Purpose: Four-day school weeks are being employed with greater frequency across the United States, primarily in rural areas. Schools provide broad support for both learning and overall child wellbeing (e.g., school meals, physical activity opportunities). By reducing exposure to the school environment, four-day school weeks may impact the allocation of household time and money, leading to changes in food security, health behaviors, family time and routines, employment, work-family balance, and childcare strategies compared to traditional five-day school weeks. Our objective is to provide novel evidence about the impacts of four-day school weeks on children and families.

Methods: Focus groups were conducted in rural four-day school week districts in Oregon and Montana, two of the states with highest four-day school week use. In partnership with local Cooperative Extension and school personnel, parents and guardians of elementary-aged children were recruited to participate. Each focus group was moderated for 1.5 hours by research team members utilizing a pre-developed discussion guide. Completed focus group transcripts were analyzed independently by two research team members using a grounded theory approach to identify themes related to the impact of the four-day school week on child and family health and wellbeing.

Results/Findings: Four focus groups across three different four-day schools have been conducted with a total of 23 participants. Consistently mentioned themes included, (1) childcare access, (2) community supports (e.g., access to food banks, and recreation opportunities), (3) family time, (4) financial impacts, and (5) appointments and errands. A main finding was that all participants would choose the four-day school week over the traditional five-day schedule.

Conclusions: Initial results suggest both benefits and challenges to this school schedule, with most participants indicating overall satisfaction with the four-day school week schedule. However, the current sample may only represent some experiences and perspectives, and efforts are needed to recruit more diverse participants in additional focus groups. After study completion, results will be communicated to inform decision-making related to four-day school week implementation.

Purpose: Youth sport is an important community system for physical activity (PA) promotion and chronic disease prevention. However, inequalities in exposure and access to youth sport opportunities (YSO) exist based on geography, ethnic minority status, and economic disadvantage. These inequalities in YSO may be due to local social structural disadvantages that create preventable health inequities in PA. This study aims to identify social system structures for the provision of YSO in early childhood in rural Nebraska, USA communities.

Methods: Semi-structured interviews were conducted virtually with 11 stakeholders purposefully recruited from two rural communities to examine local youth sport systems for three- to eight-year-old children. Stakeholders were Extension Educators (n=2), childcare providers (n=2) and organization (e.g., YMCA) leaders (n=7). Independent coders (n=2) analyzed results following thematic analysis.

Results: Four main themes emerged from the data. Theme 1. Youth Sport Production Process. Stakeholders reported that YSO were offered by a primary community organization or parent entrepreneurs rather than a community-wide coordinating body. Decisions about youth sports were driven by community members’ perceived needs and the physical infrastructure available to offer YSO. Theme 2. Community Structure. Under this theme, both communities acted as a regional hub for youth sport, with community members from nearby towns travelling to the central hub for opportunities. Within each community, multiple opportunities for youth sports were offered seasonally, however, these opportunities often excluded children under age five. Theme 3. Consumer Demand Process. Parents and community members viewed YSO as an avenue for youth to become competitive athletes as they grew up, with a focus on participating in local high school sport teams. Challenges to youth sport participation included travel distance, time commitments, and cost at the household level. Theme 4. Information Flow. Information about YSO flowed from the organization to community members through schools, social media, physical advertisements, and word-of-mouth.

Conclusions: Rural communities did not have a recognized coordinating system for YSO. A system for the coordination of community YSO, consisting of a coalition, community process, and data monitoring and feedback to inform decision-making, may aid in improving equitable access to youth sport for all children.

Impact of community characteristics on inequality in physical activity among children

Ann E. Rogers (Corresponding Author, Presenting Author), Christopher S. Wichman, Michaela A. Schenkelberg, David A. Dzewaltowski

Purpose: Community characteristics (e.g., rurality) have been shown to impact population health physical activity (PA) outcomes, such as average PA levels, among children. Little is known about the level of inequality in the distribution of PA among children at a community level, that is, whether all or only a subset of children in a community accrue PA. This study examined the impact of community geographic, sociodemographic, and community program and policy (CPP) characteristics on inequality in PA in a large sample of American communities using data from the Healthy Communities Study.

Methods: CPPs promoting children’s PA were assessed in a sample of communities (n=130) by key informant interviews. Each community was assigned an intensity score based on reach, duration, and behavioral intervention strategies used in existing CPPs. Moderate-to-vigorous PA (MVPA) volume, operationalized as the frequency and duration of participation in MVPA activities, of children (n=4688) in each community was measured by self-/caregiver-report. A Gini coefficient for each community was calculated to quantify inequality in MVPA volume. Gini ranges from 0 to 1, where 0 indicates perfect equality and 1 indicates complete inequality. Generalized estimating equations examined the impact of community geographic (e.g., rurality), sociodemographic (e.g., income), and CPP intensity on MVPA volume inequality.

Results: Mean CPP intensity across communities was 24.0 (range = 8.5–53.5). Mean inequality in MVPA volume across communities was 0.62 (range=0.39–0.86). The effects of CPP intensity (P=0.99) and community income (P=0.28), region (P=0.31), and urbanicity (P=0.64) on inequality at the community level were not significant. The effect of community minority classification on MVPA volume inequality was significant (P=0.01), such that communities classified as African American (Gini=0.67) had greater PA inequality than communities classified as “other” (Gini=0.60).

Conclusions: MVPA volume inequality varied across communities, but further research is needed to understand drivers of this variability. Additional measures of community social structure may aid in understanding variability in PA inequality. Indicators such as the Gini coefficient can illuminate inequalities in PA among children and may inform community efforts to increase the level and equality of population PA.

Title: Formative research to develop “DC-SIPS,” a multi-level intervention to reduce sugary drink intake and promote water intake among Black youth in Washington, D.C.

Authors: Natalie Vallone (Presenting and Corresponding Author), Nia I. Bodrick, Jasmine H. Kaidbey, Mariana F. Grilo, Shaleen Arora, Adam Dawer, Natasha Kumar, Jaiden Bluth, Natalie Lueders, Jennifer M. Sacheck, William H. Dietz, Karen A. McDonnell, William D. Evans, Allison C. Sylvetsky (Corresponding Author)

Purpose: Children’s consumption of sugary drinks (SD) considerably exceeds public health recommendations, particularly among Black adolescents from low-income households. However, few interventions have specifically focused on reducing SD intake in this population. The purpose of this study was to conduct formative research to develop DC-SIPS (Decreasing Children’s Sugar Intake Through Pediatricians and Social Marketing), a multi-level intervention to reduce SD consumption and increase water intake among low-income, Black adolescents seen at a pediatric primary care clinic in Washington, D.C.

Methods: In-depth, qualitative interviews with pediatricians (n=6), children ages 11-14 years old (n=17), and their parents (n=13) were conducted to obtain feedback on the intervention concept and prototype DC-SIPS branding and messaging. Components of the social ecological model, social cognitive theory, and message effects theory were utilized to develop preliminary materials and semi-structured interview guides. Interviews were recorded and transcribed, and data were analyzed using thematic analysis.

Results: Pediatricians, children, and parents expressed enthusiasm for DC-SIPS and provided suggestions to refine the intervention concept and improve branding. Pediatricians described key facilitators of the concept including feasibility of SD reduction counseling and the popularity of social media. Children and parents emphasized the need to enhance visual aspects of the social media content through the addition of more vibrant colors, playful fonts, and consistent branding. The use of incentive-based challenges as a strategy to promote engagement with the program was also suggested by pediatricians, children, and parents.

Conclusions: Findings of this formative research informed refinement of prototype DC-SIPS content and development of additional messaging content. The feasibility and acceptability of the refined and newly developed content consistent with participant feedback will be tested in a six-week pilot intervention. Additional factors, such as the perceived effectiveness of the content in promoting behavior change, will be evaluated to inform further refinements to DC-SIPS with the long-term goal of investigating the efficacy of DC-SIPS in a larger-scale randomized controlled trial.

Purpose: United States (US) minoritized and recent immigrant youth disproportionately experience health disparities in fitness, an established proxy of present and future health. Fitness differences by place of birth (POB) could exacerbate inequities in adulthood chronic disease development. This study examined fitness differences among Latino youth by POB and sex.

Methods: This longitudinal observational study drew data from the NYC FITNESSGRAM (2009-2019) for public school Latino youth (grades 4-12) with objectively-measured fitness (n=577,639 students; 2,236,590 observations). POB was categorized: NYC (n=1,686,504 observations); continental US [non-NYC] (n=98,583); South America (n=77,768), Central America (n=41,833), Dominican Republic (n=235,764), Puerto Rico (n=33,898), Mexico (n=48,837), and other [non-North/South America] (n=13,403). Sex-/age-specific performance by POB was assessed using healthy fitness zones (HFZ) defined by The Cooper Institute as individual fitness sufficient for good overall health. HFZ were examined for aerobic capacity, muscular strength, and muscular endurance tests. Repeated measures multilevel models were fit to the data, clustering observations by students, adjusting for sex, age, grade, English-language learner, primary language spoken at home, school, neighborhood linguistic isolation, and neighborhood poverty.

Results: The sample included 49% females (39.9% and 68.9% living in high or very high neighborhood poverty and linguistic isolation areas, respectively, 25.6% English Language Learners, mean age=13.0±2.6 years) with 18.9% overall prevalence of achieving HFZ for all three tests. After controlling for individual/neighborhood factors, NYC-born students had an increased likelihood of not achieving HFZ for all three tests (RR=1.1; 95%CI 1.06,1.03) versus US-born (non-NYC) students. South America-born (RR=0.86; 95%CI 0.82,0.90) and Central America-born (RR=0.83; 95%CI 0.79,0.88) students had the lowest likelihood of not achieving HFZ for all three tests versus US-born (non-NYC) students. Among male students, likelihood of not achieving HFZ for all three tests for male South America-born students was 0.83 (95%CI 0.79,0.87), whereas among female South American-born students the likelihood was 0.93 (95%CI 0.87,1.00) versus US-born (non-NYC) for male and female students, respectively.

Conclusions: Heterogeneity in fitness for Latino children highlights the need for tailored physical fitness programs and policies to reduce fitness disparities, especially in urban settings. Future research should examine fitness differences across other racial/ethnic youth subgroups to support future healthier generations.

Purpose: In the United States, obesity is 6.2 times higher in rural areas than in urban areas (Okobi et al., 2021). Rural areas have limited access to built environmental features, healthy food outlets, and commercial weight control programs (Befort et al., 2016). Building Healthy Families (BHF) is a rural Family Healthy Weight Program (FHWP) for 6–12-year-old children, with parent/guardian (parent) participation. The purpose of this study is to evaluate the effectiveness of BHF, an evidence-based, 12-week program on reducing body composition and clinical health indicators in parent participants.

Methods: Families with at least one child with a BMI ≥95th percentile for age and gender enrolled in BHF and attended 12 weekly group-based sessions covering nutrition education, physical activity, and lifestyle modification education. Parents’ age, weight, height, blood pressure, and body composition (DXA) were assessed at baseline, 12 weeks, and 6 months. Blood lipid profiles and liver enzymes were assessed at baseline and 6 months for parents with a BMI ≥ 30.

Results: 84 families initiated participation (n=137 parents: 55 males (BMI=33.74±7.47 kg·m-2), 82 females (BMI=33.18±7.86 kg·m-2)). 108 parents completed 12-week assessments and 68 parents completed 6-month assessments. Parents had significant improvements in body mass (-6.65±4.72 kg), BMI (-2.15±1.78 kg·m-2), body fat (-3.43±2.90 %), fat mass (-5.24±3.46 kg), systolic blood pressure (-4.01±9.43 mm/Hg), and diastolic blood pressure (-2.61±8.12 mm/Hg) from baseline to 12 weeks (p<0.05). Continual improvements were found at 6 months in body mass, BMI, body fat, fat mass, systolic blood pressure, in addition to improved ALT, and total cholesterol (p<0.05).

Conclusion: This study demonstrated that BHF can produce significant improvements in body composition and clinical health indicators in 6 months among the parent participants of the program. Similarly, other community-based rural FHWP’s have found parents’ short-term decreases in BMI to be -0.94±1.6 kg·m-2 and long-term decreases to be -0.57±2.4 kg·m-2 (Janicke et al., 2016). Hence, FHWPs can be beneficial for parent/guardian weight management. Results also indicate BHF may be as or more effective than other FHWPs in improving body composition and clinical health indicators in 6 months.