Purpose: Adolescence is a critical time for establishing healthy behaviors, as poor habits may persist into adulthood, increasing the risk of lifestyle-related chronic diseases. Extant research has identified that unhealthy behaviors tend to cluster in predictable patterns. However, the literature in adolescence is limited, particularly in terms of studies that include a wide range of health behaviors (e.g., behavioral nutrition, physical activity, sedentary activity, sleep, and substance use), have rigorous/multidimensional measurement (i.e., actigraphy, 24-hr dietary recalls), and employ sophisticated analyses. Addressing existing gaps, this study characterized health behavior profiles in adolescents and examined their associations with mental health.

Methods: This study draws data from two assessment points completed by 201 adolescents from a larger longitudinal study in the Midwest United States (53.7% female, Time 1 m-age=15.37; Time 2 m-age=16.29; 41.3% below U.S. federal poverty guidelines). Participants completed 24-hour dietary recalls on three non-consecutive days and wore an actigraph for 14 days. Self-report measures supplemented objective measurement. Mixture models were conducted in Mplus.

Results/Findings: Analyses identified three distinct patterns of health behaviors among adolescents. The most common pattern (51.9%) involved above average physical activity compared to others in the sample, but diets high in added sugar and sleep well below recommended duration; this group had minimal substance use. The next most common pattern (27.9%) was characterized by overall healthy behaviors in terms of diet, physical activity, sedentary activity, and sleep, except nearly half endorsed e-cigarette use. The smallest, but most concerning group (20.2%) had high caffeine and sugar consumption, limited fruit/vegetable intake, and were the most sedentary, least physically active, and had below-average sleep duration, along with the most substance use. Analyses exploring associations between the probability of pattern membership and mental health found that these adolescents were more likely to have co-occurring mental health symptoms (chi-squared(2)=13.74, p < .001).

Conclusions: This study contributes to the advancement of behavioral nutrition, physical activity, and sleep knowledge and practice by providing insights into the interrelated nature of adolescent health behaviors and their connection to mental health. Identifying high-risk groups allows for more efficient intervention efforts, opening up multiple targets for intervention.

Background:
Approximately 3 million young children in the US face food insecurity. To combat this, USDA’s Food and Nutrition Assistance Programs (FNAPs) such as SNAP (Supplemental Nutrition Assistance Program), Head Start (HS), and Women, Infants, and Children (WIC), help low-income families with young children. However, research gaps exist in understanding the influence of these FNAPs, individually and collectively, on improving household food environments that significantly affect children's health and development.
Purpose:
To compare SNAP beneficiaries with those receiving HS, WIC, or both, and evaluate their influence on household food environment measures, assessing food and nutrition security, healthfulness, dietary choices, food store perceived limited availability, utilization barriers, and food access barriers in households with 2–6-year-old children.
Method:
This study, part of SNAP-Ed Needs and Assets Assessment Survey 'Healthy People, Healthy State,' analyzed cross-sectional data from Nebraska's low-income households (n=2337), focusing on households with at least one 2-6-year-old child (n=1316) and a subgroup exclusively participating in SNAP (n=257), SNAP+HS (n=349), SNAP+WIC (n=132), and SNAP+WIC+HS (n=83). We compared program participation for household food environment means using MANOVA while controlling for demographics and applied Benjamini-Hochberg correction, then compared corrected p-values to α=0.05.
Results:
Compared to other groups, SNAP+HS reported comparatively higher levels of household food security, whereas SNAP+HS+WIC reported lower levels (p<0.01). SNAP+HS also showed higher levels of nutrition security, dietary choices, better perceived availability of healthy foods in stores, fewer food access and utilization barriers (p<0.001, p<0.05). In pairwise comparisons, SNAP+HS consistently outperformed other groups in most measures, except for healthfulness choice.
Conclusion:
Recent ACF-FNS policy changes aim to facilitate SNAP households’ access to HS, aligning with this study's findings. Integrating HS with SNAP offers a promising approach to improve overall food environment and child development outcomes for low-income families by combining nutritional assistance with early childhood education and health services. However, perceived lack of control over acquiring healthy foods among participants suggest a need for targeted nutrition education. Combination of three FNAPs may pose challenges due to potential complexity of coordinating multiple programs. Future research should explore long-term outcomes, implementation challenges, family experiences, and demographic variations to inform policies and practices.

Purpose: The widespread use of device-based measures is promising for physical activity (PA) surveillance efforts, but comparison of PA estimates across devices is limited by the varied cut-points used to operationalize PA. Utilizing device-agnostic, alternative metrics derived from raw acceleration data represents an opportunity to overcome this issue and reduce bias in associations with health outcomes. This study investigated the association between PA volume and intensity, as expressed in monitor-independent movement summary (MIMS) unit metrics, and four adiposity indicators among children and adolescents.
Methods: Nationally-representative cross-sectional data from three cycles of the US National Health and Nutrition Survey (2011-2012; 2012 National Youth Fitness Survey; 2013-2014) were analyzed. A total of 5,260 participants (49% female) between 6 to 17 years of age wore an accelerometer on their non-dominant wrist for 7-days. MIMS units were used to represent PA volume (Daily MIMS/1000 units) and intensity (Peak 60-min MIMS/100 units). Four adiposity indicators were examined: body mass index (BMI) z-scores, body fat percentage via dual-energy X-ray absorptiometry, overweight/obesity status, and abdominal obesity status. Weighted linear and logistic regression models were computed to examine associations between PA volume and intensity with adiposity indicators, adjusted for sex, age, race/ethnicity, household income, parental education, sleep duration and caloric intake.
Results: PA volume and intensity were inversely associated with BMI z-scores (Daily MIMS: B = -0.02, 95% CI: -0.03, -0.01; Peak-60 MIMS: B = -0.03, 95% CI: -0.03, -0.02) and body fat percentage (Daily MIMS: B = -0.31, 95% CI: -0.43, -0.19; Peak-60 MIMS: B = -0.26, 95% CI: -0.31, -0.22). PA volume and intensity were also associated with significantly lower odds of overweight/obesity (Daily MIMS: OR = 0.95, 95% CI: 0.93, 0.97; Peak-60 MIMS: OR = 0.94, 95% CI: 0.93, 0.95) and abdominal obesity (Daily MIMS: OR = 0.94, 95% CI: 0.92, 0.97; Peak-60 MIMS: OR = 0.94, 95% CI: 0.93, 0.95).
Conclusions: Greater PA volume and intensity may be protective against adiposity indicators during childhood and adolescence. Longitudinal studies using cut-point-free metrics such as MIMS units are warranted to determine the respective influences of total volume and intensity of PA for adiposity prevention among youth.

Purpose: Given low levels of aerobic physical activity in children and adults, and the further declines in activity that occur during adolescence, interventions are needed before this period, to prevent declines and capitalize on this ideal period for family-based health promotion. The goal of the current study was to develop and iteratively refine a prototype of the Family Fit app to be used in an intervention to promote parent-child dyad physical activity.

Methods: An Advisory Board of parent-child dyads (child 9-12 years old) were recruited from the community to participate in iterative app testing and refinement, facilitated via Zoom. In Rounds 1 and 2, dyads participated in interactive co-design activities (e.g., modified version of layer elaboration) and provided input on app prototypes. Prototyped materials included physical activity targets and progress displays, feedback messages, topics for a parent support Facebook group, brief training videos, and the study logo and colors. In Round 3, dyads participated in a 2-week field test of the app. Dyads completed a final semi-structured interview to explore their experience using the app and advice for refinements.

Results: All 9 dyads (parents: 40.1+4.8 years, 88% female; children: 10.6+1.2 years, 55% female) participated in Round 1, and 8 (88.9%) participated in Rounds 2 and 3. In response to feedback in Rounds 1 and 2, the app menu was streamlined (e.g., switching from list of features to picture icons), additional discussion topics were added to feedback messages and the Facebook group, and the logo and feedback graphs were adjusted to include more colors. Round 3 results demonstrated that the dyads largely enjoyed the app and found it easy to navigate. However, they reported difficulty reading certain features due to font size. In response, new linked-out versions of reports were added, including a web app to display larger versions of progress graphs.

Conclusions: Following iterative refinements, the final version of the Family Fit app was found to be usable and acceptable. The app will now be tested in a randomized pilot to explore the feasibility of an app-supported intervention to promote parent-child dyad physical activity.

PURPOSE/BACKGROUND: The Structured Days Hypothesis (SDH) posits children have healthier movement behaviors (sleep, physical activity, and screen time) when engaged in structured environments, such as during the school year. However, most research supporting the SDH has been conducted among elementary-aged children. Therefore, the purpose of this study was to examine if the SDH holds true in preschool-aged children, comparing their 24-hour movement behaviors during the school year versus during the summer.
METHODS: Preschool-aged children between 3-5yrs (N=39; 53% female; 61% White; 5.0±0.3yrs) were recruited from 8 preschool programs serving families with low income during Spring 2023. Parents completed nightly surveys about daily screen time and nocturnal sleep. Children wore an Actigraph GT3X accelerometer around their waist to measure light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) for 7 days during the school year (April/May 2023) and summer (July 2023). Accelerometry was processed using GGIR (v2.8-2). Valid days were defined as ≥16 hours/day of wear time. Mixed effects models compared school year versus summer movement behaviors. Sex and accelerometer non-wear time were included as covariates.
RESULTS: When comparing the school year and summer, children had an average of 97.4 minutes/day vs 120.2 minutes/day (22.8; 95CI = 4.7, 41.0) of screen time, 606.6 minutes/night vs 645.6 minutes/night (39.0; 95 CI = 18.6, 58.8) of sleep, 130.0 minutes/day vs 156.3 minutes/day (26.3; 95CI = 7.6, 45.0) of LPA, and 203.4 minutes/day vs 194.7 minutes/day (-8.7; 95CI = -29.3, 11.8) of MVPA, respectively.
CONCLUSION: Preschool-aged children accumulated significantly more minutes of LPA, screen time, and sleep, with no changes in MVPA, on summer days compared to the school year. Findings are consistent with previous literature in elementary aged children suggesting children spend more time on screens and more time sleeping when engaged in unstructured environments; however, our findings for LPA and MVPA are inconsistent with previous research. Studies with large sample sizes are required to further understand the context of what preschool-aged children are doing that could explain these inconsistencies.

Purpose: Excessive sedentary time (ST) may disrupt cardiac autonomic nervous system (cANS) function, which could increase cardiovascular disease risk. Mechanisms underlying risk are unknown in youth and may be influenced by high body fat (BF) and low cardiorespiratory fitness (CRF). This preliminary study investigated free-living associations of daily ST with cANS via heart rate variability (HRV) among youth with overweight and obesity (OW/OB). We further explored BF and CRF as moderators in these relationships.

Methods: Preliminary data were collected from 15 youth aged 8-11 years with OW/OB (mean age=9.5±0.9 years, 40% girls, 87% Hispanic). Youth wore a thigh-mounted activPAL accelerometer and MyPatch electrocardiogram (ECG) monitor for 24 hours for 7 consecutive days. Youth who had ≥3 days with ≥10 hours of waking time each day were included. BF percent and CRF were collected via dual-energy x-ray absorptiometry and treadmill VO₂max testing, respectively. Day-level total ST (minutes) via accelerometry and day-level mean HRV metrics [standard deviation of normal-to-normal intervals (SDNN), root mean square of successive normal-to-normal interval differences (RMSSD), low frequency (LF), high frequency (HF), LF/HF ratio] via ECG were calculated. Multilevel models assessed whether within-person and between-person ST predicted each day-level mean HRV variable, adjusting for sex, ethnicity, and day-level moderate physical activity and accelerometer wear time. Interaction terms were included to assess person-level BF percent and CRF as moderators.

Results/findings: There were 71 valid days of accelerometer and ECG data. Compared to others, more weekly time in ST was associated with lower SDNN (β=-0.13 ms, p=0.01), HF (β=-2.19 ms², p=0.03), and higher LF/HF ratio (β=0.01, p=0.05) and marginally associated with lower RMSSD (β=-0.13 ms, p=0.09) and LF (β=-1.85 ms², p=0.09). Within-person ST was not associated with HRV (p>0.05). BF percent and CRF did not moderate ST-HRV associations (p>0.05).

Conclusions: More weekly average time in ST was associated with worse cANS function on multiple HRV metrics, but day-level ST was not associated with cANS function. Week-level, habitual ST may be an important behavioral target for preventing adverse cANS alterations in youth vulnerable to high cardiovascular disease risk. More studies are needed in larger samples to support our preliminary findings.