Long-term effects of the COVID-19 pandemic on children's physical activity and sedentary behavior.

Background: During the early months of the COVID-19 pandemic, decreases in physical activity (PA) and increases in sedentary behavior (SB) were reported among children in the United States (U.S.). This follow-up analysis examines 13-month effects of the COVID-19 pandemic on children's PA and SB one year into the pandemic. Methods: Parents of 5-13-year-old children in the U.S. (N = 71) reported on their child's PA and SB during the early COVID-19 period (April-May 2020) and again 12-14 months later (June-July 2021). Results: Paired t-tests showed significant within-subject reductions in SB minutes per day (M diff = -86.20, t = 3.26, p < 0.01) but no changes in PA minutes per day. Separate mixed-model repeated-measures analysis of covariance procedures found that within-subject changes in PA and SB did not differ by child sex or age. Conclusion: As COVID-19 restrictions lessened, there were more opportunities for children to reduce SB, but there were still barriers to engage in PA.

Legislation has Changed But Issues Remain: Provider Perceptions of Caring for People Who Use Cannabis During Pregnancy in Safety Net Health Settings, a Qualitative Pilot Study.

Objective: To identify perceptions of cannabis use and risk among maternal health providers who provide care for people who use cannabis during pregnancy in safety-net health settings. Methods: Using qualitative, constructivist ground theory methods, we conducted semistructured remote interviews with 10 providers (2 midwives, 6 OB/GYN physicians, and 2 OB/GYN residents) in Southern California, United States, between March 15, 2022, and April 6, 2022. We selected participants through selective sampling using a convenience sample and snowball approach. Providers were eligible for the study if they self-reported via survey to being a maternal health provider (e.g., physician, doula, midwife, and so on) providing care in a safety-net health setting and had cared for people who used cannabis during pregnancy in the last year. Analysis drew upon grounded theory methods to document the socio-structural contexts that contribute to provider perceptions about cannabis. This study was approved by the University of Southern California Institutional Review Board (UP-21-00282-AM009). Results: We identified three categories of provider perceptions of cannabis use and risk during pregnancy: (1) Relying on self-education, (2) Taking a case-by-case approach, and (3) Avoiding cannabis discussions to maintain an alliance with patients. Findings indicate that provider reluctance to counsel patients about cannabis in favor of preserving a therapeutic relationship can overlook the lack of resources and access to health care alternatives available to low-income patients that can shape self-medicating. Conclusions: Nonpunitive policies and training on cannabis use are critical steps for supporting providers to counsel patients who use cannabis during pregnancy, alongside a harm reduction approach that acknowledges the broader socio-structural contexts and barriers facing patients who disclose use.

Motivational Profile as a Predictor of Physical Activity Among US Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study.

This study used a daily diary approach to examine associations between day-level physical activity (PA) behavior, PA-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months (April-June 2020) of the pandemic. A total of 468 US adults (Mage = 34.8 y, 79% female) participated in a 28-day smartphone-based daily diary study assessing PA. A baseline survey assessed PA and motivation for PA using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time (days since the US March 13, 2020, COVID-19 national emergency declaration) on daily PA minutes. Latent profile analysis identified 4 distinct motivational profiles for PA among this sample: profile 1: high amotivation (n = 100, 21%); profile 2: low controlled motivation (n = 55, 12%); profile 3: high external regulation (n = 47, 10%); and profile 4: moderate autonomous motivation (n = 266, 57%). After controlling for baseline PA, there were significant interactions between profile and time on daily PA (-0.21, P < .01). Profile 2 showed greater decreases in daily PA minutes over time than profile 1 (b = -0.29, P < .01). Profiles 3 and 4 did not indicate significant decreases in PA compared with profile 1 (b = 0.14, P = .31 and b = -0.16, P = .05, respectively). Contrary to previous research, individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in PA over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. These findings suggest that external motivation may have provided short-term protection against declines in PA observed during early months of the COVID-19 pandemic.

Emotion regulation expectancies and smoking cessation factors: A daily diary study of California adults who smoke cigarettes during a practice quit attempt.

SIGNIFICANCE: Cross-sectional studies have shown that greater cigarette smoking-related emotion regulation expectancies were associated with retrospectively reported withdrawal during prior quit attempts and greater barriers to cessation. Few studies have investigated the relationship of within-person daily emotion regulation expectancies to factors related to initiating and maintaining a brief quit attempt. METHODS: People living in California who smoked cigarettes daily (n = 220, 50 % female; 48.5 % white, 14.6 % Hispanic, 16.7 % Black or African American, 9.6 % Asian, 7.6 % Multi-race, 3.0 % other race; mean age=43.71 years old) completed a practice quit attempt and 28-days of daily diary surveys. In the morning, participants reported non-smoking and smoking emotion regulation expectancies based on the Affective Processing Questionnaire, daily abstinence plan, abstinence self-efficacy, and cigarettes smoked. Successful abstinence plans were calculated as days with an abstinence plan and no cigarettes smoked. Multilevel models investigated whether within-person emotion regulation expectancies were associated with abstinence plan, self-efficacy, and successful abstinence plan. RESULTS: Greater within-person non-smoking emotion regulation expectancies were associated with increased odds of having an abstinence plan, higher self-efficacy, and a successful abstinence plan on a given day (ps < .05). Greater within-person smoking emotion regulation expectancies were associated with lower odds of having an abstinence plan and lower self-efficacy (ps < .001) but did not significantly associate with a successful abstinence plan. CONCLUSIONS: These findings show that within-person levels of expectations in emotion regulation abilities may contribute to factors relevant to initiating and achieving daily abstinence during a practice attempt.

Interactive associations between abstinence plans and romantic partner conflict and support with cigarette smoking.

BACKGROUND: While most individuals who smoke cigarettes desire to quit, quit motivation can change daily and sustained abstinence is rarely achieved in quit attempts. Assessment of psychosocial factors that moderate associations between daily abstinence intentions and smoking behavior is necessary to inform effective cessation efforts. METHODS: A secondary analysis was conducted using data from a 28-day ecological momentary assessment study among individuals who smoke and who were not actively planning a long-term quit attempt (N = 81 individuals; N = 1585 days). We examined main effect and interaction associations between primary predictors (daily abstinence plans and within- and between-person estimates of perceived romantic relationship conflict and support) and daily number of cigarettes smoked, as well as baseline emotion regulation difficulties as a moderator of these associations. RESULTS: Smoking was reduced on days with an abstinence plan (ß=-0.57,p<.001), especially among individuals with lower average levels of conflict (plan × between-person conflict interaction: ß=0.98, p < .001), and higher average levels of support (plan × between-person support interaction: ß=0.26, p < .001). Additionally, smoking was increased on days when participants had higher levels of conflict than usual (ß=0.07, p < .01), but only on days when participants did not have a plan (plan × within-person conflict interaction:ß=-0.10, p < .05). Emotion regulation difficulties did not moderate any associations. CONCLUSION: This study adds to the literature on the influence of negative aspects of social experience on smoking behavior. Further, the present study underlines the importance of assessing the influence of both positive and negative aspects of - and within- and between-person differences in - social experiences.

Interactions between daily abstinence plans and approach/avoidance motivation on cigarette smoking in pre-quit smokers.

Enhancing motivation to quit among smokers who are not ready for cessation is a key component of several interventions. However, there is a dearth of empirical data about motivational factors and smoking behavior among pre-quit smokers. Here, we examined interactions between approach/avoidance goal motivations and daily abstinence plan (i.e., plans to either continue or abstain from smoking) on daily cigarette use. Current smokers (n = 82; M = 11.4 cigs/day; 46% Female) completed a baseline assessment, including a measure of approach/avoidance motivation [Behavioral Inhibition and Behavioral Activation Scales (BIS/BAS)], followed by 28-days of Ecological Momentary Assessment (EMA). EMA included a morning assessment of abstinence plan, and evening assessment of cigarettes smoked. Multilevel linear models tested interactions between BIS/BAS and abstinence plan on cigarette smoking (defined as percent change from within-subject mean). There was a significant abstinence plan × BIS interaction, F(1, 637) = 6.567, p = .011, and abstinence plan × BAS interaction, F(1, 637) = 6.553, p = .011, on cigarette smoking. High BIS and low BAS were each associated with reduced smoking on abstinence days and increased smoking on non-abstinence days. Modest rates of smoking cessation may be due to the unassisted, spontaneous nature of most quit attempts. Among pre-quit smokers, high behavioral inhibition and low behavioral activation may underlie the ability to intentionally vary smoking levels according to individuals' daily abstinence plans. Future studies should examine how motivational factors during the pre-quit stage may predict long-term smoking cessation in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining Whether Physical Activity Location Choices Were Associated With Weekly Physical Activity Maintenance Across 13 Months of the COVID-19 Pandemic in Emerging Adults.

BACKGROUND: Recent studies have shown potentially detrimental effects of the COVID-19 pandemic on physical activity (PA) in emerging adults (ages 18-29 y). However, studies that examined the effects of COVID-19 on PA location choices and maintenance for this age group remain limited. The current study investigated changes in PA location choices across 13 months during the pandemic and their associations with PA maintenance in this population. METHODS: Emerging adults (N = 197) living in the United States completed weekly survey on personal smartphones (May 2020-June 2021) regarding PA location choices and maintenance. Mixed-effects models examined the main effects of PA location choice and its interaction with weeks into the pandemic on participants' PA maintenance. RESULTS: On a given week, participants performing PA on roads/sidewalks or at parks/open spaces were 1½ and 2 times as likely to maintain PA levels, respectively. Moreover, after September 2021, weeks when individuals performed PA on roads/sidewalks had a protective effect on PA maintenance. CONCLUSIONS: Performing PA on roads/sidewalks and at parks/open spaces was associated with PA maintenance during the COVID-19 pandemic. PA promotion and intervention efforts for emerging adults during large-scale disruptions to daily life should focus on providing programmed activities in open spaces to maintain their PA levels.

Dyadic Effects of Pokémon GO on Physical Activity and Sedentary Behavior in Mothers and Children.

Family-based mobile health applications may be an opportunity to increase children's physical activity (PA) levels. Researchers have highlighted Pokémon GO as a potential model for future PA interventions as it integrates PA with social gamification. This study provides descriptive data on Pokémon GO usage among mothers and their children and examines differences in moderate to vigorous PA (MVPA) over time among individuals playing Pokémon GO compared to non-players using a dyadic subsample from a three-year longitudinal study. After the release of Pokémon Go in July 2016, 156 mother-child dyads completed questionnaires about Pokémon Go usage and wore accelerometers continuously for seven days at baseline (Sep 2016), six months, and twelve months. Independent sample t-tests and chi-square tests were used to investigate differences in demographics and daily MVPA by player status cross-sectionally at each time point. At baseline, six mothers and 21 children reported playing Pokémon Go. Baseline demographic characteristics were not associated with player status. Across time, mothers engaged in an average of 21.12 minutes of daily MVPA (SD = 19.7) and children in 29.35 minutes (SD = 18.88). Children's daily MVPA did not differ by player status, but mothers who reported playing engaged in higher daily MVPA (M = 46.84, SD = 38.07) compared to non-players (M = 21.40, SD = 23.31). This naturalistic study lacked power to further analyze changes in MVPA after the release of the game due to lack of engagement with Pokémon GO. Understanding how to design a family-oriented game to bring together gamification, physical activity, and family-based interventions will be important for future public health efforts.

Examining the day-level impact of physical activity on affect during the early months of the COVID-19 pandemic: An ecological momentary assessment study.

Engaging in physical activity (PA) may be a promising approach to mitigate the effects of the COVID-19 pandemic and related restrictions on daily affect. The study used ecological momentary assessment (EMA) to examine the within-subject associations of day-level PA with same-day evening affect. Interactions between daily PA and overall stress related to COVID-19 predicting evening affect were also examined. Adults living in the U.S. (N = 157, M age = 31.7, 84.1% female) participated in a 28-day smartphone-based EMA study during the early months of the pandemic (April - June 2020). Evening EMA surveys assessed daily PA minutes, momentary positive activated and deactivated affect, and momentary negative activated and deactivated affect. An online questionnaire assessed demographics. Multi-level linear regression models assessed day-level associations between PA and evening affect, controlling for age, sex, income, body mass index, employment status, and morning affect. There were N = 2,409 person-days in the analysis. Baseline COVID-19 stress was not associated with daily PA minutes (p = .09) or positive-activated affect (p = .14), but was associated with lower positive-deactivated affect (p < .001) and greater negative-activated and negative-deactivated affect (ps < .001) in the evenings. On days when individuals reported more PA than usual, they reported greater positive-activated and positive-deactivated affect, and lower negative-activated and negative-deactivated affect in the evening (ps < .001). The interaction of day-level PA and COVID-19 stress predicting evening positive-activated, positive-deactivated, negative-activated, and negative-deactivated affect was not significant (ps > .05). During the early months of the pandemic, adults experienced improved evening affect on days when they engaged in more PA. However, data did not show that PA counteracts detrimental effects of the COVID-19 pandemic on evening affect. Public health efforts should strategically promote and address barriers to PA during the pandemic.

Interactions among Reward Sensitivity and Fast-Food Access on Healthy Eating Index Scores in Adolescents: A Cross-Sectional Study.

Food cues in the environment may contribute to obesity as the consumption of unhealthy foods may reinforce reward pathways in the brain. To understand how person-level differences in reward sensitivity may be associated with diet quality, this study aimed to examine the moderating role of the availability of fast food in the environment on the relationship between reward sensitivity and diet quality in adolescents. Participants (n = 152; 55% female; Mage: 12.5 ± 0.93 y) completed the drive and reward subscales of the Behavioral Inhibition System (BIS)/Behavioral Activation System (BAS) Scale to assess reward sensitivity and completed two 24 h dietary recalls from which Healthy Eating Index (HEI) scores (total score and subscales of adequacy and moderation) were calculated. Fast-food environment (FFE) was operationalized as the total number of fast-food outlets within 1 km around participants' home address. Linear regressions were used to examine the main effects and interactions between reward sensitivity and FFE in relation to HEI score. Interactions were found between FFE and BAS drive (p = 0.02) and BAS reward (p < 0.01) on HEI adequacy. There were no interaction effects on HEI moderation or HEI total scores. For individuals who had lower access exposure to fast-food outlets (-1 SD), there was a stronger positive association between higher BAS drive (t = 2.85, p = 0.01, 95% CI (0.35, 1.94)) and HEI adequacy scores and between higher BAS reward (t = 3.27, p > 0.01, 95% CI (0.72, 2.93)) and HEI adequacy scores. By examining reward sensitivity to potential food cues in residential neighborhood food environments, it is possible to understand which adolescents are more sensitive to environmental food cues and implement interventions to buffer these influences.

Impact of self-efficacy on daily intention to not smoke.

BACKGROUND: To improve cessation interventions, it is necessary to understand the factors associated with daily motivation to not smoke. One hypothesized factor is self-efficacy; however, there has been a lack of evidence investigating self-efficacy as a dynamic construct. METHODS: This study examined the influence of baseline and daily self-efficacy on setting daily abstinence plans in pre-quit smokers and successful plans. Participants (N = 76) completed measures of self-efficacy at baseline, and each evening during 28 days of ecological momentary assessment. RESULTS: Baseline self-efficacy was not correlated with mean daily rating of self-efficacy or variance in ratings. GLMM found that participants who had higher baseline self-efficacy than others were more likely to set an abstinence plan while participants who had a higher rating of self-efficacy on the previous night than others were more likely to set a plan on any given morning. Participants were less likely to set an abstinence plan if they had smoked on the previous day but were more likely if they had set an abstinence plan on the previous day. Participants were less likely to have a successful plan not to smoke if they smoked on the previous day. CONCLUSIONS: The current data indicates that both baseline rating and day-to-day fluctuations in SE influence daily abstinence plan in pre-quit smokers. Future intervention research could examine the use of methods designed to increase and maintain a person's daily self-efficacy and how this can be leveraged to encourage these smokers to attempt long-term cessation.

The COMET study: Examining the effects of COVID-19-related perceived stress on Los Angeles Mothers' dysregulated eating behaviors, child feeding practices, and body mass index.

The COVID-19 pandemic and associated restrictions and mandates have had pronounced implications on the well-being of individuals. This study conducted exploratory analyses of the relationship between COVID-19-related life changes and COVID-19-related perceived stress and associations between COVID-19-related perceived stress and dysregulated maternal eating behaviors, child feeding practices, and body mass index (BMI) in Los Angeles mothers. Mothers (Mage = 37.6 ± 6.9) of children aged 5-11 (N = 197, response rate 92.5%) completed an online questionnaire assessing COVID-19-related life changes, COVID-19-related perceived stress, mechanisms used to cope with COVID-19, child feeding practices, their own eating behavior, demographics, and height and weight. The highest proportion of participants reported changes to work, disruptions due to childcare challenges, and increased home responsibilities. Higher COVID-19-related perceived stress was experienced by those who reported loss of work hours (29%), loss of job (15.2%), reduced ability to afford childcare (18.8%), and reduced ability to afford rent/mortgage (19.8%) (ps < 0.05) than those who did not. The most common strategy that mothers indicated using to cope with COVID-19 related stress was eating comfort foods (e.g., candy and chips) (58.7%). COVID-19-related perceived stress was positively associated with mother's BMI and emotional eating (ps < 0.05). Rewarding their child's eating and behavior with food were both positively associated with the number of COVID-19 related life changes (ps < 0.05). This study yields new knowledge of the effects of the COVID-19 pandemic on mothers' dysregulated eating behaviors and child feeding practices. The results highlight the importance of conducting further research to confirm these findings and understand the nature of associations between COVID-19-related perceived stress and health. This is crucial in order to explore ways in which lasting impacts of the pandemic on mental and physical health can be prevented.

Momentary and personal characteristics predicting maternal fruit and vegetable preparation for children using ecological momentary assessment.

A large body of literature on child-focused research regarding healthy eating within the family context has focused on behavioral management strategies, such as reinforcement, or parental modeling through personal intake or encouragement. However, food preparation behaviors among mothers have been understudied. Also unknown is how maternal food preparation behaviors vary across population subgroups and contexts. The study objective was to elucidate momentary characteristics (i.e., time of day, weekday, and family meals) and personal characteristics (i.e., ethnicity, working status, household characteristics, body mass index, income, and child's age) associated with maternal fruit and vegetable (F/V) preparation through ecological momentary assessment (EMA). 186 mothers (Mage = 40.81) of children (Mage = 9.61, 49.5% female) completed six semi-annual waves, each lasting seven days. Mothers completed up to eight EMA surveys a day, which assessed family meals and F/V preparation, and reported personal characteristics through paper questionnaires. Multilevel generalized estimating equations examined the likelihood of F/V preparation. Momentary, within-day characteristics (i.e., occurrence of family meals, weekdays, afternoons) were associated with greater likelihood of mothers' fresh F/V preparation (ps < 0.05). Additionally, personal characteristics such as non-Hispanic ethnicity, not working full-time, having a child aged six months to five years in the household, and lower child BMI-z were associated with greater fresh F/V preparation among mothers (ps < 0.05). Findings may inform family-based obesity and nutrition intervention programs by understanding which families and in what contexts mothers are more likely to prepare F/Vs.

Early effects of the COVID-19 pandemic on physical activity locations and behaviors in adults living in the United States.

COVID-19 restrictions and social-distancing may inhibit adults from attaining recommended levels of physical activity. This study examined early impact of COVID-19 pandemic on physical activity in adults during the first two months of restrictions in the U.S. and how physical activity locations were associated with physical activity levels during this period. Adults (N = 268) completed an online survey between April 10-May 25, 2020. Participants reported minutes of vigorous, moderate, and walking physical activity for past 7 days (early-COVID-19) and for a typical week in February 2020 (pre-COVID-19). Adults reported locations (e.g., home/garage, parks/trails) were they were active over the past 7 days. Past 12-month step count data were extracted from participants' personal smartphones. Participants (18-74 years old, 22% Hispanic/Latino, 81% female) showed reductions in vigorous (M diff  = -66.9 min/week), moderate (M diff  = -92.4 min/week), walking (M diff -70.8 min/week), and step counts (M diff  = -2232 steps/day) from the pre- to early-COVID19 periods. Reductions in walking and steps were larger for low-income and Hispanic/Latino adults. During early-COVID19, more vigorous and moderate activity were reported by those who were active in their home/garage or driveway/yard, and more steps were recorded by those who were active on the roads in their neighborhood or at parks/trails. We observed a decline in adults' physical activity during the first two months of the COVID-19 pandemic based on retrospective self-report and device-based measures. Although these restrictions were necessary to slow the spread of the virus, data indicate that there may be unintended consequences on health-related behaviors.

Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.

BACKGROUND: COVID-19 restrictions such as the closure of schools and parks, and the cancellation of youth sports and activity classes around the United States may prevent children from achieving recommended levels of physical activity (PA). This study examined the effects of the COVID-19 pandemic on PA and sedentary behavior (SB) in U.S. children. METHOD: Parents and legal guardians of U.S. children (ages 5-13) were recruited through convenience sampling and completed an online survey between April 25-May 16, 2020. Measures included an assessment of their child's previous day PA and SB by indicating time spent in 11 common types of PA and 12 common types of SB for children. Parents also reported perceived changes in levels of PA and SB between the pre-COVID-19 (February 2020) and early-COVID-19 (April-May 2020) periods. Additionally, parents reported locations (e.g., home/garage, parks/trails, gyms/fitness centers) where their children had performed PA and their children's use of remote/streaming services for PA. RESULTS: From parent reports, children (N = 211) (53% female, 13% Hispanic, Mage = 8.73 [SD = 2.58] years) represented 35 states and the District of Columbia. The most common physical activities during the early-COVID-19 period were free play/unstructured activity (e.g., running around, tag) (90% of children) and going for a walk (55% of children). Children engaged in about 90 min of school-related sitting and over 8 h of leisure-related sitting a day. Parents of older children (ages 9-13) vs. younger children (ages 5-8) perceived greater decreases in PA and greater increases in SB from the pre- to early-COVID-19 periods. Children were more likely to perform PA at home indoors or on neighborhood streets during the early- vs. pre-COVID-19 periods. About a third of children used remote/streaming services for activity classes and lessons during the early-COVID-19 period. CONCLUSION: Short-term changes in PA and SB in reaction to COVID-19 may become permanently entrenched, leading to increased risk of obesity, diabetes, and cardiovascular disease in children. Programmatic and policy strategies should be geared towards promoting PA and reducing SB over the next 12 months.

Lower total and regional grey matter brain volumes in youth with perinatally-acquired HIV infection: Associations with HIV disease severity, substance use, and cognition.

Despite improved survival due to combination antiretroviral therapy (cART), youth with perinatally-acquired HIV (PHIV) show cognitive deficits and developmental delay at increased rates. HIV affects the brain during critical periods of development, and the brain may be a persistent reservoir for HIV due to suboptimal blood brain barrier penetration of cART. We conducted structural magnetic resonance imaging (sMRI) and cognitive testing in 40 PHIV youth (mean age=16.7years) recruited from the NIH Pediatric HIV/AIDS Cohort Study (PHACS) who are part of the first generation of PHIV youth surviving into adulthood. Historical and current HIV disease severity and substance use measures were also collected. Total and regional cortical grey matter brain volumes were compared to a group of 334 typically-developing, HIV-unexposed and uninfected youth (frequency-matched for age and sex) from the Pediatric Imaging, Neurocognition, and Genetics (PING) study (mean age=16.1years). PHIV youth had smaller (2.8-5.1%) total and regional grey matter volumes than HIV-unexposed and uninfected youth, with smallest volumes seen among PHIV youth with higher past peak viral load (VL) and recent unsuppressed VL. In PHIV youth, worse cognitive performance correlated with smaller volumes. This pattern of smaller grey matter volumes suggests that PHIV infection may influence brain development and underlie cognitive dysfunction seen in this population. Among PHIV youth, smaller volumes were also linked to substance use (alcohol use: 9.0-13.4%; marijuana use: 10.1-16.0%). In this study, collection of substance use information was limited to the PHIV cohort; future studies should also collect substance use information in controls to further address interactions between HIV and substance use on brain volume.