Community Asset Identification in Support of a Place-Based, Early Childhood Obesity Prevention and School Readiness Initiative

Despite extensive community efforts that have resulted in obesity decreases in Cambridge, MA over the last decade, obesity among Black youth remains disproportionately high. Likewise, racial/ethnic academic achievement disparities persist and are evident at early ages. Prior research and emerging national policy recommendations confirm the need for place-based, early childhood interventions to address persistent racial/ethnic disparities in obesity and school readiness. A community-based participatory research initiative is developing an intervention targeted to pre-kindergarten children and their families in a diverse Cambridge neighborhood. The intervention will partner with a Cambridge Public Schools (CPS) program designed to support school readiness through extended pre-school, health care, and community-based services. To identify community partners and plan our efforts to promote healthy eating and active living (HEAL) and support school readiness, we conducted a community asset assessment. Through mixed-methods, we (1) identified 239 potential HEAL assets in Area 4; (2) mapped assets to analyze the distribution and proximity of assets to neighborhood children (age 0-5); and (3) interviewed community leaders to provide context. Our findings informed our understanding of the community and helped prioritize the public housing authority, a childcare “clearinghouse”, and a coalition of faith-based organizations as high-impact intervention partners and settings

Aerobic Fitness, Micronutrient Status, and Academic Achievement in Indian School-Aged Children

Aerobic fitness has been shown to have several beneficial effects on child health. However, research on its relationship with academic performance has been limited, particularly in developing countries and among undernourished populations. This study examined the association between aerobic fitness and academic achievement in clinically healthy but nutritionally compromised Indian school-aged children and assessed whether micronutrient status affects this association. 273 participants, aged 7 to 10.5 years, were enrolled from three primary schools in Bangalore, India. Data on participants’ aerobic fitness (20-m shuttle test), demographics, anthropometry, diet, physical activity, and micronutrient status were abstracted. School-wide exam scores in mathematics and Kannada language served as indicators of academic performance and were standardized by grade level. The strength of the fitness/achievement association was analyzed using Spearman’s rank correlation, multiple variable logistic regression, and multi-level models. Significant positive correlations between aerobic capacity (VO2 peak) and academic scores in math and Kannada were observed (P < 0.05). After standardizing scores across grade levels and adjusting for school, gender, socioeconomic status, and weight status (BMI Z-score), children with greater aerobic capacities (mL * kg-1 * min-1) had greater odds of scoring above average on math and Kannada exams (OR=1.08, 95% CI: 1.02 to 1.15 and OR=1.11, 95% CI: 1.04 to 1.18, respectively). This association remained significant after adjusting for micronutrient deficiencies. These findings provide preliminary evidence of a fitness/achievement association in Indian children. While the mechanisms by which aerobic fitness may be linked to academic achievement require further investigation, the results suggest that educators and policymakers should consider the adequacy of opportunities for physical activity and fitness in schools for both their physical and potential academic benefits

Comfort and utility of school-based weight screening: the student perspective

<p>Abstract</p> <p>Background</p> <p>Weight screening in schools has been proposed as one strategy to address childhood obesity. Students' response to such screening is unexplored, however. In this study we evaluated the perceived comfort, utility and impact of school-based weight screening from the perspective of middle school-aged students.</p> <p>Methods</p> <p>A cross-sectional study of 852 ethnically diverse 5^th–8^thgrade students. Associations were investigated between measured height and weight screening data and responses to a self-administered questionnaire completed immediately following weight screening in physical education class. BMI categories were based on the revised 2000 CDC growth chart and definitions: 5^th–85^thBMI percentile = healthy weight, 85^th–95^thBMI percentile = at risk for overweight, and >95^thpercentile BMI = overweight.</p> <p>Results</p> <p>Overall, students' comfort level with weight screening varied depending on the student's own weight status. More overweight students (38.1%) reported being uncomfortable than healthy weight students (8.1%) (p < 0.001). In particular, overweight female students (54.8%) compared to healthy weight female students (21.6%) reported being uncomfortable (p < 0.01). About half (54.9%) of all students reported knowing their weight prior to screening, and 58.9% reported that it was useful to learn their height and weight. Compared to healthy weight students, overweight students were significantly more likely to report the intention to perform weight modification related activities such as visiting a doctor (Odds ratio (OR) = 2.0, 95% CI = 1.3, 3.1), eating more fruits and vegetables (OR = 2.7, 95% CI = 1.7, 4.1), and increasing physical activity (OR = 4.3, 95% CI = 2.7, 7.0).</p> <p>Conclusion</p> <p>Overall, the majority of the middle school students did not report discomfort with school-based weight screening, did report that receiving height and weight information was useful, and generally report appropriate weight control intentions. These proportions varied across weight status categories, however, with students who were at risk for overweight or overweight reporting higher levels of discomfort. For schools that conduct weight screening, it is essential that they also provide comfortable and private settings as well as education or counseling regarding healthy weight control practices.</p

The Exposure Peaks of Traffic-Related Ultrafine Particles Associated with Inflammatory Biomarkers and Blood Lipid Profiles

In this article, we explored the effects of ultrafine particle (UFP) peak exposure on inflammatory biomarkers and blood lipids using two novel metrics—the intensity of peaks and the frequency of peaks. We used data previously collected by the Community Assessment of Freeway Exposure and Health project from participants in the Greater Boston Area. The UFP exposure data were time-activity-adjusted hourly average concentration, estimated using land use regression models based on mobile-monitored ambient concentrations. The outcome data included C-reactive protein, interleukin-6 (IL-6), tumor necrosis factor-alpha receptor 2 (TNF-RII), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and total cholesterol. For each health indicator, multivariate regression models were used to assess their associations with UFP peaks (N = 364–411). After adjusting for age, sex, body mass index, smoking status and education level, an increase in UFP peak exposure was significantly (p < 0.05) associated with an increase in TNF-RII and a decrease in HDL and triglycerides. Increases in UFP peaks were also significantly associated with increased IL-6 and decreased total cholesterol, while the same associations were not significant when annual average exposure was used. Our work suggests that analysis using peak exposure metrics could reveal more details about the effect of environmental exposures than the annual average metric

Final logistic regression models predicting odds of academic success in math and Kannada from aerobic fitness (n = 273).

<p>Odds ratios are presented as point estimates (95% confidence interval) and are adjusted for school, gender, SES, and BMIZ. Academic success in math and Kannada is defined as a Z-score > 0.</p><p>*<i>P</i> < 0.05;</p><p>**<i>P</i> < 0.01;</p><p>***<i>P</i> < 0.001</p><p>Final logistic regression models predicting odds of academic success in math and Kannada from aerobic fitness (n = 273).</p

Characteristics of participants (n = 273 unless stated otherwise).

<p>Values are percentages (number) for categorical data, median (Q1, Q3) for non-normally distributed data, and mean ± SD for normally distributed data.</p><p>^a n = 243</p><p>Characteristics of participants (n = 273 unless stated otherwise).</p

Percentage of participants with above average academic performances by maximum speed reached on 20-m shuttle test.

<p>Scoring above average in math (solid triangle) and Kannada (solid square) was defined by an academic Z-score > 0. The initial speed of the 20-m shuttle was set at 4 km * h^-1 (1.11 m * s^-1) and increased by 0.5 km * h^-1 (0.14 m * s^-1) every minute. Academic Z-scores were adjusted for school, gender, and SES. The percentage of participants with above-average performances in math and Kannada increased as the maximum speed reached increased. The number of participants reaching the above maximum speeds is as follows: 7.0 or 7.5 km * hr^-1, 22 students; 8.0 or 8.5 km * hr^-1, 89 students; 9.0 or 9.5 km * hr^-1, 109 students; 10.0 km * hr^-1 or greater, 53. Participants reaching maximum speeds of 10.0 km * hr^-1 or greater were grouped due to the relatively small number of participants who reached speeds above 10.0 km * hr^-1. Values presented are adjusted mean±SE.</p

Prevalence of micronutrient deficiencies (n = 268–273).

<p>Values are percentages (% deficient).</p><p>^a Analysis only for participants with CRP < 47.62 nmol * L^-1</p><p>Prevalence of micronutrient deficiencies (n = 268–273).</p

The FLEX study school-based physical activity programs – measurement and evaluation of implementation

Abstract Background Increasing children’s physical activity (PA) at school is critical to obesity prevention and health promotion. Implementing novel, low-cost PA programs offers potential to contribute to children’s in-school PA, particularly in resource-constrained schools. This evaluation describes implementation fidelity, reach, and dose of two PA programs in the Fueling Learning through Exercise (FLEX) Study. Methods Thirteen diverse, low-income Massachusetts elementary schools were recruited and randomized to the 100 Mile Club walking/running program (n = 7) or CHALK/Just Move classroom activity break PA program (n = 6). Intervention programs were delivered across two school years. Surveys with program champions/teachers and children, in-session measurement of children’s PA by accelerometry (Actigraph GT3X) in a subset of schools, and key informant interviews were used to collect information on implementation, including fidelity, dose, reach, and sustainability, and to calculate an implementation score. Results Six CHALK/Just Move schools implemented the program in both years. Two schools randomized to 100 Mile Club did not implement at all, and only three schools implemented both years. Implementing schools had similar implementation scores (range = 0–3; 100 Mile Club = 2.0 vs. CHALK/Just Move = 1.9) but fidelity to core and enhanced elements differed between programs. In 100 Mile Club schools, dose of program delivered was greater than in CHALK/Just Move schools (34.9 vs. 19.7 min per week). Dose of PA received per session was also greater in 100 Mile Club schools (n = 55, 2 schools) compared with CHALK/Just Move schools (n = 160, 2 schools) (13.6 min vs. 2.7 min per session). A slightly higher proportion of eligible children participated in CHALK/Just Move compared to 100 Mile Club (54.0% vs. 31.2%). Both programs were well received by champions/teachers and students. Conclusions Program implementation varied across programs and schools, and erosion in delivery was seen over the two years. However, among implementing schools, additional PA was delivered and received, and the programs were generally well-received. Although school resource issues remain barriers to implemention, this evaluation demonstrates that low-cost programs may enhance PA opportunities. Future research should evaluate how multiple programs can be implemented to increase children’s PA at school. Trial registration ClinicalTrials.gov Identifier: NCT02810834. Registered May 11, 2015

Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey.

BACKGROUND: Despite being motivated to improve nutrition and physical activity behaviors, cancer survivors are still burdened by suboptimal dietary intake and low levels of physical activity. OBJECTIVE: The aim of this study was to assess changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, barriers to eating a healthy diet and staying physically active, and sources for seeking nutrition advice reported by breast cancer survivors. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: The study included 315 survivors of breast cancer who were recruited through social media and provided completed responses to an online exploratory survey. MAIN OUTCOME MEASURES: Self-reported changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, perceived barriers to healthy eating and physical activity, and sources of nutrition advice were measured. STATISTICAL ANALYSIS: Frequency distribution of nutrition and physical activity behaviors and changes, barriers to healthy eating and physical activity, and sources of nutrition advice were estimated. RESULTS: About 84.4% of the breast cancer survivors reported at least 1 positive behavior for improving nutrition and physical activity after cancer diagnosis or treatment. Fatigue was the top barrier to both making healthy food choices (72.1%) and staying physically active (65.7%), followed by stress (69.5%) and treatment-related changes in eating habits (eg, change in tastes, loss of appetite, and craving unhealthy food) (31.4% to 48.6%) as barriers to healthy eating, and pain or discomfort (53.7%) as barriers to being physically active. Internet search (74.9%) was the primary source for seeking nutrition advice. Fewer than half reported seeking nutrition advice from health care providers. CONCLUSIONS: Despite making positive changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, breast cancer survivors experience treatment-related barriers to eating a healthy diet and staying physically active. Our results reinforce the need for developing tailored intervention programs and integrating nutrition into oncology care