Physical Inactivity and Sedentariness: Languorous Behavior Among Adolescents in 80 Countries.

PURPOSE: High rates of adolescent physical inactivity and sedentary behavior have been reported worldwide, but the combined prevalence of languorous behavior (physical inactivity and/or sedentary behavior) may more accurately reflect just how few adolescents meet World Health Organization recommendations. METHODS: We analyzed nationally representative data from 325,219 students in 80 countries that participated in the Global School-based Student Health Survey between 2009 and 2018. Students were classified as physically inactive if they reported engaging in moderate or vigorous physical activity less than 60 minutes daily. Students were classified as being sedentary if they sat for three or more hours per day outside of school, such as when having screen time not related to studying. Statistics for each country were generated using complex samples analysis, then the results from all countries were synthesized. RESULTS: In total, 84% of students were physically inactive, 37% were sedentary, and 91% met the definition for the concept we are calling languorous behavior. DISCUSSION: Establishing specific evidence-based guidelines for increasing physical activity and decreasing sitting time will enable progress toward reducing languorous behavior among adolescents.

Anxiety and school absenteeism without permission among adolescents in 69 low- and middle-income countries.

Background: Anxiety disorders are common among adolescents. In high-income countries, anxiety is a known contributor to truancy and school refusal, but this association has been understudied in low- and middle-income countries (LMICs). Methods: We used complex samples analysis to examine the association between self-reported worry-induced insomnia (an indicator of anxiety) and unauthorized school absenteeism among 268,142 adolescents from 69 LMICs that participated in the Global School-based Student Health Survey (GSHS). Results: The median proportion of students who reported experiencing symptoms of anxiety most or all of the time during the previous year was 11.4% (range: 3.6%-28.2%); in 44 of the 69 countries, girls had a significantly higher prevalence of anxiety than boys. The percentage of students reporting school absence without permission during the past month was 30.2% (range: 14.7%-56.0%); in 40 countries, boys were significantly more likely than girls to report that they had missed school without permission. In 53 countries, adolescents who reported frequent anxiety were significantly more likely to miss school than adolescents reporting infrequent anxiety; in most of those countries, the association was significant for both girls and boys. Conclusion: School-based interventions that help children and adolescents learn how to manage stress and refer students with symptoms of psychiatric disorders to healthcare services that can provide formal diagnosis and clinical treatment may be useful for improving both mental health and school attendance, thus contributing to achievement of Sustainable Development Goals related to both health (SDG 3.4) and education (SDG 4.1).

Perceptions and Barriers to SNAP Utilization Among Asian and Pacific Islanders in Greater Los Angeles.

PURPOSE: To examine the perceptions of and barriers to Supplemental Nutrition Assistance Program (SNAP) participation among Asian and Pacific Islander (API) immigrants. DESIGN: Qualitative focus groups were conducted in 4 API communities. SETTING AND PARTICIPANTS: Participants were recruited from 4 API communities (n = 68; 22 Tongan, 18 Vietnamese, 16 Filipino, and 12 Chinese) through local community-based organizations in Los Angeles and Orange Counties. METHOD: Trained bilingual and bicultural researchers conducted 8 focus groups in English, Chinese, and Vietnamese. Prior to the start of each focus group, participants completed a demographic questionnaire which included a United States Department of Agriculture (USDA) Food Security Module. ANALYSIS: Audio recordings were transcribed verbatim and those in the native languages were transcribed verbatim. Transcripts in native languages were reviewed and translated into English. All transcripts were organized in ATLAS ti version 8.0 and analyzed using thematic analysis. The USDA Food Security Module results were scored and assessed for food insecurity. RESULTS: Median age of participants was 58 years and 59.4% (n = 38) were food insecure. Barriers to SNAP participation were identified and organized within the Social Ecological Model by the following themes: (1) unclear program information, (2) application process, (3) shame, and (4) pride. Despite commonalities found across API subgroups, unique challenges with public charge and immigration existed within the subgroups. CONCLUSION: Culturally relevant in-language SNAP materials and multilevel interventions are needed to mitigate barriers and increase SNAP participation rates among low-income API groups.

A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women Infants and Children Program.

Women of reproductive age are particularly at risk of obesity because of excessive gestational weight gain (GWG) and postpartum weight retention, resulting in poor health outcomes for both mothers and infants. The purpose of this qualitative study was to examine perceptions and barriers to GWG among low-income women in the WIC program to inform the development of an intervention study. Eleven focus groups were conducted and stratified by ethnicity, and each group included women of varying age, parity, and prepregnancy BMI ranges. Participants reported receiving pressure from spouse and family members to "eat for two" among multiple barriers to appropriate weight gain during pregnancy. Participants were concerned about gaining too much weight but had minimal knowledge of weight gain goals during pregnancy. Receiving regular weight monitoring was reported, but participants had inconsistent discussions about weight gain with healthcare providers. Most were not aware of the IOM guidelines nor the fact that gestational weight gain goals differed by prepregnancy weight status. Results of these focus groups analyses informed the design of a pregnancy weight tracker and accompanying educational handout for use in an intervention study. These findings suggest an important opportunity for GWG education in all settings where pregnant women are seen.