Neighborhood Public Transportation Access and Adolescent Body Mass Index: Results from the FLASHE Study.

Background: Prior investigators have examined the relationship between neighborhood public transportation access and physical activity among adolescents, but research is lacking on the association with obesity in this age group. This study examines the association between neighborhood public transportation access and adolescent BMI using a national sample. Methods: We used cross-sectional data from the Family Life, Activity, Sun, Health, and Eating study, a national survey (2014) that assessed physical activity and diet, among adolescents (aged 12-17 years, N = 1737) and their parents. We ran crude and adjusted linear regression models to test the association between neighborhood-level public transportation access (less prevalent and prevalent) and individual participant-level BMI z-scores. Results: The analytic sample included 336 adolescents (50% female; 69% had healthy weight; 28% had overweight or obesity). Adjusted models showed a positive relationship between high public transportation access and adolescent z-BMI (b = 0.25, confidence interval [95% CI]: -0.01 to 0.50). In stratified analyses, high public transportation access was associated with higher z-BMI for high school students (b = 0.57, 95% CI: 0.23-0.91), males (b = 0.48, 95% CI: 0.09-0.87), and adolescents in households with an income below $99,999 (0.29, 95% CI: 0.02-0.56). Conclusion: Neighborhood public transportation access is associated with adolescent BMI, but the direction of this association varies across urban adolescent demographic subgroups. Further research is needed to clarify the relationships between individual and social-environmental factors that impact public transportation access and its association with adolescent BMI.

Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study.

OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS: We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS: Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS: Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.

LATIN-19: A Grassroots Coalition to Mitigate the Effect of COVID-19 on the Latinx Community in North Carolina.

BACKGROUND: Social inequity is a primary driver of health disparities, creating multiple barriers to good health. These inequities were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic, with Latinx communities suffering more than others. Grassroots collaborations have long existed to address disparities. OBJECTIVE: We describe the creation and work of the Latinx Advocacy Team and Interdisciplinary Network for COVID-19 (LATIN-19; http://latin19.org/), a multisector coalition in North Carolina created to address the unique challenges of COVID-19 in the Latinx community. METHODS: We discuss challenges and solutions that LATIN-19 addressed and the impact of LATIN-19 on community partners and members. RESULTS: LATIN-19 learned of challenges including, lack of awareness, need for data systems to track disparities, the need to increase access to resources, the need for policy changes, and the need to coordinate services by community organizations. CONCLUSIONS: LATIN-19 represents a grassroots organization that has had an impact on community and community organizations that spans beyond COVID-19.

The Association Between Neighborhood Public Transportation Usage and Youth Physical Activity.

INTRODUCTION: Routine adolescent physical activity is a well-established predictor of positive health across the lifespan, although wide disparities in youth physical activity engagement persist across sex and race/ethnicity. Transportation barriers may be related to adolescents' ability to access physical activity opportunities. This study examines the association between neighborhood public transportation usage and adolescent physical activity using a national sample. METHODS: Cross-sectional data were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014), a national sample of adolescents aged 12-17 years. Linear regression examined the association between neighborhood public transportation usage on the basis of neighborhood-level public transportation use and individual-level youth moderate-to-vigorous physical activity minutes per week. Models were developed for weekday, weekend, and combined moderate-to-vigorous physical activity for all youth and across sex and race/ethnicity subgroups. Analyses were run in 2020. RESULTS: The final analytic data set included 1,247 adolescents aged 12-17 years (71% non-Hispanic White, 49% male, mean age=14.52 [SD=1.59] years). Adjusted models showed a stronger magnitude of association between high neighborhood public transportation usage and both weekday (ß=8.79, 95% CI=1.00, 16.59) and combined (ß=13.74, 95% CI=1.14, 26.35) moderate-to-vigorous physical activity than between low/moderate neighborhood public transportation usage and moderate-to-vigorous physical activity. The magnitude of the neighborhood public transportation usage-moderate-to-vigorous physical activity association was strongest among non-Hispanic Black and Hispanic adolescent girls. CONCLUSIONS: This study found an association between neighborhood public transportation usage and adolescent moderate-to-vigorous physical activity, particularly among non-Hispanic Black and Hispanic adolescent girls. Findings from this research have the potential to inform targeted interventions for promoting adolescent physical activity to ultimately reduce chronic health disparities across the lifespan.

Cue-based treatment for light smokers: A proof of concept pilot.

INTRODUCTION: Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. METHODS: We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling.Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). RESULTS: We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. CONCLUSIONS: Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03416621.