Physical activity among transgender individuals: A systematic review of quantitative and qualitative studies.

Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.

Cost Utility Analysis of an After-School Sports Sampling Program.

PURPOSE: The purposes of this study are to describe the costs of implementing an after-school physical activity intervention in three diverse, low-resourced, schools and to understand the potential aerobic impact of this program by cost. DESIGN: We conducted a cost utilization study from an 8.5-month physical activity intervention. SETTING: Three diverse, low-resourced, middle schools in the Midwest; The sample (N = 178) were mostly males (52.2%), African American or Black (54.8%), and divided between 6th, 7th, and 8th grades. METHOD: Costs were collected from contracts, invoices, payroll, and receipts. Metabolic equivalents were collected from past literature. Costs/MET-hour were calculated for the schools and entire program by dividing costs by total MET-hours engaged in physical activity. RESULTS: Costs were $2.51/MET-hour, $8.96/MET-hour, and $10.73/MET-hour for the three schools. On average, the intervention had a cost of $4.73/MET-hour. CONCLUSIONS: Cost/MET-hour for the present study is comparable or lower than other school-based physical activity interventions that require additional staff time and programming outside of standard classroom activities. Scale-up of after-school programs may be one way to improve the costs of programs in both schools and districts.

Cost Analysis of a Culturally Appropriate, Community-Delivered Intervention to Increase Physical Activity.

PURPOSE: Understand the cost of delivering existing community-based, no cost to participant, aerobic dance and yoga classes in an underserved, racial and ethnic minority community in the Midwest. DESIGN: Pilot 4-month observational, descriptive, cost analysis of community fitness classes. SETTING: Community-wide, group-based, fitness classes online, and in parks and community centers in traditionally Black neighborhoods in Kansas City. PARTICIPANTS: Participants (N = 1428) were recruited from underserved, racial and ethnic minority areas of Kansas City, Missouri. INTERVENTION: Aerobic dance and yoga classes were provided free of charge to all residents of Kansas City, Missouri online and in-person. Each class was approximately 1 hour, with a warmup and cooldown. All classes were delivered by African American women. METHODS: Descriptive statistics of the costs for the program are presented. Cost per metabolic equivalents (MET) were calculated. Independent samples t-tests were conducted to examine differences between aerobic dance and yoga cost per MET. RESULTS: The total program costs were $10,759.88 USD, with 1428 participants attending 82 classes over the 4-month intervention. The cost per MET was $1.67, $1.11, and $0.74/MET-hour/session/attendee for low, moderate, and high-intensity aerobic dance, respectively, and $3.02/MET-hour/session/attendee for yoga. Aerobic dance had a significantly lower cost per MET than yoga (t = 13.6, P < .001, t = 47.6, P < .001, t = 92.8, P < .001, for low, moderate, and high-intensity, respectively). CONCLUSIONS: Delivering community-based, physical activity interventions in racial and ethnic minority communities is a potential way to increase physical activity. The costs of group-based fitness classes are similar to other physical activity interventions. Further research needs to be conducted on the costs to increase physical activity of traditionally underserved populations who suffer from higher rates of inactivity and comorbidities.

Pediatric autoimmune myelofibrosis: Experience from a large pediatric tertiary care center.

Autoimmune myelofibrosis (AIMF) is a rare disorder characterized by cytopenias and autoimmunity, with characteristic bone marrow findings that include lymphocytic infiltration and fibrosis. AIMF is described predominantly in adult populations who have systemic lupus erythematosis (SLE), with scant pediatric cases described mainly in older adolescents with SLE. Here, we described the largest single-center pediatric experience of pediatric autoimmune myelofibrosis (PAIMF) series, demonstrating both similarities and distinctions from the adult experience. Patients overall respond well to steroid therapy, but these patients were significantly younger, infrequently carried a diagnosis of SLE, and causative genetic lesions were identified in many cases.

The Effectiveness of an After-school Sport Sampling Intervention on Urban Middle School Youth in the Midwest: Posttest-Only Study.

BACKGROUND: Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. OBJECTIVE: The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. METHODS: Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. RESULTS: The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). CONCLUSIONS: An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/37126.

Fresh Produce Delivery to Middle School Youth: Outcomes of a Case Study in Providing Fresh Fruit and Vegetables to Underserved Youth.

PURPOSE: The purpose of this study was to evaluate a weekly school-based fruit and vegetable delivery via a mobile market on urban middle schoolers' nutrition behaviors. DESIGN: One-group, pretest-posttest design, quasi-experimental intervention in middle schoolers (6th-8th graders, N = 158) in Kansas City, MO. INTERVENTION: Weekly delivery of free produce via a mobile market over 12 weeks. MEASURES: A self-administered survey to assess self-report consumption of fruits, vegetables, soda, and sports drinks. ANALYSIS: Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were conducted to compare youth at baseline and 12 weeks. RESULTS: More youth reported consuming fresh fruit (73.8% to 83.3%; χ2 = 7.76, P = .005) and vegetables (66.4% to 71.3%; χ2 = 13.55, P = <.001) from baseline to follow-up. Less youth reported soda (49.0% to 52.8%; χ2= 6.33, P = .012) and sports drinks (41.8% to 38.2%; χ2= 12.32, P < .001) from baseline to follow-up. CONCLUSIONS: A mobile produce delivery intervention, like the Healthy Harvest Mobile Market, may be an effective strategy to increase fruit and vegetable consumption for adolescents.

Pediatric Eosinophilia: A Review and Multiyear Investigation into Etiologies.

OBJECTIVES: To identify the etiology of peripheral eosinophilia in a large pediatric population and to develop a diagnostic algorithm to help guide diagnosis and management of peripheral eosinophilia in the outpatient pediatric population. STUDY DESIGN: We performed a retrospective chart review of children presenting to Texas Children's Hospital in Houston with peripheral eosinophilia between January 1, 2011 and December 31, 2019. Eosinophilia was classified as mild (absolute eosinophil count [AEC] >500 and <1500 cells/µL), moderate (AEC >1500 and <4500 cells/µL), or severe (AEC >4500 cells/µL). Demographic information and diagnostic workup data were collected. RESULTS: A total of 771 patients aged <18 years were evaluated. The most common cause of eosinophilia was allergy (n = 357; 46%), with atopy (n = 296) and drug reaction (n = 54) the most common subcauses. This was followed by unknown etiology (n = 274; 36%), infectious causes (n = 72; 9%), and eosinophilic disorders (n = 47; 6%). Many patients with an unknown cause (n = 202; 74%) had limited or no follow-up testing. CONCLUSIONS: More information on the etiology of pediatric eosinophilia and workup data could help identify the causes. This study provides important information on the evaluation of eosinophilia in the US pediatric population, including a diagnostic algorithm to guide primary care pediatricians.

Pediatric refractory immune thrombocytopenia: A systematic review.

Pediatric immune thrombocytopenia (ITP) is an acquired disorder associated with autoimmune destruction and impairment of platelet production in children. Some children exhibit poor or transient response to ITP-directed treatments and are referred to as having refractory ITP (rITP). There is currently no consensus on the definition of rITP, nor evidence-based treatment guidelines for patients with rITP. After a survey of pediatric ITP experts demonstrated lack of consensus on pediatric rITP, we pursued a systematic review to examine the reported clinical phenotypes and treatment outcomes in pediatric rITP. The search identified 253 relevant manuscripts; following review, 11 studies proposed a definition for pediatric rITP with no consensus amongst them. Most definitions included suboptimal response to medical management, while some outlined specific platelet thresholds to define this suboptimal response. Common attributes identified in this study should be used to propose a comprehensive definition, which will facilitate outcome comparisons of future rITP studies.

Risk factors and prognostic significance of platelet count abnormalities in children with HIV infection on antiretroviral therapy.

OBJECTIVES: To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH). DESIGN: A retrospective nested case control study of patients 0-18 years in five Baylor International Pediatric AIDS Initiative (BIPAI) centers in sub-Sahara Africa, 2004-2014. METHODS: Clinical and laboratory variables including complete blood counts (CBC) were extracted from the BIPAI electronic medical record system. Incident cases of T/T were identified and frequency-matched on follow-up time with controls with normal platelets. We calculated the prevalence and incidence density of T/T and used conditional logistic regression to evaluate their association with selected clinical variables. We constructed Kaplan-Meier curves and a Cox proportional hazards model to evaluate the impact of T/T on survival. RESULTS: Two thousand, one hundred and nine children were sampled. The incidence density of thrombocytopenia was 1 per 57.9 (95% confidence interval [CI] 50.3-66.8) CWH-years. Thrombocytopenia was higher in children with WHO Stage III/IV, lower in children on zidovudine, and had no association with use of lamivudine or nevirapine, CD4 + suppression, age, and nutrition status. Thrombocytopenia was independently associated with 2.2-fold higher mortality (95% CI 1.62-3.08). The incidence density of thrombocytosis was 1 per 11.4 (95% CI 10.7-12.1) CWH-years. Thrombocytosis was associated with higher CD4 + cell count, younger age, and use of lamivudine or nevirapine, and did not impact survival. CONCLUSIONS: Platelet count is a clinically valuable biomarker of HIV clinical progression and mortality. Laboratory studies are necessary to elucidate the mechanisms of T/T.

Physical activity, balance, and bicycling in older adults.

Falls are a critical public health issue among older adults. One notable factor contributing to falls in older adults is a deterioration of the structures supporting balance and overall balance control. Preliminary evidence suggests older adults who ride a bicycle have better balance than those who do not. Cycling may be an effective intervention to prevent falls among older adults. This study aims to objectively measure the relationship between bicycling, physical activity, and balance for older adults. Older adult cyclists (n = 19) and non-cyclists (n = 27) were recruited to (1) complete a survey that assessed demographics; (2) wear an accelerometer for 3 weeks to objectively assess physical activity; and (3) complete balance-related tasks on force platforms. Mann-Whitney U-tests were performed to detect differences in balance and physical activity metrics between cyclists and non-cyclists. Cyclists were significantly more physically active than non-cyclists. Cyclists, compared to non-cyclists, exhibited differences in balance-related temporospatial metrics and long-range temporal correlations that suggest a more tightly regulated postural control strategy that may relate to higher stability. Cycling was observed to correlate more strongly with balance outcomes than other physical activity. Taken together, these results demonstrate the possible implications for cycling as an effective intervention to improve balance and reduce fall risk.

The Relationship Between Social Integration and Physical Activity, Diet, and Sleep Among Youths: Cross-sectional Survey Study.

BACKGROUND: Social integration has been shown to predict physical activity (PA), diet, and sleep in adults. However, these associations have not been well-studied in youth samples. Using a life course perspective, it is imperative to study this in youths as social and health behaviors are established early in life. OBJECTIVE: The purpose of this study was to understand the relationship between social integration and PA, diet, and sleep for urban, middle-school youth. METHODS: Cross-sectional baseline data from middle-school youths (N=73) who participated in an afterschool health behavior intervention were included in this study. RESULTS: Time with friends significantly predicted moderate to vigorous intensity PA (ß=.33, P=.02). Time spent with family was significantly related to fruit consumption (t66=1.38, P=.005) and vegetable consumption (t72=1.96, P=.01). CONCLUSIONS: Social integration appears to be related to both PA and nutrition behaviors in youths. Future research should expand on our findings to explain how different domains of social integration may impact youths' health behaviors. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/37126.

Risk factors and prognostic significance of anemia in children with HIV infection on antiretroviral therapy.

OBJECTIVES: To establish the incidence, risk factors and prognostic effect of anemia in children living with HIV (CLWH). DESIGN: Retrospective nested case-control study of patients 0-18 years in five centers in sub-Saharan Africa, 2004-2014. METHODS: Incident cases of anemia were identified from electronic records and matched with CLWH without anemia. We calculated the incidence density of anemia and used conditional logistic regression to evaluate its association with risk factors, stratified by severity and type of anemia. We used a Cox proportional hazards model to evaluate the impact of anemia on survival. RESULTS: Two thousand, one hundred and thirty-seven children were sampled. The incidence density of anemia was 1 per 6.6 CLWH-years. Anemia was moderate in 31.8% and severe in 17.3% of anemia cases, which had 10-year mortality hazards of 3.4 and 4.5, respectively. Microcytic anemia (36% cases) was associated with 2.3-fold hazard of 10-year mortality, and with malnutrition and CD4 + suppression. Normocytic anemia (50.5% cases) was associated with 2.6-fold hazards of 10-year mortality, and with more severe malnutrition, CD4 + suppression, and WHO stage, but inversely associated with lamivudine and nevirapine therapy. Macrocytic anemia (13.5% cases) was neither associated with higher 10-year mortality nor with severe malnutrition or CD4 + suppression but was associated with WHO stage II/III and negatively associated with lamivudine therapy. CONCLUSION: This large multicountry study of CLWH found a high incidence density of anemia. Higher severity, normocytic and microcytic types of anemia were independently associated with long-term mortality. Laboratory studies are needed to decipher the mechanisms of anemia and how it impacts mortality in CLWH.

Untargeted metabolomic profiling in a patient with glycogen storage disease Ib receiving empagliflozin treatment.

Glycogen storage disease type Ib (GSD-Ib) is a rare inborn error of glycogen metabolism uniquely associated with neutropenia and neutrophil dysfunction, causing severe infections, inflammatory bowel disease (IBD), and impaired wound healing. Recently, kidney sodium-glucose co-transporter-2 (SGLT2) inhibitors such as empagliflozin known to reduce plasma levels of 1,5-anhydroglucitol (1,5-AG) and its toxic derivatives in neutrophils, have been described as a new treatment option in case reports of patients with GSD-Ib from Europe and Asia. We report our experience with an 11-year-old girl with GSD-Ib presenting with short fasting hypoglycemia, neutropenia with neutrophil dysfunction, recurrent infections, suboptimal growth, iron-deficiency anemia, and IBD. Treatment with daily empagliflozin improved neutrophil counts and function with a significant reduction in G-CSF needs. Significant improvement in IBD has led to weight gain with improved nutritional markers and improved fasting tolerance. Reduction of maximum empagliflozin dose was needed due to arthralgia. No other significant side effects of empagliflozin were observed. This report uniquely highlights the novel use of untargeted metabolomics profiling for monitoring plasma levels of 1,5-AG to assess empagliflozin dose responsiveness and guide dietary management and G-CSF therapy. Clinical improvement correlated to rapid normalization of 1,5-AG levels in plasma sustained after dose reduction. In conclusion, empagliflozin appeared to be a safe treatment option for GSD-Ib-associated neutropenia and neutrophil dysfunction. Global untargeted metabolomics is an efficient method to assess biochemical responsiveness to treatment.

Changes to Physical Activity Levels in Adults Aged 50+ in the First Six Months of the COVID-19 Pandemic.

The purpose of this study is to qualitatively explore the impact of the COVID-19 pandemic on older adults' PA nearly 6 months into the pandemic. Approximately 230 interviews were conducted with a diverse sample of participants (22.1% Black and 10.8% Hispanic). Data were transcribed in fall 2020 and analyzed using NVivo 12. Overall, most older adults (54.6%) interviewed reported no change in their PA, often reporting that their work kept them active. Decreases in PA for older adults (42.7%) were attributed to little social connectedness and stay-at-home restrictions. The few reporting an increase in PA (2.6%) had more time available to be active, including setting goals while staying home. This data provides an insight on how COVID-19 impacted PA levels for older adults. These findings can inform tailored interventions to promote PA during the pandemic.

Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study.

BACKGROUND: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. OBJECTIVE: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. METHODS: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. RESULTS: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. CONCLUSIONS: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37126.

Understanding Physical Activity Differences Among Older Adults: Validating a Proposed Typology of Physical Activity as a Tool to Increase Physical Activity by Older Adults.

Objective: Being physically active as one ages benefits both physical and mental health and remains a public health need. A typology to understand older adults' PA level and intentions can be vital to developing strategies to promote PA. Methods: The researchers developed a comprehensive interview guide and interviewed adults 50 years and older (n=232) to test the validity of the four-type typology (1). Frail, (2). Ambivalent, (3). Aspiring, (4). Active). Results: The Kruskal-Wallis test and the Bonferonni post hoc analysis indicated that there were significant differences between types and for each PA category measured, revealing a continuum of PA levels by type and confirmed the four types within this continuum. Discussion: The validated typology and the associated tool can be used to identify and implement built environment improvements and interventions aimed to support PA needs of older adults.

Molecular Diagnosis Is Vital to the Accurate Classification and Management of Thrombotic Thrombocytopenic Purpura in Children.

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening hematologic disease, presenting a myriad of diagnostic and management challenges in children. Here, we provide a review of this disorder and discuss 2 exemplary cases of TTP occurring in adolescents, emphasizing the need for consideration of late-onset congenital TTP (cTTP). We demonstrate the importance of early confirmation of ADAMTS13 enzyme deficiency and the presence or absence of ADAMTS13 inhibitor in order to rapidly initiate the appropriate life-saving therapies. Ultimately, molecular testing is paramount to distinguishing between congenital and acquired immune-mediated TTP.

Decreased Physical Activity Among Youth Resulting From COVID-19 Pandemic-Related School Closures: Natural Experimental Study.

BACKGROUND: The COVID-19 pandemic has resulted in the closure of schools and may have inadvertently resulted in decreased physical activity for youth. Emerging evidence suggests that school closures due to the COVID-19 pandemic could have hastened the inactivity of youth, possibly due to a lack of structure outside of school and increased access to sedentary activities. OBJECTIVE: The purpose of this study was to assess changes in physical activity from pre-school closure (before the pandemic) to post-school closure (during the pandemic) among youth in spring 2020. METHODS: This study used a natural experimental design; youth were enrolled in a physical activity study prior to the lockdown, which was enforced due to the pandemic. The number of device-assessed steps per day and moderate-to-vigorous physical activity minutes per week were measured by using a Garmin Vivofit 4 (Garmin Ltd) accelerometer over 8 weeks. Mixed effects models were used to compare physical activity variables, which were measured before and during the COVID-19 pandemic. RESULTS: Youth were primarily Hispanic or Latinx (8/17, 47%) and female (10/17, 59%). The number of daily steps decreased by 45.4% during the school closure, from a pre-school closure mean of 8003 steps per day to a post-school closure mean of 4366 steps per day. Daily moderate-to-vigorous physical activity decreased by 42.5%, from a pre-school closure mean of 80.18 minutes per week to a post-school closure mean of 46.13 minutes per week. CONCLUSIONS: Youth are engaging in roughly half as much physical activity during the school closure as they were prior to the school closure. If additional evidence supports these claims, interventions are needed to support youths' engagement in physical activity in the Midwest.

Physical Literacy of Marginalized Middle School Adolescents in Kansas City Public Schools.

PURPOSE: Physical inactivity among adolescents in the United States continues to be a pervasive and growing problem, especially among low income and adolescents of color. Physical literacy is important for adolescents to engage in physical activity. However, few studies have assessed physical literacy among marginalized populations. The purpose of this study is to describe levels of physical literacy among marginalized adolescents in a Midwest City. METHODS: Data were collected from 169 participants (85 adolescents and 84 parents). Adolescents included in the study were from 4 Kansas City (Missouri) public schools. Univariate statistics were calculated for 3 physical literacy domains (PLAYinventory, PLAYself, and PLAYparent). To assess for differences among groups, the authors conducted a single-factor analysis of variance (1-way analysis of variance). RESULTS: The sample (N = 169) was primarily Hispanic (48.2% adolescents and 42.9% parents). Sedentary behaviors were self-reported as the highest overall activities adolescents participated in within the past 12 months. The mean physical literacy score for this sample was 71.9 among adolescent reported and 72.7 among parent reported. Analysis of variance of racial and ethnic groups for PLAYself and PLAYparent assessments showed no significant difference in values. Compared with other subscales of both the PLAYparent and PLAYself instrument, parents and adolescents showed a lack of confidence in adolescent's ability to be active in the 4 environments (land, water, ice, and snow). CONCLUSION: Physical literacy is shown to be important in maintaining physical activity throughout life; given this, it is important to understand how to increase confidence of seasonal specific skills in marginalized adolescents.

Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19-Related Health Challenges: Formative Research Study.

BACKGROUND: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). OBJECTIVE: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. METHODS: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. RESULTS: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. CONCLUSIONS: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted.