Purpose: Formula feeding provides a viable alternative to breastfeeding, offering benefits such as convenience and the ability to provide consistent nutrition. Substantial error in the dilution of the formula, however, may lead to hypernatremia, dehydration, gastroenteritis, and other digestive problems, or long-term excessive weight gain. The present study was aimed to investigate the accuracy of caregiver measurements, compared with manufacturer specifications, when preparing infant formula under multiple conditions.

Methods: A diverse sample of caregivers (N = 84, 39% non-Hispanic white) from Kansas and Nevada participated in this cross-over experimental study. Each participant measured infant formula powder and water using their own materials (bottles, formula, and scoop) and a standardized researcher set of materials. Participants were asked to hand-scoop infant formula powder and pour water to prepare 4oz and 7oz feedings, simulating usual practices. Research assistants recorded weights using a calibrated Bonvoisin Lab Scale 5000g x 0.01g high precision electronic analytical balance. The weights listed (in grams) on the formula label for each type of infant formula powder served as the theoretical gold standard. Linear mixed effects models were used to estimate primary fixed effects of target amount (4oz versus 7oz) and materials (participant versus researcher) on mean absolute percent error (MAPE) of measurement.

Results: Across all conditions MAPE was significantly greater for measuring powder than for water (9.03% vs. 4.44%; p<0.001). In models mutually adjusting for relevant caregiver characteristics, there was significantly greater powder MAPE for: 7oz feeding (vs. 4oz; p=0.006); participant materials (vs. researcher; p<0.001); among those occasionally breastfeeding (vs. only bottle feeding; p=0.001); smaller typical feeding volumes (vs. larger volumes; p=0.02). For water MAPE, there were no significant differences by condition or caregiver characteristics (p>0.05).

Conclusions: We observed considerable measurement variability and error during infant formula preparation, particularly for hand-scooping of powder, which tended toward higher values than the gold standard. Greater measurement error was associated with the 7oz preparation and—unexpectedly—with the participants’ own materials. In combination, error from powder and water could compound, generally toward under-dilution of formula. Many caregivers and infants may benefit from interventions to improve formula feeding practices.

Purpose: Formula feeding offers a convenient alternative to breastfeeding, with the potential to provide consistent nutrition. Making substantial errors in the preparation of formula can pose serious threats to infant health. The present study aimed to compare the accuracy of caregiver measurements while preparing infant formula for feeding under multiple conditions, including the presence or absence of a simulated crying baby.

Methods: A diverse sample of caregivers (N = 84) from Kansas and Nevada participated in this crossover experimental study, wherein each participant measured infant formula powder and water. Participants were randomly assigned to prepare formula with or without the simulated crying baby (holding a life-size doll while a recording of a crying infant was played), then asked to hand-scoop infant formula powder and pour water to prepare 4oz and 7oz feedings. Research assistants meticulously recorded weights using a calibrated high-precision electronic analytical balance. The weights (g) listed on the formula label for each type of infant formula powder served as the theoretical gold standard for mean absolute percent error (MAPE) calculations. Due to positive skew, MAPE values were log-transformed. Linear mixed effects models (for both powder and water) were used to estimate the primary fixed effects of baby (present versus absent) target amount (4oz versus 7oz) and materials (participant versus researcher) on MAPE measurement.

Results: Compared to when the baby was absent (MAPE=9%), there was a non-significant effect on powder formula MAPE with the baby present (10%; βBaby=1.16, 95% CI=[0.99; 1.34], p=0.056), representing a 16% greater error with the baby present. The standardized effect size for the baby condition was 0.15, considered small in magnitude. Results were similar for water MAPE (4.3–4.5%; βBaby=0.96, 95% CI=[0.80; 1.14], p=0.63); standardized effect size=-0.04. Interactions between materials and target amount with baby presence were not significant for either powder or water.

Conclusions: We observed substantial error during infant formula preparation, with no significant differences between measurements in the presence or absence of a simulated crying baby. Due to possible negative health outcomes from over-dilution and under-dilution errors, some caregivers and infants may benefit from interventions to improve formula-feeding practices.

Purpose: The New York City Fitnessgram (NYCFG) comprises a powerful surveillance system monitoring longitudinal changes in objectively measured youth physical fitness for the largest and most diverse school system in the nation. Fitness (aerobic capacity, muscular strength, muscular endurance, flexibility, body composition) and physical activity are strongly associated, and frequent vigorous physical activity predicts fitness. However, even objective measurements may be subject to errors and inaccuracies. Recent improvements in data completeness and use of calibrated scales have highlighted potential for height and weight data quality issues in the NYCFG as youth transition from middle to high school. Therefore, we aimed to explore methods to identify data biases across middle and high school subgroups. We additionally propose strategies to address biases in physical fitness surveillance data systems more broadly.

Methods: Data comprised 10 consecutive years of the NYCFG (2009/10-2019/20). Data quality was assessed using two proxy variables; 1) Implausible weight loss: Decreasing weight >5% over two consecutive years; 2) Shrinking: Decreasing height >.01cm over two consecutive years. Prevalence of implausible weight loss and shrinking were assessed overall, and by individual grade level (5th-12th), sex, race/ethnicity, weight class, and sex*race/ethnicity subgroups.

Results/findings: The analytic population included 1,255,650 youth (4,204,546 observations; 51% male, 39% Hispanic, 28% non-Hispanic black, 36% with overweight/obesity). The overall prevalence of implausible weight loss and shrinking ranged from 2.8-10.2% and 2.4-14.4%, respectively. Implausible weight loss was more prevalent among girls than boys (up to 10.1% vs. 7.6%, respectively), and youth who were overweight, particularly between 8th and 9th grades (10.3%). Shrinking was more prevalent among girls than boys (up to 15.3% vs. 7.9%, respectively), and youth with Class III obesity (up to 16.7% from 9-10th grade).

Conclusions: Inaccuracies in data reporting are likely occurring in the NYCFG surveillance system, particularly for select subgroups. Future research should explore methods to mitigate BMI data inaccuracies, including data flags, corrective weighting for subgroups, and reducing weight stigma during data collection. This work can provide insight for youth fitness surveillance systems nationally to improve data quality, and ensure that reporting objective measures of physical fitness address accurate health inequities to promote youth health.

Purpose: Our study seeks to examine the short- and long-term effectiveness of a multi-component Nurturing Healthy Teachers intervention implemented over 9 months in improving multiple health-related outcomes among teachers of Pre-K and elementary school age kids. The primary aim is to examine impacts of NHT on nutrition security, diet, mental health and well-being, and markers of metabolic health, and to evaluate the extent to which these impacts, if any, are mediated by food insecurity.

Methods: 28 elementary schools in Houston, Texas, were recruited for the Nurturing Healthy Teachers study. The study design was non-randomized controlled trial (16 intervention and 12 comparison schools). Nurturing Healthy Teachers intervention included teachers receiving Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education proven to improve dietary and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. Baseline data was obtained from 337 teachers from November 2022 to April 2023. Post-intervention measurements were completed in December 2023. During both in-person visits at schools, we measured participating teacher weight, blood pressure, veggie meter reading (skin carotenoid levels), and glycosylated hemoglobin (HbA1c) levels measured. Teachers completed surveys on demographics, food security, mental health, dietary behaviors, and home nutrition environment. The primary outcome was food insecurity. Secondary outcomes included mental and metabolic health outcomes. Descriptive statistics, correlations, and regression modeling were used to examine associations among these variables.

Results: At baseline, most of the participants were female, 63% identified as Hispanic, were highly educated, and had a mean age of 42.5 years. Moderate to severe depression was experienced by 18% of teachers at baseline in addition to 23% of teacher experiencing moderate to severe anxiety. Overall, 50% of teachers were classified as being obese and 20% had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6%. Results of pre-to-post intervention impact on study primary and secondary outcomes are currently being conducted and will be presented.
Conclusions: The results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.

The SWITCH initiative (School Wellness Integration Targeting Child Health) provides a capacity-building framework for schools to build and sustain school wellness programming. The standardized implementation model guides schools to plan and deliver programming focused on physical activity, nutrition, and sedentary behavior. Success with implementation varies based on a variety of school level factors, but little attention has been given to the organizational climate and structure of schools as a predictor of school wellness programming. Specifically, few studies have investigated the impact of staff mental well-being on school implementation or distal outcomes from school wellness programming. The present study summarizes descriptive information about school staff needs and interests related to mental well-being using schools engaged in the 2023 iteration of SWITCH.

The study was a needs assessment initiative and used a mixed method approach. School Core Teams in SWITCH were guided to promote school-wide completion of the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) as a standardized instrument to examine staff well-being. Schools were incentivized to promote completion of the survey by at least 50% of school staff to ensure generalizable data. A total of 481 staff from 21 schools (84% of targeted schools) completed the needs assessment survey with an average of 50.81 (± 8.32). The results reveal variability in needs regarding school mental health programming as staff were in high (13%), moderate (64%), low (15%), and very low (8%) categories of the WEMWBS classifications. Across schools, staff responses averaged at 63.71 (± 2.27) in high, 51.53 (±18.2) moderate, 42.26 (± 0.67 ) low, and 34.95 (± 2.40) in very low categories.

Approximately 68 % of schools re-enrolled in the 2024 iteration of SWITCH with 60% choosing to participate in the follow-up implementation cycle focused on fostering changes in school staff well-being. Schools in the 2024 iteration were guided to adopt 1 of 3 adapted staff well-being activities (Alliance for Healthier Generation (2 schools), Make It OK (2 schools), or 5-2-1-0 Healthy Choices Count! (8 schools). Survey and interviews of schools will be integrated using mixed method approaches to summarize the effectiveness of staff well-being training to support schools.