Physical Activity Impacts of an Activity-Friendly Community: A Natural Experiment Study Protocol.

Background: Stakeholders from multiple sectors are increasingly aware of the critical need for identifying sustainable interventions that promote healthy lifestyle behaviors. Activity-friendly communities (AFCs) have been known to provide opportunities for engaging in physical activity (PA) across the life course, which is a key to healthy living and healthy aging. Purpose: Our purpose is to describe the study protocol developed for a research project that examines: (a) the short- and long-term changes in total levels and spatial and temporal patterns of PA after individuals move from non-AFCs to an AFC; and (b) what built and natural environmental factors lead to changes in PA resulting from such a move, either directly or indirectly (e.g., by affecting psychosocial factors related to PA). Methods: This protocol is for a longitudinal, case-comparison study utilizing a unique natural experiment opportunity in Austin, Texas, USA. Case participants were those adults who moved from non-AFCs to an AFC. Matching comparison participants were residents from similar non-AFCs who did not move during the study period. Recruitment venues included local businesses, social and print media, community events, and individual referrals. Objectively measured moderate-to-vigorous PA and associated spatial and temporal patterns served as the key outcomes of interest. Independent (e.g., physical environments), confounding (e.g., demographic factors), and mediating variables (e.g., psychosocial factors) were captured using a combination of objective (e.g., GIS, GPS, Tanita scale) and subjective measures (e.g., survey, travel diary). Statistical analyses will be conducted using multiple methods, including difference-in-differences models, repeated-measures linear mixed models, hierarchical marked space-time Poisson point pattern analysis, and hierarchical linear mixed models. Conclusion: Natural experiment studies help investigate causal relationships between health and place. However, multiple challenges associated with participant recruitment, extensive and extended data collection activities, and unpredictable intervention schedules have discouraged many researchers from implementing such studies in community-based populations. This detailed study protocol will inform the execution of future studies to explore how AFCs impact population health across the life course.

Global research on syndemics: a meta-knowledge analysis (2001-2020).

BACKGROUND: Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years. METHODS: We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship. RESULTS: We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science. CONCLUSIONS: The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.

Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis.

INTRODUCTION: The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic. METHOD: We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression. RESULTS: A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups. CONCLUSION: South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.

Self-Perceptions and Factors Associated With Being Put Down at School Among Middle and High School Students.

This study assessed the prevalence of verbally being put down by others and intrapersonal and normative factors associated with being put down by others among middle and high school students. Students (N = 1,027) completed the Adolescent Health Risk Behavior Survey. Over 16% of participants reported being put down at school. Students who identified with the negative words confused, unattractive, dull, and careless and identified less with the positive words popular, smart, considerate, cool, and self-confident reported being put down by others. High school students were less likely to be put down. As students scored higher on the Negative Self-Description Scale, their odds of being put down increased. As students scored higher on the Positive Self-Description Scale, their odds of being put down decreased. Students who perceived their friends drinking alcohol regularly were less likely to be put down. Strategies to enhance self-perceptions to raise self-awareness and form healthy/positive identities are needed.

Epidemiology of mental health problems in COVID-19: a review.

The novel coronavirus disease 2019 (COVID-19) has become a pandemic affecting health and wellbeing globally. In addition to the physical health, economic, and social implications, the psychological impacts of this pandemic are increasingly being reported in the scientific literature. This narrative review reflected on scholarly articles on the epidemiology of mental health problems in COVID-19. The current literature suggests that people affected by COVID-19 may have a high burden of mental health problems, including depression, anxiety disorders, stress, panic attack, irrational anger, impulsivity, somatization disorder, sleep disorders, emotional disturbance, posttraumatic stress symptoms, and suicidal behavior. Moreover, several factors associated with mental health problems in COVID-19 are found, which include age, gender, marital status, education, occupation, income, place of living, close contact with people with COVID-19, comorbid physical and mental health problems, exposure to COVID-19 related news and social media, coping styles, stigma, psychosocial support, health communication, confidence in health services, personal protective measures, risk of contracting COVID-19, and perceived likelihood of survival. Furthermore, the epidemiological distribution of mental health problems and associated factors were heterogeneous among the general public, COVID-19 patients, and healthcare providers. The current evidence suggests that a psychiatric epidemic is cooccurring with the COVID-19 pandemic, which necessitates the attention of the global health community. Future epidemiological studies should emphasize on psychopathological variations and temporality of mental health problems in different populations. Nonetheless, multipronged interventions should be developed and adopted to address the existing psychosocial challenges and promote mental health amid the COVID-19 pandemic.

Prevalence of mental disorders among people who are homeless: An umbrella review.

BACKGROUND: Homelessness is a major problem that critically impacts the mental health and well-being of the affected individuals. This umbrella review aimed to evaluate the current evidence on the prevalence of mental disorders among homeless people from evidence-based systematic reviews and meta-analyses. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Joanna Briggs Institute (JBI) methodology for umbrella reviews. We searched 12 major databases and additional sources to identify systematically conducted reviews and meta-analyses reporting the prevalence of mental disorders among homeless populations. RESULTS: We evaluated 1,277 citations and found 15 reviews meeting our criteria. Most studies were conducted among high-income countries with samples from different age groups. Studies reported high prevalence rates of depressive and anxiety disorders, schizophrenia spectrum and psychotic disorders, substance use disorders, suicidal behavior, bipolar and mood disorders, neurocognitive disorders and other mental disorders among homeless people. Moreover, studies also reported a high burden of co-occurring mental and physical health problems among the homeless experiencing mental disorders. CONCLUSION: This umbrella review synthesized the current evidence on the epidemiological burden of mental disorders in homelessness. This evidence necessitates advanced research to explore psychosocial and epidemiological correlates and adopt multipronged interventions to prevent, identify and treat mental disorders among homeless populations.

Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses.

Mental disorders are highly prevalent in eight South Asian countries, yet there is a gap of a synthesized overview of the prevalence of mental disorders in this region. This umbrella review aims to summarize the prevalence of mental disorders from systematic reviews and meta-analyses of South Asian studies. A systematic search of 11 major databases and additional sources was conducted until December 11, 2019. Articles were included if they were systematic reviews or meta-analyses, reported the prevalence of mental disorders, and reported primary studies conducted in South Asian countries only. Among 2591 citations, a total of 23 reviews met all the criteria of this umbrella review. The synthesized findings from those reviews suggest high prevalence rates for mental disorders, including depressive disorders, anxiety disorders, mood disorders, suicidal behavior and self-harm, schizophrenia, substance use disorders, neurodevelopmental disorders, dementia, and other mental health problems. Also, findings suggest a high burden of maternal depression, psychiatric comorbidities in chronic physical illnesses, and various mental disorders among children, elderly adults, refugees, and other vulnerable populations. Most studies were from India whereas evidence from Afghanistan, Bhutan, and Maldives was limited. The findings of this review are constrained with heterogeneity in prevalence estimations, methodologies, sampling issues, and limitations in the existing literature, which should be addressed in future research. The evidence synthesized in this review provides national and regional overview of the prevalence of mental disorders, which may inform better policymaking and practice advancing mental health in South Asia.

Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses.

With ever-increasing prevalence of various mental disorders worldwide, a comprehensive evaluation of the prevalence of co-occurring psychiatric disorders among individuals with autism spectrum disorder (ASD) is needed to strengthen the knowledge base. This umbrella review aims to summarize the current evidence on the prevalence of comorbid psychiatric disorders among people with ASD. A systematic search of 12 major databases and additional sources was conducted. Any systematically conducted narrative, qualitative, or meta-analytic review reporting the prevalence of psychiatric disorders among people with ASD with no age or geographical restriction were included. From a total of 2755 records, 26 articles representing 14 systematic reviews and 12 meta-analyses met the criteria of this review. The synthesized findings reveal a high burden of comorbid psychiatric disorders among people with ASD, including anxiety disorders, depressive disorders, bipolar and mood disorders, schizophrenia spectrum, suicidal behavior disorders, attention-deficit/hyperactivity disorder, disruptive, impulse-control and conduct disorders amongst diverse age groups, with a majority in younger participants. Most studies were conducted in developed nations, with limited evidence from low and middle-income countries. These synthesized findings provide high-quality evidence for clinical and policy-level decision-making from a global overview of the status of comorbid psychiatric disorders among people with ASD.

Factors that influence the intention to use mobile phone caller tunes for patient reporting of adverse drug reactions: a qualitative study.

BACKGROUND: Patient reporting of adverse drug reactions (ADRs) is low in low- and middle-income countries, in part because of poor awareness to report. With the increase in mobile subscription, mobile phones can be used as a platform to disseminate information on ADRs. The aim of this study was to qualitatively assess the potential of using mobile phone caller tunes (the message or sound the caller hears before the receiver answers the call) to encourage patient reporting of ADRs. METHODS: A total of 38 key informant interviews and 12 focus group discussions (57 participants in groups of 4-5) were conducted in Accra, Ghana. The transcripts were analysed using key constructs of the Technology Acceptance Model (TAM) including perceived usefulness, perceived ease of use, and behavioural intention to use caller tunes for patient reporting of ADRs. RESULTS: Respondents mentioned lack of knowledge on reporting ADRs, and their willingness to use mobile phone caller tunes to promote patient reporting of ADRs. Many respondents pointed out how ADRs usually led to discontinuity in medication use, usually without consultation with health professionals. Caller tunes were regarded an innovative, accessible and convenient platform to disseminate information on ADRs. Most respondents intended to use caller tunes with drug safety information to promote ADR reporting, particularly to help their friends and family members. Simplicity of the message, use of songs or messages in local languages and price of downloading the caller tunes were important considerations. CONCLUSION: There is a need for the creation and testing of caller tunes on ADRs in Ghana to promote patient or consumer reporting of ADRs. Further studies are needed to assess factors that could influence the creation and use of caller tunes to disseminate information on drug safety.

Weight-Related Barriers for Overweight Students in an Elementary Physical Education Classroom: An Exploratory Case Study with One Physical Education Teacher.

INTRODUCTION: As physical performance may be more difficult for overweight children than for their non-overweight peers, understanding how weight impacts student performance in the physical education (P.E.) classroom could inform school-based obesity prevention programming. MATERIALS AND METHODS: This qualitative case study examined one elementary physical educator's perspectives of overweight students' weight-related experiences in her classroom. Narratives were elicited during an in-depth interview and analyzed using structural and thematic analyses. We utilized the social cognitive theory to inform our exploration of the narratives. FINDINGS: The thematic analysis illuminated a behavioral pattern of student refusal to participate in the P.E. classroom while the structural analysis emphasized the teacher's constructive, individualized responses to participation refusals. Combined, the two analytic techniques provided a more holistic snapshot of the experiences of overweight students in this elementary school. In addition, a preliminary model explaining the behavioral pattern among overweight students in this particular P.E. classroom was created. DISCUSSION: Students who were overweight were more likely to initially refuse to attempt physical tasks in the classroom because they feared peer ridicule, and the teacher played a critical role in whether these students chose to participate in subsequent classes. As agents of change, P.E. educators should be included in formative stages of comprehensive, systemic changes to combat childhood obesity.

Adolescent Social Networks and Alcohol Use: Variability by Gender and Type.

BACKGROUND: Scientists have established that social networks influence adolescents' substance use behavior, an influence that varies by gender. However, the role of gender in this mechanism of influence remains poorly understood. Particularly, the role an adolescent's gender, alongside the gender composition of his/her network, plays in facilitating or constraining alcohol use is still unclear. OBJECTIVES: This study examined the associations among the gender composition of adolescents' networks, select network characteristics, intrapersonal and interpersonal factors, and alcohol use among a sample of adolescents in the United States. METHODS: We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Analyses of adolescents' network characteristics were conducted using UCINET 6; and logistic regression analyses testing the associations between gender composition of the network and alcohol use were conducted using SPSS 20. RESULTS: Our results indicate that the gender composition of adolescents' networks in our sample is associated with alcohol use. Adolescents in predominantly female or predominantly male friendship networks were less likely to report alcohol use compared to adolescents in an equal/balanced network. In addition, depending upon the context/type of network, intrapersonal and interpersonal factors varied in their association with alcohol use. Conclusions/Importance: Based on these findings, we make several recommendations for the future research. We call for researchers to further examine gender as a risk factor for alcohol abuse, particularly within the complex interplay between gender and network contexts.

Evaluating the Influence of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Allocation Package on Healthy Food Availability, Accessibility, and Affordability in Texas.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was implemented to improve the health of pregnant women and children of low socioeconomic status. In 2009, the program was revised to provide a wider variety of healthy food choices (eg, fresh fruits, vegetables, and whole-grain items). OBJECTIVES: The purpose of this study was to evaluate (1) the impact of the revised WIC Nutrition Program's food allocation package on the availability, accessibility, and affordability of healthy foods in WIC-authorized grocery stores in Texas; and (2) how the impact of the policy change differed by store types and between rural and urban regions. DESIGN: WIC-approved stores (n=105) across Texas were assessed using a validated instrument (88 items). Pre- (June-September 2009) and post-new WIC package implementation (June-September 2012) audits were conducted. Paired-sample t tests were conducted to compare the differences between pre- and post-implementation audits on shelf width and number of varieties (ie, availability), visibility (ie, accessibility), and inflation-adjusted price (ie, affordability). RESULTS: Across the 105 stores, post-implementation audits showed increased availability in terms of shelf space for most key healthy food options, including fruit (P<0.001), vegetables (P<0.01), cereal (P<0.001), and varieties of vegetables (P<0.001). Food visibility increased for fresh juices (P<0.001). Visibility of WIC labeling improved for foods such as fruits (P<0.05), WIC cereal (P<0.05), and whole-grain or whole-wheat bread (P<0.01). Inflation-adjusted prices decreased only for bread (P<0.001) and dry grain beans (P<0.001). The positive effects of the policy change on food availability and visibility were observed in stores of different types and in different locations, although smaller or fewer effects were noted in small stores and stores in rural regions. CONCLUSIONS: Implementation of the revised WIC food package has generally improved availability and accessibility, but not affordability, of healthy foods in WIC-authorized stores in Texas. Future studies are needed to explore the impact of the revised program on healthy food option purchases and consumption patterns among Texas WIC participants.

Using Family-Focused Garden, Nutrition, and Physical Activity Programs To Reduce Childhood Obesity: The Texas! Go! Eat! Grow! Pilot Study.

BACKGROUND: The TEXAS! GROW! EAT! GO! (TGEG) randomized, control trial is a 5-year study to measure the impact of a nutrition and gardening intervention and/or physical activity (PA) intervention on the weight status of third-grade students. This article describes the results of the pilot study to test the feasibility of two interventions and test the measures to be used in the main trial. METHODS: The pilot study was conducted in one school with third-grade students and their parents or guardians. The Junior Master Gardner (JMG) and Walk Across Texas (WAT) interventions were implemented over a 5-month period in three third-grade classrooms during spring 2012. The respective interventions focused on improving healthy eating and PA behaviors of children and their families. Baseline and immediate post-test data were collected from students and parents/guardians to measure four child, four parent, and four parent-child interaction behaviors. Process data regarding implementation were also collected from teachers and school administration. RESULTS: Forty-four students and 34 parents or guardians provided both pre- and post-test data. Paired-sample t-tests showed statistically significant changes in student knowledge, vegetable preferences, vegetable consumption, and home food availability (all p < 0.05). At baseline, participants' weight status categories included 57% obese, 10% overweight, and 31% normal weight. Postintervention, weight status categories included 39% obese, 16% overweight, and normal 45%. Data collected from teachers indicated high levels of implementation fidelity. CONCLUSIONS: Implementation of both interventions occurred at a very high fidelity level, which led to positive changes in BMI status, and several dietary and PA behaviors. Although the pilot study indicated feasibility of the two interventions for school implementation, results guided revisions to the TGEG program and its survey instruments.

Motivations, Barriers, and Behaviors Related to Obtaining and Discussing Family Health History: A Sex-Based Comparison Among Young Adults.

BACKGROUND: Genetic predisposition is a risk factor for many chronic diseases, yet little is known about the frequency in which college students seek out their family health history or with whom they communicate relevant information. PURPOSE: This study examines motivations and barriers associated with obtaining one's family health history and discussing it with others. METHODS: Data were analyzed from 625 college students using an internet-delivered questionnaire, which comprised of questions about intentions and motivations to obtain and share family health history as well as barriers encountered when obtaining family health history. Responses were bifurcated by participants' sex. Chi-squared and t statistics were used to identify response differences by sex. RESULTS: Females were significantly more likely than males to be motivated to obtain their family health history, and more likely to have shared their family health history with others; state that they would share their family health history with others; and express a preference for sharing their family health history with a wider range of people. DISCUSSION: Educational interventions and improved student health services could be effective mechanisms to increase college students' knowledge, awareness, and perceived importance of obtaining their family health history.

Influence of the Home Food Environment on Children's Fruit and Vegetable Consumption: A Study of Rural Low-Income Families.

BACKGROUND: This investigation sought to identify micro-level built and sociocultural characteristics of a home food environment that have been theoretically linked with fruit and vegetable (F&V) consumption. METHOD: We examined rural families (n = 298) from the southeastern United States. Hierarchical multiple regression analyses determined the association between the outcome variable (F&V consumption) and micro-level built and sociocultural characteristics of a home food environment. RESULTS: Demographic characteristics were entered at Step 1, explaining 14% of variance in vegetable consumption and 9% in fruit consumption. After entry of sociocultural factors in the home food environment, such as parenting styles and so on, in Block 2, the total variance explained increased by 25% for vegetable consumption and 12% for fruit consumption. Micro-level built environmental factors such as the availability of F&V in the home was entered at Block 3, total variance explained by the model for vegetable consumption was 67%, F(17, 111) = 13.5, p < .001, and for fruit consumption was 57%, F(17, 160) = 12.5, p < .001. CONCLUSION: F&V availability was the most important variable influencing a child's consumption of F&V. There are modifiable factors within the rural low-income home that could serve as priorities for intervention to improve F&V consumption.

Children's active commuting to school: an interplay of self-efficacy, social economic disadvantage, and environmental characteristics.

BACKGROUND: Active commuting to school (ACS) can promote children's physical activity and may help prevent childhood obesity. Previous researchers in various disciplines, e.g., health, urban planning, and transportation, have identified various predictors of ACS. However, little research has been carried out into investigating the effect of self-efficacy on ACS. The purpose of this study is to investigate the roles of children's and parents' self-efficacy in children's ACS, controlling for sociodemographic and objective environmental characteristics. METHODS: This study is part of the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, which includes data from 857 parent/child pairs from 74 schools who lived within two miles of school in Texas. Measures included children's usual modes of commuting to school, participants' sociodemographics, perceived self-efficacy toward ACS, sources of children's self-efficacy, school settings, and objective environmental constraints. Multilevel structural equation modeling (SEM) was employed to test the hypothesized pathways using Mplus 7.0. RESULTS: Around 18% of the children were active commuters. Two sources of children's self-efficacy were identified, i.e., emotional states (ß = 0.36, p < 0.001) and social modeling (ß = 0.28, p < 0.01). Compared with children's self-efficacy (ß = 0.16, p < 0.001), parents' self-efficacy (ß = 0.63, p < 0.001) had a stronger influence on children's ACS. Participants' social economic disadvantage (ß = 0.40, p < 0.001), environmental constraints (ß = -0.49, p < 0.001), and school setting (ß = -0.17, p = 0.029) all had statistically significant direct effects on children's ACS. CONCLUSIONS: Future initiatives should consider both parents' and children's self-efficacy in developing strategies for promoting children's ACS. Social disadvantage and environmental constraints also need to be addressed for effective interventions. The work reported here provides support for the continuing exploration of the role of self-efficacy in children's ACS.

Psychosocial correlates of smokeless tobacco use among Indiana adolescents.

Adolescent tobacco use is influenced by intrapersonal (e.g., impulse control) and external factors, such as behaviors of friends and peers. The relationships of these factors to smokeless tobacco (ST) use are not yet fully understood. This is especially true as it pertains to the simultaneous examination of psychological and normative perceptions. Using constructs of the Biopsychosocial Model, this study investigates factors associated with lifetime ST use among middle and high school students. Data were analyzed from 938 Indiana middle and high school students. Binary sequential logistic regression was performed to examine the relationship of personal characteristics and psychosocial measures to adolescent lifetime ST use. Approximately 9 % reported having ever used ST, among which 78.6 % were male. Females and younger students were less likely to have used ST in their lifetime, whereas participants with a sibling smoker and those who compared their life to the lives of others were more likely to report lifetime ST usage. In the presence of psychological and normative variables, sex, age, and comparing one's life to others remained significant. Additionally, participants who perceived higher friend approval of substance use were significantly more likely to report lifetime ST use. Understanding the normative perceptions of adolescents may lend insight into the drivers of ST use adolescent subgroups and, which may enable community and school officials to tailor interventions to prevent ST initiation and promote cessation.

What are Asian-American youth consuming? A systematic literature review.

Numerous studies have explored dietary practices among children, but there are limited studies on children of Asian background in the US. This review had three aims: (a) review literature regarding Asian-American youth's dietary behaviors, (b) critically evaluate the methodological quality of such research, and (c) provide recommendations for future nutrition-related research on Asian-American youth. The authors conducted a systematic literature review through MEDLINE (EBSCO), CINAHL Plus with Full Text (EBSCO), and Embase (Ovid); extracted descriptive data; and evaluated methodological quality. Thirteen articles were included. Major findings included: (a) frequent consumption of milk, fruit, meat, unenriched white rice, vegetables, and high-fat and high-sugar items among Asian-American children and (b) acculturation's influences on diet, resulting in Asian-American youth consuming diets characterized by both Asian and American foods. Findings from this review may inform education and promotion programs and services for Asian Americans in the US.

African-American Fathers' Perspectives on Their Children's Health Education: A Qualitative, Exploratory Study.

PURPOSE: To investigate African-American fathers' (AAF) perceptions regarding the applicability and need for their involvement as a health connection for their children and describe how participating fathers' behavior was affected by their attitudes, knowledge, and perceptions of their influence on their children's health. METHODS: This exploratory study gathered data via semi-structured focus groups (n = 3) and thematically analyzed it utilizing a grounded theory approach. Participants included AAF (n = 20) with a mean age of 37 years (SD 11.79), with at least one child between 6 and 18 years old. RESULTS: Four major themes were revealed: (1) appropriate health education for participants' children (should first and foremost be delivered by parents); (2) participants' paternal health-related guidance approach (reactive, rather than proactive); (3) participants' perceived influences on health-related communication with their children (gender roles, efficacy constraints); and (4) paternal definitions of health (most often associated with diet). CONCLUSION: Understanding AAFs' perceived and desired role in their children's health edification can inform initiatives that actively engage these men, and nurture their level of involvement, to promote positive health behaviors among their children; this is necessary to realize their potential to actively improve the health of their children, families, and communities.

Perceived barriers to children's active commuting to school: a systematic review of empirical, methodological and theoretical evidence.

Active commuting to school (ACS) may increase children's daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children's ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children's ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child's ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers' awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.