic-community partnerships to improve child health.

Development and Interrater Reliability of an Observational School Environment Checklist: A Practical, Comprehensive Tool to Assess Healthy Eating and Physical Activity Opportunities in Schools.

INTRODUCTION: Comprehensive, objective assessment of schools' eating and physical activity environments is critical to developing and evaluating policies and interventions to reduce pediatric obesity inequities; however, few tools exist that describe the entire school comprehensively and are feasible with restricted resources. This study describes development and reliability of the observational school environment checklist (OSEC), a comprehensive observational audit tool. METHOD: We developed the OSEC through iterative adaptations of existing instruments and pilot testing. The tool assesses four focus areas: cafeteria, lobby/hallway, gym, and outdoor areas. For reliability testing, two trained auditors independently completed the OSEC and met to resolve disagreements. For items with poor agreement, a third independent coder coded photographs taken during auditing. Percent agreement and Cohen's kappa were calculated for all items and across four evidence-based constructs: atmosphere, accessibility, attractiveness, and advertising. RESULTS: After iterative development, the 88-item OSEC was tested for reliability in 18 schools. Items with poor (<80%) agreement or redundancy were discarded or reworded (n = 16 items). All four constructs had acceptable agreement, ranging by focus area: 72.3% (attractiveness), 86.3% to 97.1% (atmosphere), 82.9% to 100% (accessibility), and 92.9% (advertising). Cohen's kappa ranges were acceptable: 0.66-0.91 (atmosphere), 0.60-1.00 (accessibility), 0.46 (attractiveness), and 0.77 (advertising). After adding similar items across domains (n = 49) to improve comprehensiveness, the final tool contained 121 binary items. IMPLICATIONS: The OSEC reliably and comprehensively captures the school environment. It requires few resources or expertise to administer, has acceptable reliability, and can assess atmosphere, accessibility, attractiveness, and advertising in school areas where students engage in eating and physical activity.

A systematic review of early speech interventions for children with cleft palate.

BACKGROUND: Children with cleft palate with or without cleft lip (CP±L) are at high risk of problems with early speech sound production, and these difficulties can persist into later childhood. Early intervention could help to reduce the number of children whose problems become persistent. However, much research in the field to date has focused on older children. There is a need to determine if providing intervention during the phase of early typical speech development leads to better outcomes. AIMS: To review the evidence for the effectiveness of interventions targeting speech, delivered in the first 3 years of life for children with CP±L, and discuss factors such as intervention type, facilitator, dosage, outcome measures and the age of the child. METHODS & PROCEDURES: The systematic review was registered with PROSPERO (CRD42019121964). Eight bibliographic databases including CINAHL and MEDLINE were searched in August 2018. Studies were included if participants received speech and language interventions before 37 months and if they reported outcomes for speech. Two reviewers independently completed inclusion reviews, quality analysis and data extraction. OUTCOME & RESULTS: The review included seven papers: one pilot randomized controlled trial, one controlled trial, four cohort studies and one case series report. Interventions largely took a naturalistic approach, namely focused stimulation and milieu teaching. The findings provide preliminary support for naturalistic interventions and suggest that these interventions can be delivered by parents with suitable training. Studies included in the review provided low-strength evidence with variation in both the type of intervention, the manner of delivery and in the risk of bias in the designs used. CONCLUSIONS & IMPLICATIONS: The papers included in this review suggest that early naturalistic interventions can have positive impacts on the speech development of children with CP±L. However, the reported methodological quality of the publications overall was weak, and the current evidence lacks clarity and specificity in terms of therapy technique, delivery and optimum age of delivery. Future research should use more robust methodological designs to determine whether early speech interventions are beneficial for children born with CP±L. WHAT THIS PAPER ADDS: What is already known on the subject Children with CP±L show difficulties with early speech development and often have restricted speech sound inventories. They may reach the canonical babbling stage later than children without CP±L and studies have shown that 20% of children with CP±L have speech which is considered unintelligible or barely intelligible at age 5. It has been proposed that early intervention can lessen the impact of CP±L on speech development. However, currently, the evidence for early interventions for children with CP±L is limited, with the majority of studies focusing on children aged 3 years and older. What this paper adds to existing knowledge This paper reviews the evidence for different types of early interventions for speech provided to children born with CP±L and whether these interventions are effective in supporting speech sound development. In this review, early intervention is defined as intervention provided to children in the first 3 years of life. This review describes intervention approaches and how they are delivered for this population. What are the potential or actual clinical implications of this work? In the UK, children born with CP±L and their families are supported by National Health Service (NHS) services over a 20-year period and speech and language therapy sessions may take place over many weeks and months. If providing early intervention in the first 3 years of life is effective, there is the potential for improved speech outcomes in early childhood and a reduced burden of care on children, families and services. This review considers the evidence for early speech intervention for children with CP±L in the first 3 years of life and identifies areas for future research.

Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children.

OBJECTIVE: The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). DESIGN: We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programs (e.g. CARES stimulus payment, school meals). SETTING: Maryland, United States. PARTICIPANTS: Economically, geographically, and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n=496). RESULTS: Prevalence of risk of FI was unchanged (pre-pandemic: 22%, early-pandemic: 25%, p=0.27). Risk of early-pandemic FI was elevated for non-Hispanic Black (aRR=2.1 [95% CI 1.1, 4.0]) and Other families (aRR=2.6 [1.3, 5.4]) and families earning ≤300% federal poverty level. Among pre-pandemic food secure families, decreased income, job loss, and reduced hours were associated with increased early-pandemic FI risk (aRR=2.1 [1.2, 3.6] to 2.5 [1.5, 4.1]); CARES stimulus payment (aRR=0.5 [0.3, 0.9]) and continued school meal participation (aRR=0.2 [0.1, 0.9]) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net program participation was not associated with early-pandemic FI risk. CONCLUSIONS: The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics.

Disparities in Local Wellness Policies Implementation Across Maryland Schools.

BACKGROUND: School-level implementation of district-level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom-specific LWPs implementation were examined. METHODS: An administrator survey (N = 756 schools; 24/24 districts) included 6 classrooms LWP best-practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha = .71; elementary and middle/high examined separately) was used to examine associations with student body income (free-and-reduced priced meals (FARMS): ≤40%, 41-75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district-level clustering, with moderation examined. RESULTS: Classroom implementation scores were: elementary = 3.1 ± 1.8 (range: 0-6/6 items) and middle/high = 2.3 ± 1.6 (range:0-5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS-eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed. CONCLUSIONS: Disparities in classroom-specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low-income students.

Associations between elementary and middle school teachers' physical activity promoting practices and teacher- and school-level factors.

BACKGROUND: Few studies have evaluated teacher- and school-level characteristics associated with implementation of recommended physical activity (PA) promoting practices. The purpose of this study is to examine associations between teachers' PA practices and: [1] teacher-level factors, including their own PA, and [2] school-level factors. METHODS: This cross-sectional study examined time spent daily in light PA (LPA) and moderate-vigorous PA (MVPA) in association with 7 teacher PA practices among 288 classroom/special area teachers and teaching assistants in 20 urban, suburban and rural schools (recruited through a school wellness trial) in 4 districts. LPA and MVPA was assessed using 24-h ankle accelerometry (up to seven consecutive days). A sum score for teacher PA practices was assessed via survey (7 items; sum score range: 7-35; Cronbach's alpha = 0.73; higher scores indicate more PA promoting practices). Teacher-level factors included gender, race, self-reported height/weight, years teaching, and education. School-level factors included school type, free-and-reduced-price meal eligibility, student racial/ethnic composition, and urbanicity. Analyses included multilevel regression models, accounting for clustering within schools and adjusting for demographic covariates and school district. RESULTS: Teachers were 91% female, 63% elementary, 60% white, mean age 43.2 years (SD = 11.3), and 41% obese). Teachers wore accelerometers an average of 5.8 days, spent 399.6 min in LPA (SD = 85.0) per day, 24.1 min in MVPA (SD = 14.4) per day, and the mean teacher PA practices sum score was 22.4 (SD = 5.0). Every 15-min increase in MVPA was related to an increase in teacher PA practices sum score (coeff =1.07; SE = 0.28; p < 0.001). Female gender (versus males; coeff = - 1.95; SE = 0.92, p = 0.034), an obese weight status (versus non-obese; coeff = - 1.38; SE = 0.54, p = 0.010), and teaching in a middle school (versus elementary; coeff = - 3.86; SE = 0.54, p < 0.001) were associated with lower teacher PA practices scores. LPA was not associated with teacher PA promoting practices. CONCLUSIONS: Teachers with higher MVPA, but not higher LPA, and those without obesity were more likely to implement PA promoting practices that could positively impact their students' PA. Similar to prior studies, these practices were more commonly implemented in elementary schools and by male teachers. Future studies in schools should explore whether improvement of teacher health behaviors subsequently impacts student health behaviors. TRIAL REGISTRATION: Clinical Trials, NCT03432715 ; Registered on 02/2/2018.

Still striding toward social justice? Redirecting physical activity research in a post-COVID-19 world.

The COVID-19 crisis and parallel Black Lives Matter movement have amplified longstanding systemic injustices among people of color (POC). POC have been differentially affected by COVID-19, reflecting the disproportionate burden of ongoing chronic health challenges associated with socioeconomic inequalities and unhealthy behaviors, including a lack of physical activity. Clear and well-established benefits link daily physical activity to health and well-being-physical, mental, and existential. Despite these benefits, POC face additional barriers to participation. Thus, increasing physical activity among POC requires additional considerations so that POC can receive the same opportunities to safely participate in physical activity as Americans who are White. Framed within the Ecologic Model of Physical Activity, this commentary briefly describes health disparities in COVID-19, physical activity, and chronic disease experienced by POC; outlines underlying putative mechanisms that connect these disparities; and offers potential solutions to reduce these disparities. As behavioral medicine leaders, we advocate that solutions must redirect the focus of behavioral research toward community-informed and systems solutions.

Elementary Schools' Response to Student Wellness Needs during the COVID-19 Shutdown: A Qualitative Exploration Using the R = MC2 Readiness Heuristic.

During spring of 2020, the COVID-19 pandemic and accompanying public health advisories forced K-12 schools throughout the United States to suspend in-person instruction. School personnel rapidly transitioned to remote provision of academic instruction and wellness services such as school meals and counseling services. The aim of this study was to investigate how schools responded to the transition to remote supports, including assessment of what readiness characteristics schools leveraged or developed to facilitate those transitions. Semi-structured interviews informed by school wellness implementation literature were conducted in the spring of 2020. Personnel (n = 50) from 39 urban and rural elementary schools nationwide participated. The readiness = motivation capacity2 (R = MC2) heuristic, developed by Scaccia and colleagues, guided coding to determine themes related to schools' readiness to support student wellness in innovative ways during the pandemic closure. Two distinct code sets emerged, defined according to the R = MC2 heuristic (1) Innovations: roles that schools took on during the pandemic response, and (2) Readiness: factors influencing schools' motivation and capacity to carry out those roles. Schools demonstrated unprecedented capacity and motivation to provide crucial wellness support to students and families early in the COVID-19 pandemic. These efforts can inform future resource allocation and new strategies to implement school wellness practices when schools resume normal operations.