In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes.
Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students.
Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs.
Beginning in March 2020, the COVID-19 pandemic triggered a sudden and severe economic downturn and led to disruptions in domestic and international food systems and supply chains. Over the first few months of the pandemic, in the United States, many stores had empty shelves, bars and restaurants closed, and children could no longer go to school. The unemployment rate increased from 3.5% in February 2020 to 14.8% in April 2020, leading to economic instability for many households. As a result, household food insecurity, defined as having limited or inconsistent access to nutritious and affordable food, increased rapidly.
During the first months of 2021, vaccinations began rolling out, more individuals returned to in-person work, children to schools, and restrictions were gradually phased out. Unemployment has decreased since the April 2020 peak to 5.4% in July 2021, but remains above pre-pandemic levels. This brief describes the prevalence of household food insecurity, job disruptions, and food-related behaviors as reported by a nationally representative sample of 1,643 U.S. adults, both in the year prior to the COVID-19 pandemic (March 2019 – March 2020) and during the first four months of 2021 (January – April 2021), a period representing approximately one year since the onset of the pandemic.
Relationships between food and physical activity (PA) environments and children's related behaviors are complex.
Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections. Regression analyses examined whether derived classes were related to food consumption, PA, and overweight among 404 low-income children.
Compared to children living in Low PA-Low Food environments, children in High Intersection&Parks-Moderate Density&Food, and High Density-Low Parks-High Food environments, had significantly greater sugar-sweetened beverage consumption (ps<0.01) and overweight/obesity (ps<0.001). Children in the High Density-Low Parks-High Food environments were more likely to walk to destinations (p = 0.01)
Recognizing and leveraging beneficial aspects of neighborhood patterns may be more effective at positively influencing children's eating and PA behaviors compared to isolating individual aspects of the built environment.
Purpose: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores.
Design: Nonexperimental.
Setting: Four New Jersey cities.
Subjects: Random selection of 229 and 96 corner stores in rounds 1 and 2, respectively.
Measures: An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct in-store audits. The 7-item SCAT was developed and used for round 2 phone audits.
Analysis: Exploratory factor analysis and item response theory were used to develop the SCAT.
Results: The SCAT was highly correlated with the adapted NEMS-CS ( r = .79). Short-form corner store audit tool scores placed stores in the same healthfulness categories as did the adapted NEMS-CS in 88% of the cases. Phone response matches indicated that store owners did not distinguish between 2% and low-fat milk and tended to round up the fruit and vegetable count to 5 if they had fewer varieties.
Conclusion: The SCAT discriminates between higher versus lower healthfulness scores of corner stores and is feasible for use as a phone audit tool.
Objective: This study compared the prices of unhealthy (chips) and healthy (ready-to-eat fruit) snacks that students are likely to purchase from corner stores.
Methods: Snacks were purchased from 325 New Jersey corner stores; chip prices were compared with fruit prices overall and by store sales volume and block group characteristics.
Results: Prices did not differ significantly between chips and fruit in the overall sample in which both items were available (n = 104) (chips: $0.46 ± $0.15; fruit: $0.49 ± $0.19; P = .48) or by store or block group characteristics. Neither mean fruit prices nor mean chip prices differed by store sales volume or by neighborhood characteristics.
Conclusions and implications: Promoting ready-to-eat fruits in corner stores to children as a price-neutral alternative to calorically dense snacks can be a viable strategy to improve the nutritional quality of snacks commonly purchased at corner stores.
Background: Active commuting to school (ACS) increases students' daily physical activity, but associations between student weight and ACS are inconsistent. Few studies examining ACS and weight account for distance commuted. This study examines the association between students' weight status and ACS, taking into account distance to school.
Methods: In 2009-10 a random digit-dial household survey conducted in low-income minority cities collected information about ACS for 1 randomly selected school-going student per household. Parents provided measured heights and weights. Distance commuted was obtained using geocoded home and school addresses. Multivariate regression analyses assessed associations of ACS and distance commuted with weight status.
Results: 36.6% of students were overweight/obese; 47.2% engaged in ACS. Distance walked/biked to school was associated with 7% lower odds of overweight/obesity (OR = 0.93, 95% CI: 0.88- 0.99). Without distance commuted in the model, ACS was not associated with students' weight status. Compared with no ACS, ACS greater than a half-mile was associated with 65% lower odds of a student being overweight/obese (OR = 0.35, 95% CI: 0.16- 0.78); ACS less than a half-mile was not.
Conclusions: ACS is significantly inversely associated with overweight/obesity among students who commute beyond a one-half mile threshold.
Background
Few children accumulate the recommended ≥60 minutes of physical activity each day. Active travel to and from school (ATS) is a potential source of increased activity for children, accounting for 22% of total trips and time spent traveling by school-aged children.
Purpose
This study identifies the association of parents’ perceptions of the neighborhood, geospatial variables, and demographic characteristics with ATS among students in four low-income, densely populated urban communities with predominantly minority populations.
Methods
Data were collected in 2009–2010 from households with school-attending children in four low-income New Jersey cities. Multivariate logistic regression analyses (n=765) identified predictors of ATS. Analyses were conducted in 2012.
Results
In all, 54% of students actively commuted to school. Students whose parents perceived the neighborhood as very unpleasant for activity were less likely (OR=0.39) to actively commute, as were students living farther from school, with a 6% reduction in ATS for every 0.10 mile increase in distance to school. Perceptions of crime, traffic, and sidewalk conditions were not predictors of ATS.
Conclusions
Parents’ perceptions of the pleasantness of the neighborhood, independent of the effects of distance from school, may outweigh concerns about crime, traffic, or conditions of sidewalks in predicting active commuting to school in the low-income urban communities studied. Efforts such as cleaning up graffiti, taking care of abandoned buildings, and providing shade trees to improve neighborhood environments are likely to increase ATS, as are efforts that encourage locating schools closer to the populations they serve.
Background
Participation in the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) among 0- to 5-year-old children is associated with healthier diets. Extension of dietary benefits to older, age-ineligible children (5-18 years old) residing in WIC households has not been fully investigated.
Objective
Examine the association between household WIC participation and dietary behaviors of age-ineligible children.
Design
Cross-sectional secondary analysis of data collected from 2 independent panels (2009-2010 and 2014) of the New Jersey Child Health Study, using household surveys. Questions derived from national surveys assessed consumption frequency of specific foods among 5- to 18-year-old children.
Participants/setting
The analytic sample included 616 age-ineligible children from households with incomes below 200% of the federal poverty level, 398 of whom were from WIC-participating households.
Main outcome measures
Eating behaviors were measured as frequency of daily consumption of fruit, vegetables, 100% juice, sugar-sweetened beverages, and sweet and salty snacks.
Statistical analysis
Multivariable negative binomial models examined the association between eating behaviors and household WIC participation status adjusting for child’s age, sex, and race; mother’s education; city of residence; household size; and panel. Results are expressed as incidence rate ratios (IRRs).
Results
Household WIC participation was not associated with dietary behaviors among age-ineligible children (5-18 years old) in the overall sample. However, healthier dietary patterns were observed for specific demographic groups. Compared with age-ineligible children in non-WIC households, age-ineligible children in WIC households had (1) a higher frequency of vegetable consumption among 12- to 18-year-old children (IRR = 1.29; 95% confidence interval [CI] 1.05-1.58; P = .015); (2) a marginally significant higher frequency of 100% juice consumption among females (IRR = 1.27; 95% CI 1.00-1.62; P = .053); and (3) a lower frequency of sugar-sweetened beverages consumption among Hispanic children (IRR = 0.61; 95% CI 0.43-0.86; P = .004).
Conclusions
Household WIC participation may positively influence dietary behaviors of age-ineligible children, suggesting a possible WIC spillover effect. Revisions to WIC package composition should consider the possible dietary implications for all children in the household.