Variations in Physical Activity and Screentime According to School Format During the COVID-19 Pandemic.

BACKGROUND: Early studies indicate children's physical activity (PA) decreased during the pandemic but may vary by school format and season. We longitudinally assessed changes in PA and screentime (ST) behaviors throughout 1 year of the COVID-19 pandemic and according to changes in school format. METHODS: Parents of children (5-18 years) completed a survey about school format, home characteristics, PA, and ST. Initial data were collected in November 2020 with follow-up in February, May, and August 2021. Physical activity and ST were compared by season and school format using a 4 (format) × 4 (season) repeated measures analysis of variance. RESULTS: Children were active for at least 60 minutes/day less often in winter (2.4 ± 0.3 days; p < .001; n = 176) than in other seasons. Longitudinal analysis (n = 61) showed that PA was highest among students attending school fully in-person and lowest among students attending remotely, though school format differences were not significant. Non-school ST did not differ by season or school format. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: These results suggest that changes in school format influence students' lifestyle behaviors. CONCLUSIONS: The impact on children's lifestyle behaviors should be considered in planning for safe, in-person operation of schools in the event of future pandemics or natural disasters.

Neighborhood and Family Characteristics Associated with Adiposity and Physical Activity Engagement among Preschoolers in a Small Rural Community.

The purpose of this study was to evaluate family and home/neighborhood characteristics associated with physical activity (PA) and adiposity among young children living in a small rural community. METHODS: Participants were 30 parents and their youngest child aged 2-5 years. Children wore accelerometers for 7 days. Parents completed questionnaires about family lifestyle behaviors, parenting practices, and home/neighborhood characteristics. RESULTS: None of the family lifestyle behaviors were associated with child BMI percentile. Backyard size was inversely associated with moderate to vigorous physical activity on weekday afternoons (rho = -0.488, p = 0.006), as was perception of neighborhood dangers (rho = -0.388, p = 0.034). Perceived neighborhood safety (rho = 0.453, p = 0.012), the presence of sidewalks (rho = 0.499, p = 0.012), and public playground use (rho = 0.406, p = 0.026) were each associated with higher weekday afternoon MVPA. CONCLUSIONS: Findings suggest neighborhood safety, sidewalks, and use of public playgrounds are positively associated with MVPA among preschoolers, while backyard size and access to play equipment at home are not. These findings have implications for rural communities where space is plentiful but access to community space and sidewalks may be limited.

Associations between health-related family environment and objective child sleep quality.

AIM: This study aimed to assess the relationship between the family environment and behaviours with objective child sleep quality. METHODS: Twenty-four children (aged 2-5 years) and their parents participated. Child sleep was assessed by accelerometer. Health of the family environment was quantified using the Family Nutrition and Physical Activity Screening Tool (FNPA). Exact Wilcoxon rank sum tests and linear regression were used to determine associations between FNPA scores and child sleep. RESULTS: Healthier Total FNPA, Physical Activity FNPA, and Sleep Routine scores were associated with earlier bedtime. Healthier Sleep Routine score was associated with more total minutes of sleep per night. Healthier screen time-related FNPA construct scores were associated with earlier bedtime. CONCLUSIONS: A composite score of family environment and behaviours, including physical activity- and nutrition-related constructs, was related to child sleep quality. Focus should be placed on the obesogenic family environment and healthy sleep routines to promote overall health among pre-school-aged populations.

Foundational knowledge regarding childhood obesity: a cross-sectional study of medical students.

BACKGROUND: Documentation and diagnosis of childhood obesity in primary care is poor and providers are often unfamiliar with guidelines. This lack of knowledge may be attributed to insufficient training in medical school and residency; however, no studies have evaluated medical students' knowledge of recommendations. METHODS: We distributed a modified version of the Physician Survey of Practice on Diet, Physical Activity, and Weight Control to medical students at a single university. Descriptive analyses assessed knowledge and attitudes of childhood obesity and diabetes. RESULTS: Of the 213 participating students, 74% indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). They reported screening glucose 4.5 years earlier in patients with risk factors compared to those without (p < 0.001). CONCLUSIONS: Although students recognized the need for earlier diabetes screening in children with risk factors, we determined that overall, student knowledge of obesity-related preventative care was inadequate.

Influence of Osteopathic Medical Students' Personal Health on Attitudes Toward Counseling Obese Pediatric Patients.

CONTEXT: Research has shown that physicians with positive health and lifestyle behaviors have more positive attitudes toward effective counseling, but little is known about how personal health behaviors of medical students influence their attitudes regarding pediatric obesity counseling before entering practice. OBJECTIVE: To determine whether the personal health status and habits of osteopathic medical students influence their attitudes toward counseling obese pediatric patients regarding lifestyle behaviors. METHODS: A cross-sectional survey was distributed electronically to first- through fourth-year osteopathic medical students. The survey assessed students' personal lifestyle habits and their top anticipated barriers to providing pediatric weight counseling. RESULTS: A total of 200 participants completed the survey. National physical activity recommendations were met by 81 participants (40.5%). These 81 participants had significantly more positive attitudes toward pediatric physical activity counseling than participants who did not meet the recommendations (H=-35.06, P=.001) or those who only met resistance training recommendations (H=40.63, P=.021). Participants with obesity had significantly lower pediatric weight management counseling scores than overweight participants (H=40.77, P=.028). Thirty-one participants (15.5%) consumed a healthy amount of both vegetables and fruit. These 31 participants had significantly higher dietary mean item counseling scores than those who did not (H=-30.40, P=.048). Participants identified the barriers "Time" (137 [68.5%]) and "Difficult for patients to change behavior" (99 [49.5%]) most frequently. Clinical participants identified "Poor or lacking reimbursement" (21 [28.0%]) more frequently than preclinical participants (12 [9.6]). CONCLUSION: Medical students who exhibited healthier lifestyle habits were more likely to positively view pediatric obesity management counseling.

What can family medicine providers learn about concussion non-disclosure from former collegiate athletes?

BACKGROUND: Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes' understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions. METHODS: Informed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software. RESULTS: Thirty-two former collegiate athletes (24.5 ± 2.9 years old, 59.4% female, 87.5% white) participated in 7 focus groups. Three predominant themes emerged: 1) Concussions are Part of the Game: Participants believed that concussions were part of sports, and that by agreeing to play a sport they were accepting the inherent risk of concussions. Importantly, many were not familiar with concussion symptoms and what constituted a concussion; 2) Hiding Concussion Symptoms: Participants said they often hid concussion symptoms from coaches and trainers in order to avoid being taken out of or missing games. Participants were able to hide their concussions because most symptoms were indiscernible to others; and 3) Misconceptions about Concussions in Low Contact Sports: Several participants did not understand that concussions could occur in all sports including low contact or noncontact sports. The former athletes who participated in low contact sports and experienced concussions attributed their concussions to personal clumsiness rather than their sport. CONCLUSIONS: Family medicine providers as well as coaches, athletic trainers, teachers, and parents/guardians should reinforce the message that concussions can occur in all sports and inform patients about the signs and symptoms of concussions. Further, providers should ask all patients if they engaged in high school or collegiate athletics; and if yes, to describe their hardest hit to their head in order to obtain a complete medical history.

Medical Students' Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors.

BACKGROUND: Skin cancer is the most prevalent cancer in the United States. Training medical students about the importance of sun-protective behaviors is critical to reducing skin cancer rates. However, minimal research has explored osteopathic medical students' knowledge and behaviors with regard to the sun's effect on skin health. OBJECTIVE: To assess first-year osteopathic medical students' knowledge about skin cancer and UV radiation, attitudes toward tanning, and sun-protective behaviors to establish baseline values. METHODS: Using a descriptive, cross-sectional study design, the authors evaluated students' knowledge, attitudes, and behaviors through a quiz. RESULTS: A total of 121 first-year osteopathic medical students completed the quiz. The mean (SD) score was 74.6% (11.5%). Two-thirds of participants (n=82) correctly identified basal cell carcinoma as the most common skin cancer, and the majority identified the ABCDs (asymmetry, border irregularity, color, and diameter) of melanoma detection (96 [79.3%], 106 [87.6%], 108 [89.3%], and 94 [77.7%], respectively). Most participants were aware that cloud cover and swimming underwater do not provide UV ray protection (121 [100%] and 109 [90.1%], respectively), a fact that is often misconceived. Forty participants (33.1%) usually or always used some form of sun protection when outdoors. Forty-seven participants (38.8%) believed that a tan makes one look healthy, and 43 participants (35.6%) sunbathed with the intention of tanning. CONCLUSION: Physicians are uniquely positioned to counsel patients regarding sun-protective behaviors. Thus, a medical school curriculum that includes education about the sun's effect on health is needed for the prevention and early recognition of skin cancer in future patients.

First-Year Osteopathic Medical Students' Knowledge of and Attitudes Toward Physical Activity.

CONTEXT: Current guidelines recommend that primary care physicians provide physical activity counseling as part of routine preventive health care. However, education regarding physical activity counseling often is not included or is inadequately covered in medical school curriculum, and it is unclear whether future physicians are prepared to offer effective counseling in this area. OBJECTIVE: To examine first-year medical students' knowledge of and attitudes toward physical activity and the importance of physical activity in patient counseling. METHODS: An anonymous electronic survey was distributed to all first-year students enrolled at the Ohio University Heritage College of Osteopathic Medicine. The survey assessed students' knowledge, beliefs, and behavior regarding physical activity and physical activity counseling for patients. The frequencies of students' weekly physical activity were computed to assess students' physical activity behaviors. Attitudes toward personal importance of physical activity and physical activity counseling in primary care were also assessed by response frequency. The relationship between students' knowledge of and participation in physical activity and the priority placed on exercise for future patients were assessed by correlation. RESULTS: Of 243 potential participants, 144 students (59.3%) returned the survey. The majority of students (131 of 144 [91.0%]) indicated that living a healthy lifestyle was very or extremely important to them, and 125 of 144 (86.9%) prioritized physical activity as moderately, very, or extremely important. Of 122 students, 81 (66.4%) exercised for at least 30 minutes on 3 or more of the past 7 days, and 36 (29.5%) reported doing so on 5 or more of the past 7 days. Nearly all of the students (127 of 133 [95.5%]) indicated that exercise is important for their future patients, 97 of 133 (72.9%) indicated feeling moderately or extremely comfortable counseling patients on exercise, and 113 of 134 (84.3%) desired to include physical activity counseling in their practice. Fifty of 134 students (40.3%) indicated that they were aware of current physical activity recommendations for adults in the United States; however, of these 50 students, 1 (2.0%) provided a correct definition of the national recommendations. CONCLUSION: Although students prioritized healthy lifestyles for themselves and their future patients and indicated a desire to include physical activity counseling as part of routine clinical care, the majority were unaware of the current physical activity recommendations. Thus, there is a need to address physical activity recommendations in the medical school curriculum.

Evaluation of Nighttime Media Use and Sleep Patterns in First-semester College Students.

OBJECTIVE: We evaluated how nighttime media use is associated with sleep behaviors in firstsemester college students, and variation by weight status. METHODS: In September 2016, first-semester college students (N = 114) completed surveys evaluating nighttime media usage (NMU) and sleep behaviors. Height, weight, and waist circumference were measured, and weight status was determined by body mass index. RESULTS: Students reported a mean sleep duration of 7.26 ± 0.93 hours. Only 33% (N = 38) reported sleeping at least 8 hours/night on average. Higher scores on the Pittsburgh Sleep Quality Index were correlated with reports of texting after bed (r = .199, p = .04). Total time in bed was correlated with texting in bed (r = .217, p = .026) and device-related sleep interruptions (r = .215, p = .028). Social media usage (r = 0.270, p = .005), mobile gaming (r = .208, p = .033), and texting (r = .293, p = .002) were correlated with sleep interruptions. NMU was positively correlated with weight and weight status. CONCLUSIONS: These results suggest NMU is associated with reduced sleep quality.