A Multivariate Probit Regression of the Uptake of Adolescent Vaccines Among Racial/Ethnic Minority Adolescents Before and During the COVID-19 Pandemic.

PURPOSE: The uptake of adolescent vaccines has improved over the years. However, research of the effects of the COVID-19 pandemic on this uptake among racial/ethnic minority adolescents has been limited. This study was conducted to compare the probability of uptake of the human papillomavirus (HPV); tetanus, diphtheria, and acellular pertussis (Tdap); and quadrivalent meningococcal conjugate (MenACWY) vaccines among racial/ethnic minority adolescents ages 13-17 years in 2019, 2020, and 2021. METHODS: Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), multivariate probit regression was used to model variation in uptake of these three adolescent vaccines (n = 38,128). The outcome measures were HPV, Tdap, and MenACWY vaccine uptake. RESULTS: The probability of uptake of HPV vaccine was higher in 2020 (Coef = 0.09 [95% confidence interval (CI), 0.03-0.16]) and 2021 (Coef = 0.07 [95% CI, 0.00-0.15]) than in 2019. The probability of uptake of MenACWY vaccine was higher in 2020 (Coef = 0.08 [95% CI, 0.02-0.15]) than in 2019. The probability of uptake of recommended vaccines varied among racial/ethnic minorities with non-Hispanic Black adolescents exhibiting higher probability of uptake of HPV vaccine (Coef = 0.10 [95% CI, 0.01-0.19]) than Tdap vaccine. U.S. Census region and insurance status were associated with the uptake of all recommended vaccines. DISCUSSION: Progress in the uptake of these recommended vaccines may not have been interrupted by the COVID-19 pandemic. Also, disparities in uptake of the recommended vaccines still exist despite increased uptake during the pandemic. Future research should examine the disparities as well as examine regional differences in the uptake of these three adolescent vaccines.

The prevalence of human papillomavirus vaccination among racial and ethnic minority adolescents during the COVID-19 pandemic.

BACKGROUND: Human papillomavirus (HPV) vaccination among adolescents has steadily improved over the past several years. However, research conducted to determine whether the COVID-19 pandemic disrupted this positive trend in HPV vaccine initiation among racial and ethnic minority adolescents is limited. Therefore, this study was conducted to determine if the COVID-19 pandemic and the resulting changes in the US health-care sector affected the increasing HPV vaccine initiation among non-Hispanic Black and Hispanic adolescents aged 13-17 years. METHODS: Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), logistic regression and moderation analysis were used to model race-specific variations in HPV vaccine initiation (n = 49 031). Two-sided P values of up to .05 were considered statistically significant. RESULTS: Hispanic (adjusted odds ratio [AOR] = 1.35, 95% confidence interval [CI] = 1.16 to 1.57) and non-Hispanic Black (AOR = 1.29, 95% CI = 1.10 to 1.51) adolescents had higher odds of HPV vaccine initiation than did non-Hispanic White adolescents. Additionally, the odds of HPV vaccine initiation were higher in 2021 (AOR = 1.22, 95% CI = 1.08 to 1.38) than in 2019. Other variables-age, region, sex, insurance status, and poverty status-were also associated with HPV vaccine initiation. CONCLUSION: These findings demonstrate that during the COVID-19 pandemic, racial and ethnic minorities had higher odds of receiving the HPV vaccine. Therefore, more research of the impact of the pandemic on HPV vaccine initiation among non-Hispanic White and racial and ethnic minority adolescents is needed.

Parent-reported provider recommendation of HPV vaccination among minority adolescents before and during the COVID-19 pandemic: Findings from the National Immunization Survey-Teen, 2019-2021.

Provider recommendation of human papillomavirus (HPV) vaccination among adolescents has steadily improved over the years, however, limited research has been conducted to examine if the COVID-19 pandemic disrupted this positive trend in parent-reported provider recommendation among minority adolescents. Therefore, we conducted the present study to determine if there is an association between the pandemic and parent-reported provider recommendation of HPV vaccine among non-Hispanic black and Hispanic adolescents. We also examined whether any changes in parent-reported provider recommendation in the years 2019, 2020, and 2021 differed by race or ethnicity. Using a cross-sectional design to examine data from the National Immunization Survey-Teen (2019-2021), a moderation analysis and logistic regression analysis were performed to model race-specific variation in parent-reported provider recommendation (n = 50,739). We found that Hispanic parents had lower odds (aOR = 0.80 [0.71, 0.91]) of reporting receiving a recommendation compared to non-Hispanic white parents. We also found that the odds of parent-reported provider recommendation were higher in 2020 (aOR = 1.15 [1.03-1.29]) than in 2019. Other variables-age, region, sex, health insurance status, and poverty status-were all associated with parent-reported provider recommendation. These findings demonstrated that the pandemic may not have triggered any race-related gap in the recommendation of HPV vaccines, however, more pandemic-resilient public health efforts are needed to improve parent and provider communication regarding HPV vaccination of adolescents.

Heat-Resilient Schoolyards: Relations Between Temperature, Shade, and Physical Activity of Children During Recess.

BACKGROUND: Extreme heat may discourage physical activity of children while shade may provide thermal comfort. The authors determined the associations between ambient temperature, shade, and moderate to vigorous physical activity (MVPA) of children during school recess. METHODS: Children aged 8-10 (n = 213) wore accelerometers and global positioning system monitors during recess at 3 school parks in Austin, Texas (September-November 2019). Weather data originated from 10 sensors per park. The authors calculated shade from imagery using a geographic information system (GIS) and time-matched physical activity, location, temperature, and shade data. The authors specified piecewise multilevel regression to assess relations between average temperature and percentage of recess time in MVPA and shade. RESULTS: Temperature ranged 11 °C to 35 °C. Each 1 °C higher temperature was associated with a 0.7 percentage point lower time spent in MVPA, until 33 °C (91 °F) when the association changed to a 1.5 lower time (P < .01). Each 1 °C higher temperature was associated with a 0.3 percentage point higher time spent under shade, until 33 °C when the association changed to a 3.4 higher time (P < .001). At 33 °C or above, the direct association between shade and MVPA weakened (P < .05), with no interaction effect above 33 °C (P > .05). Children at the park with the most tree canopy spent 6.0 percentage points more time in MVPA (P < .01). CONCLUSIONS: Children engage in less MVPA and seek shade during extreme heat and engage in more MVPA in green schoolyards. With climate change, schools should consider interventions (eg, organizing shaded play, tree planting) to promote heat safe MVPA.

Training of Registered Dietitian Nutritionists to Improve Culinary Skills and Food Literacy.

OBJECTIVE: To understand if a culinary medicine training program increases food literacy, culinary skills, and knowledge among practicing registered dietitian nutritionists (RDN). METHODS: Prepost study design evaluating pilot test of RDN train-the-trainer curriculum from September, 2019 to January, 2020. RESULTS: On average, results indicate an increase in culinary nutrition skills (mean difference, 6.7 ± 4.4; P < 0.001; range, 10-30) and a significant increase in 5 of the 8 food literacy factors. Through process evaluation, RDNs rated the training as extremely useful to their practice (mean, 4.4 ± 0.3). CONCLUSIONS AND IMPLICATIONS: Registered dietitian nutritionist participants increased culinary nutrition skills with statistically significant scores across all individual measures. This study describes an RDN training curriculum in culinary medicine across a diverse group of practicing RDNs from a large county health care system. Culinary medicine shows a promising impact on promoting nutrition skills and confidence; however, it warrants further assessment.

The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design.

BACKGROUND: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. OBJECTIVE: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. METHODS: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening-physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. RESULTS: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening-physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). CONCLUSIONS: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.

Effects of Large-Scale Municipal Safe Routes to School Infrastructure on Student Active Travel and Physical Activity: Design, Methods, and Baseline Data of the Safe Travel Environment Evaluation in Texas Schools (STREETS) Natural Experiment.

Past evaluations of Safe Routes to School (SRTS) programs have been relatively small in scope and have lacked objective measurements of physical activity. A 2016 Mobility Bond in Austin, Texas, USA, allocated USD 27.5 million for infrastructure changes to facilitate active commuting to schools (ACS). The Safe TRavel Environment Evaluation in Texas Schools (STREETS) study aims to determine the health effects of these infrastructure changes. The purpose of this paper is to describe the STREETS study design, methods, and selected baseline results. The STREETS study is comprised of two designs: (1) a serial cross-sectional design to assess changes in ACS prevalence, and (2) a quasi-experimental, prospective cohort to examine changes in physical activity. Differences between study arms (Austin SRTS and comparison) were assessed for school demographics, ACS, and school programs. At baseline, 14.3% of school trips were made by ACS, with non-significant differences between study arms. Only 26% of schools implemented ACS-related programs. Some significant differences across SRTS and comparison schools were identified for several school- and neighborhood-level characteristics. Substantial changes are needed across area schools and neighborhoods to promote optimum ACS. STREETS study longitudinal findings will be critical for informing optimal future implementations of SRTS programs.

Acceptance- and mindfulness-based techniques for physical activity promotion in breast cancer survivors: a qualitative study.

PURPOSE: The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors. METHODS: The acceptance- and mindfulness-based physical activity intervention was delivered to participants electronically over the course of 4-8 weeks. It consisted of didactic videos, experiential exercises, and workbook-type activities that targeted principles from acceptance and commitment therapy (ACT). We conducted semi-structured, in-depth interviews with participants after they completed the intervention. Three coders conducted qualitative data analysis on interview transcripts to identify overarching themes and subthemes. RESULTS: We recruited 30 participants. Of those, 16 engaged in an individual interview. The mean age of the sample was 58.4 years (SD = 13.8). The sample was relatively well educated (50.0% college graduates) and mostly overweight or obese (58.8%). We identified two overarching themes from interviews. They were centered on (1) internal and external barriers to physical activity adherence and (2) the utility of targeting core ACT processes (acceptance and defusion, mindfulness, and values clarification) for physical activity promotion. CONCLUSION: Intervention content was perceived to be acceptable, relevant, and to fulfill important needs related to healthy living. Findings suggest that this approach to physical activity promotion can be delivered effectively online. Electronically delivered acceptance- and mindfulness-based approaches hold promise for helping insufficiently active breast cancer survivors increase physical activity.

Barriers and Facilitators of Implementing a Clinic-Integrated Food Prescription Plus Culinary Medicine Program in a Low-Income Food Insecure Population: A Qualitative Study.

BACKGROUND: Food prescription and culinary medicine programs are gaining popularity as tools for decreasing food insecurity, increasing personal agency, promoting healthy eating, and reducing the risk of chronic diseases. However, there is a gap in understanding of how health care professionals can deliver evidence-based how-to nutrition information that is tailored for culturally diverse, low-income populations. OBJECTIVE: To understand the barriers and facilitators for healthy eating among a low-income, diverse population with diabetes, and the gaps in knowledge and training needed for registered dietitian nutritionists (RDN) to address patient barriers when implementing a food prescription and CM program in a healthcare setting. DESIGN: A series of nine focus groups were conducted: six focus groups with patients with diabetes (n = 40) (three in English and three in Spanish) and three focus groups with RDN employees (n = 17). PARTICIPANTS/SETTING: A convenience sample of 40 low-income food insecure patients with diabetes receiving care at a diverse, integrated, safety net health care system in an urban setting in Texas and convenience sample of 17 RDN employees. STATISTICAL ANALYSIS: All focus group transcripts were examined by independent reviewers and blind catalogued and organized into common themes and subthemes based on constant comparative methodology. Investigator group consensus was reached on emergent themes and subthemes for the respective focus groups. RESULTS: Patients reported frustration with mixed dietary messages from different health care providers, lack of culturally inclusive recommendations, and a desire for skills to prepare tasty and healthy food. RDNs desired more training and education in cultural humility, culinary nutrition skills, and behavioral change theory. CONCLUSIONS: Our study describes how cultural humility, practical culinary nutrition skills, and consistent and coordinated messaging can help to improve patient nutrition care. Before implementation of a food prescription and culinary medicine program, efforts should promote training of RDN staff in culinary nutrition and related areas to increase acceptability and adherence of the program for patients.

School Parks as a Community Health Resource: Use of Joint-Use Parks by Children before and during COVID-19 Pandemic.

Parks are settings for physical activity that can support the physical and mental health of children during the COVID-19 pandemic. We determined the impact of the pandemic on the use of joint-use parks outside of school hours by children in Austin, TX, United States. In autumn of 2019 and autumn of 2020 (i.e., before and during the COVID-19 pandemic), we used an adapted version of the System for Observing Play and Recreation in Communities to observe whether children aged 1-12 participated in physical activity (i.e., sedentary, light and moderate, vigorous) at three parks located at schools serving mostly economically disadvantaged Latinx families. In 2020, we also observed whether children maintained social distance and wore face coverings. Results of negative binomial regression modeling revealed the pandemic was associated with a 46% [95% CI: 20-63%] and 62% [95% CI: 39-76%] decrease in the number of girls and boys at parks, respectively, and a 42% [95% CI: 16-59%] and 60% [95% CI: 36-75%] decrease in the number of girls and boys engaging in physical activity, respectively (p < 0.01). In total, 60.6% of girls and 73.6% of boys were not social distancing, and 91.8% of the time no children wore masks. Interventions should be considered to safely reintroduce children to parks for health benefits during pandemics.

Structural Racism and Immigrant Health: Exploring the Association Between Wage Theft, Mental Health, and Injury among Latino Day Laborers.

Background: Although wage theft has been discussed primarily as a labor and human rights issue, it can be conceptualized as an issue of structural racism with important consequences for immigrant health. Objectives: The objectives of this study were to: 1) identify sociodemographic, employment, and stress-related characteristics that increase Latino day laborers' odds of experiencing wage theft; 2) assess the association between wage theft and serious work-related injury; 3) assess the association between wage theft and three indicators of mental health-depression, social isolation, and alcohol use-as a function of wage theft; and 4) assess serious work-related injury as a function of wage theft controlling for mental health. Methods: Secondary data analyses were based on survey data collected from 331 Latino day laborers between November 2013 and July 2014. Regression analyses were conducted to test the relationships described above. Results: Approximately 25% of participants reported experiencing wage theft and 20% reported serious work-related injury. Wage theft was associated with working in construction and was initially associated with work-related injury. Wage theft was not significantly associated with mental health indicators. The association between wage theft and injury became non-significant when controlling for the mental health variables. Conclusions: The hardship and stress associated with wage theft incidents may ultimately lead to more frequent injury. Although we expected an association of wage theft with mental health, we found vulnerability to physical health as indicated by injury incidents. Thus, our basic premise was partially supported: wage theft may act as a stressor that stems from conditions, in part, reflecting structural racism, making workers vulnerable to poorer health.

Patterns of self-monitoring technology use and weight loss in people with overweight or obesity.

Mobile applications and paired devices allow individuals to self-monitor physical activity, dietary intake, and weight fluctuation concurrently. However, little is known regarding patterns of use of these self-monitoring technologies over time and their implications for weight loss. The objectives of this study were to identify distinct patterns of self-monitoring technology use and to investigate the associations between these patterns and weight change. We analyzed data from a 6-month weight loss intervention for school district employees with overweight or obesity (N = 225). We performed repeated measures latent profile analysis (RMLPA) to identify common patterns of self-monitoring technology use and used multiple linear regression to evaluate the relationship between self-monitoring technology use and weight change. RMLPA revealed four distinct profiles: minimal users (n = 65, 29% of sample), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5%). The dedicated all-around users with exceptional food logging lost the most weight (X2[1,225] = 5.27, p = .0217). Multiple linear regression revealed that, adjusting for covariates, only percentage of days of wireless weight scale use (B = -0.05, t(212) = -3.79, p < .001) was independently associated with weight loss. We identified distinct patterns in mHealth self-monitoring technology use for tracking weight loss behaviors. Self-monitoring of weight was most consistently linked to weight loss, while exceptional food logging characterized the group with the greatest weight loss. Weight loss interventions should promote self-monitoring of weight and consider encouraging food logging to individuals who have demonstrated consistent use of self-monitoring technologies.

Mobile applications and paired devices now enable users to track their physical activity levels, dietary intake, and weight fluctuations all in one user interface. We know that tracking each of these behaviors generally facilitates weight loss, but it is not clear how people with overweight or obesity may tend to use these multiple functions together when trying to lose weight. In a sample of 225 school district employees with overweight or obesity, we investigated whether there were common patterns in tracking these behaviors over time, and whether patterns were associated with weight loss. We identified groups reflecting four common patterns, which we termed the minimal users (n = 65, 29%), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5% of sample). The dedicated all-around users with exceptional food logging was the only group that reliably lost weight and was characterized by high tracking of activity, diet, and weight. Overall, regular use of the weight scale was most strongly associated with weight loss. It may be useful to broadly encourage self-monitoring of weight, and selectively encourage food logging to individuals amenable to this self-monitoring technology.

Heat-Moderating Effects of Bus Stop Shelters and Tree Shade on Public Transport Ridership.

Rising temperatures threaten the resilience of public transit systems. We determined whether bus stop shelters and tree canopy surrounding bus stops moderated the effect of warm season temperatures on ridership in Austin, Texas, and whether shelters and trees were equitably distributed. For bus stops (n = 2271) of Capital Metropolitan Transportation Authority, boardings per bus were measured 1 April-30 September 2019. Air temperature data originated from the Camp Mabry weather station. Tree canopy was calculated by classification of high-resolution aerial imagery from the National Agriculture Imagery Program. Data on race, ethnicity, poverty level, median age, and bus commuters within census tracts of bus stops originated from the 2014-2018 American Community Survey. Using multilevel negative binomial regression models, we found that shelters did not moderate the effect of high temperatures on ridership (p > 0.05). During high temperatures, each one-percent increase in tree canopy was associated with a lesser decrease (1.6%) in ridership compared to if there were no trees (1.7%) (p < 0.001). In general, shelters and trees were equitably distributed. Insignificant or modest effects of shelters and trees on ridership during high temperatures may be attributed to the transit dependency of riders. For climate change adaptation, we recommend tree planting at bus stops to protect from ridership losses and unhealthy exposure to extreme heat.

Cross-Sectional Relationship between Regular Bedtime and Weight Status and Obesity-Related Behaviors among Preschool and Elementary School Children: TX CORD Study.

Background: This study examines the relations between a regular weekday bedtime with weight status, diet quality, physical activity, wellbeing, and parental rules among children 2 to 12 years of age from low-income populations. Methods: The study used baseline data collected in 2012, as part of a larger quasiexperimental study design. A convenience sample of parents of children in preschools, second, or fifth grade attending Head Start centers or elementary schools located in low-income catchment areas, in Houston and Austin, TX, were recruited to participate in the study (n = 32 elementary schools; n = 12 Head Start centers). Regular weekday bedtime was measured with the question "Does your child have a regular weekday bedtime?" Results: The sample of 1467 child-parent dyads were split approximately evenly by sex, and consisted of 44.4% Pre-K, 30.4% second grade, and 25.2% fifth grade students. Six hundred twenty-two (43.6%) children were overweight or obese. Children who had a regular bedtime had 15% lower odds of being overweight or obese (adjusted odds ratio [aOR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p-value: 0.017). Also, children who had a regular bedtime had 45% higher odds of eating the recommended number of fruits and vegetables (aOR: 1.45, 95% CI: 1.02-2.07, p-value: 0.039) and had physical activity more days of the week (ß: 0.42, 95% CI: 0.26-0.57, p-value: <0.001). Conclusions: Having a regular weekday bedtime is associated with better weight status and several obesity-related health behaviors in children. Parental report of regular bedtimes for their children may be an indication of parenting skills related to other health-related behaviors for prevention of childhood obesity.

Adiposity, cardiovascular, and health-related quality of life indicators and the reallocation of waking movement behaviors in preschool children with overweight and obesity: An isotemporal data analysis.

BACKGROUND: Isotemporal substitution evaluates hypothetical time replacement scenarios of physical movement on health, with few studies conducted among ethnically diverse preschool-aged populations. This study examines the reallocation of waking movement behaviors on adiposity, cardiovascular, and quality of life indicators among low-income, majority Hispanic preschool-aged youth (2-5 years) with overweight. METHODS: Participants wore an ActiGraph monitor (waist) and completed adiposity, cardiovascular, and health-related quality of life health assessments. Covariates included age, sex, ethnicity, and socioeconomic status. The isotemporal substitution approach was employed to address study aims. RESULTS: Complete data were available for 131 preschoolers. For boys, reallocating 5 minutes of stationary time with light intensity, moderate to vigorous intensity, or total physical activity showed a relation with beneficial reductions in adiposity indicators; for girls, these relations were statistically null. For boys and girls, reallocating 5 minutes of stationary time [-2.2 (95% CI: -3.7, -0.7) mmHg], light intensity [-2.1 (95% CI: -3.7, -0.7) mmHg], or moderate intensity activity [-2.7 (95% CI: -5.0, -0.4) mmHg] to vigorous intensity activity was related to favorable systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.0, -0.1) mmHg] or total physical activity [-0.2 (95% CI: -0.3, -0.01) mmHg] was related to lowered systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.1, -0.02) bpm] was related to lowered resting heart rate. No significant results for quality of life were found. CONCLUSION: Reallocation of time from stationary time to other movement behaviors is associated with several favorable adiposity and cardiovascular health outcomes among preschool children with overweight and obesity.

Intention to use light-rail transit in Houston, Texas, United States: Findings from the Travel-Related Activity in Neighborhoods study.

Using data from the Houston Travel-Related Activity in Neighborhoods (TRAIN) study, this study examined how various factors affect whether individuals intend to use newly opened light-rail transit (LRT) lines in Houston. The Houston TRAIN study is a natural experiment on the effect of new LRT lines on both transit use and physical activity. A mixed binary logit model was developed based on a dichotomous dependent variable and rich set of variables, including sociodemographic factors, health status, travel behavior and technology, and attitudes and perceptions. The mixed model also allowed accounting for the unobserved heterogeneity across individuals in their sensitivity to observed variables. The results indicated the important role of various factors influencing the decision on intent to use the new LRT lines. In general, demographics mattered but to a lower extent than psychological or personality-related variables. For example, attitudes and perceptions toward the public transit system and consciousness of physical activities derived by using public transit were important factors. Personal health constraints negatively influenced intention to use, while experience with the public transport system was among the positive indicators. The findings show the potential of future interventions in this community to promote use of the new system, such as educational campaigns that improve perceptions of public transit use and clarify the benefits of being active. While providing growing evidence that cognitive variables are important in measuring intention to use public transit, the results emphasize the positive role of efforts integrating transportation and health to develop effective and sustainable solutions.

Evaluation of BMI Metrics to Assess Change in Adiposity in Children with Overweight and Moderate and Severe Obesity.

OBJECTIVE: This study aimed to examine the relation between change in different BMI metrics and change in adiposity over a 12-month weight management intervention. METHODS: Baseline and 12-month weights and heights from 399 children aged 2 to 12 years with BMI ≥ 85th percentile were used to calculate BMI, %BMIp95, %BMIp50, BMI z-score (BMIz), and modified BMI z-score (BMImz). Changes (Δ) in these measures were compared with changes in body fat percent (Δfat%) from bioelectrical impedance assessment. Correlation and regression models predicting associations between ΔBMI metrics and Δfat% were examined. RESULTS: A total of 89% of the cohort was Hispanic, and 34% had class 2 or 3 obesity. In models predicting Δfat% adjusting for age, sex, and weight category, R2 for ΔBMI, ΔBMIz, BMImz, Δ%BMIp95, and Δ%BMIp50 were 0.53, 0.38, 0.45, 0.53, and 0.54, respectively (all P < 0.001). Only the ΔBMIz model had an interaction with weight status. Among the models with the highest R2, age group and sex interacted with the Δ%BMIp95 model but not ΔBMI or ΔBMIp50 models. CONCLUSIONS: Longitudinal analyses demonstrate the utility of several BMI metrics other than z-score in capturing adiposity change consistently across a range of obesity severity. Characteristics of studied groups and interpretability could influence metric choice.

Transit environments for physical activity: Relationship between micro-scale built environment features surrounding light rail stations and ridership in Houston, Texas.

INTRODUCTION: Health professionals promote transport-related physical activity because travelers oftentimes walk or bike to and from transit stops or stations. Although previous studies have examined the associations between macro-scale built environment features surrounding light rail transit (LRT) stations (e.g., density) and LRT ridership, this study examined the associations between numerous micro-scale features (e.g., street-level noise pollution) and ridership. METHODS: This analysis originated from the Houston Travel-Related Activity in Neighborhoods (TRAIN) Study, a project evaluating how an LRT extension impacted adult physical activity in Houston, Texas. In 2014, researchers used the Analytic Audit Tool to quantify 58 micro-scale built environment features within six categories: Land Use Environment, Transportation Environment, Facilities, Aesthetics, Signage, and Social Environment. Feature data were obtained from 590 street segments within 0.25 miles of 22 LRT stations. For each station, separate composite indices were created per category by averaging the computed feature scores (1-7) within each category, with higher scores signifying more physical activity-promoting features. Station-level LRT ridership data were obtained from monthly ridership reports for the 12 months following station opening. Linear mixed models were constructed to examine the associations of the six built environment categories with ridership, adjusting for season, weekday vs. weekend day, and station as a random intercept. RESULTS: Holding all other variables constant, every one-unit increase in composite index scores for Transportation Environment and Social Environment was associated with an increase in daily ridership by 425 and 488 riders, respectively (p < 0.05). Every one-unit increase in composite index score for Signage was associated with a decrease of 722 riders daily (p < 0.05). The relations of Land Use Environment, Facilities, and Aesthetics with ridership were statistically null (p > 0.05). CONCLUSIONS: Enhancements to the Transportation Environment and Social Environment may slightly increase overall LRT ridership, and consequently, utilitarian physical activity.

Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX-CORD).

BACKGROUND: Many childhood obesity intervention studies report mean outcomes but do not explore the variation in responses and the characteristics of those who respond well. OBJECTIVE: To identify child and family characteristics associated with improvement in the primary outcome, %BMIp95 , of the Texas Childhood Obesity Research Demonstration project (TX-CORD). METHODS: The 12-month TX-CORD secondary prevention study randomized 549 children, ages 2 to 12 years, with BMI ≥85th percentile to the intensive intervention vs. the comparison program, with measurements at baseline, 3-, and 12-months. A growth mixture model was used to identify mutually exclusive latent %BMIp95 trajectories. Latent class regression tested associations between baseline characteristics and latent class membership. RESULTS: A 2-class solution emerged after accounting for the effect of intervention randomization. Latent Class 1 participants (86% of sample) were characterized by mild-to-moderate obesity and demonstrated a significantly greater response to the intensive intervention between 0 and 3 months (slope-on-group = -0.931, p = 0.03). A rebound between 3 and 12 months was not significantly different between arms. Latent Class 2 participants (14%), who had severe obesity, demonstrated no difference in response between intervention groups. Characteristics associated with Class 1 membership included younger age (2-5 years vs. 6-12 years: OR 3.70, p = .035) and lower maternal BMI category (< 35 kg/m2 vs. ≥ 35 kg/m2 : OR 7.14, p < .0001). CONCLUSIONS: The optimal target population for the intensive intervention are children who have milder obesity, are younger, and do not have a mother with severe obesity. Children with severe obesity may require different approaches.