Recess, unstructured play typically outdoors, is a key physical activity opportunity, and access to quality recess has been advocated as a social justice issue. In 2019, Arkansas implemented a state law that extended required recess from 20 to 40 daily minutes in elementary schools, currently the longest required recess in the US. However, there has been little statewide evaluation of this potentially impactful legislation, especially among geographically and racially diverse schools.
Purpose: To compare current implementation of Extended Recess Policy in geographically and racially diverse schools. Implementation measures will include the duration of recess and quality metrics such as number and timing of recess periods and withholding policies.
Methods: A cross-sectional, observational study of the implementation of Arkansas’s Extended Recess requirement. This study will utilize two methods to collect recess implementation data to ensure both completeness of data through a school audit, as well as stakeholder perceptions through a school survey. Implementation will be defined as the total daily amount of recess with additional variables for the duration and frequency of recess periods. Research staff will audit each school in Arkansas (n=523) for published recess schedules and phone and email contact with school administrative staff. School principals will also be surveyed with additional questions on the quality of recess which, including indoor recess policies, playground space and equipment available, and recess withholding policies. In two pilots with 25 and 34 schools respectively, 9 respondents reported schools not meeting minimum recess durations indicating potential variation in implementation.
Results/Findings: Recess duration and quality metrics will be summarized with comparisons made between rural/urban location, school demographic characteristics, using ANOVAs, linear regressions, or the appropriate non-parametric test.
Conclusions: This will contribute scientific knowledge on how the implementation of a state school physical activity policy varies across diverse schools. By determining minutes of daily recess in all schools in Arkansas and comparing daily recess duration between urban and rural and high and low Black enrollment, we will identify potential inequitable access to recess. Future efforts can be focused on schools with poor implementation to increase physical activity opportunities and to help inform future recess policies.

Purpose: Using nutrition labels can encourage healthier dietary choices among adolescents. The purpose of this study was to examine associations between nutrition label usage and eating behaviors among a statewide representative sample of 8th and 11th grade students in Texas, USA.

Methods: We analyzed associations between nutrition label use and eating behaviors from a statewide sample of 8th and 11th grade students in Texas (N=4,730, Weighted N=710,731, age = 14.7±1.6 years; 49% female, 51% Hispanic) who completed the 2019-2020 Texas School Physical Activity and Nutrition (Texas SPAN) survey. Students self-reported nutrition label usage to make food choices (5-point Likert scale from “Never to Always”) and consumption of 26 food items. Food items were used to calculate a Healthy Eating Index (HEI) score (0-100), a Healthy Foods Index (HFI) score (0-100), and an Unhealthy Foods Index (UFI) score (0-100). Weighted linear regression models were employed to examine associations between nutrition label usage and HEI, HFI, and UFI scores. The odds of consuming individual food items for nutrition label usage were also calculated from weighted logistic regression models.

Results: A total of 11.0% of students reported always/almost always using nutrition labels to make food choices, 48.6% reported sometimes using them, and 41.4% indicated they never used nutrition labels. Nutrition label usage was positively associated with HEI (b=5.79, 95%CI:4.45,7.12) and HFI (b=7.28, 95%CI:4.48,10.07), and negatively associated with UFI (b= -4.30, 95%CI:-6.25,-2.34). A dose-response relationship was observed between nutrition label usage and HEI, HFI, and UFI scores, such that the strength of these associations increased with each one-point increase in nutrition label usage. Students who used nutrition labels had higher odds of consuming healthy foods including baked meat, nuts, brown bread, vegetables, whole fruit, and yogurt (ORrange=1.32-3.07), and lower odds of consuming unhealthy foods including chips, cake, candy, and soda (ORrange=0.48-0.68).

Conclusion: Using nutrition labels to make food choices is associated with healthy eating among 8th-11th grade students, although the proportion using nutrition labels is low. Nutrition education efforts in U.S. secondary schools should be strengthened and focus on teaching students how to effectively use nutrition labels to make food choices.

Purpose: Violence is widely considered to be a public health concern that can negatively affect health and wellbeing. Individuals who live in communities with high rates of violence experience increased risk of depression and addiction. Furthermore, they are less likely to be physically active. There continues to be gaps in knowledge regarding the health and nutritional consequences of being exposed to violence. This study aimed to examine associations between self-reported exposure to community violence, food security status, and obesity among Black adults in the U.S.

Methods: Data used in this study is from a 2023 cross-sectional survey administered to 502 Black-identifying adults (age >18 years) living in the U.S. To screen for exposure to community violence and food security status, they completed the validated Survey of Exposure to Community Violence (SECV) and 6-item U.S. Household Food Security Model (30 days). Obesity status (body mass index >30) was computed using self-reported height and weight estimates provided by 432 participants. Logistic regression models were used to examine associations between self-reported exposure to community violence, low food security status, and obesity status controlling for age, gender, annual family income, and education level.

Results: Findings revealed that 247 (49.20%) of participants experienced low food security in the past 30 days. Of the participants who provided height and weight data, 144 (33.33%) were obese according to their BMI. The multivariable-adjusted model revealed that participants in the highest quartile of SECV score had significantly higher odds of low food security status compared to individuals in the lowest quartile (OR: 2.63; 95% CI: 1.51 – 4.58). Relatedly, the adjusted model indicated that individuals in the highest quartile of SECV score had greater odds of obesity compared to those in the lowest quartile (OR: 2.25; 95% CI: 1.19 – 4.26).

Conclusions: Exposure to community violence is associated with food insecurity and obesity among Black adults in the U.S. These findings add to the literature that demonstrates the health consequences of violence. Future studies should explore how exposure impacts relevant mediating factors such as dietary practices, food shopping behaviors, and access to food and safety-net resources.

Purpose: To estimate covariate adjusted sex-specific mediation pathways (total, direct, and indirect effects) between objective measures of neighbourhood walkability and neighbourhood greenness, on objective measures of cardiorespiratory and muscular fitness, using accelerometer measured physical activity as a potential mediator.

Methods: Utilizing multiple databases, we conducted a secondary analysis using a cross-sectional design. Our objectively measured neighborhood walkability variable came from the Canadian Active Living Environment Database and included an overall walkability index (i.e., the standardized sum of street connectivity, residential density, points of interest, and transit density, in a one km circular buffer from the center of participants postal code). Our objectively measured greenness variable included the Normalized Difference Vegetation Index (NDVI) dataset estimated within one km around residential postal codes. Muscular fitness and cardiorespiratory variables were also objectively measured and came from the Canadian Health Measures Survey (CHMS) (Cycles 4-6) and included both grip strength and submaximal V ̇O_2 step tests. Physical activity accelerometer data came from the CHMS and included light- (LPA), moderate- (MPA), and vigorous-intensity (VPA) cut-points. Mediation analysis was completed using the PROCESS macro and samples sizes ranged from 987 to 2796 for males and 989 to 2835 for females.

Results/findings: We found sex-specific effects. Males had indirect effects between neighbourhood walkability and cardiorespiratory fitness through the LPA (negative) and VPA (positive) pathways. Further, we found a total effect (negative) between neighbourhood walkability and grip strength, as well as an indirect effects between neighbourhood walkability and grip strength through LPA (negative) and MPA (negative) pathways, in males. For females, we found a total (positive) and direct effect (positive) between neighbourhood walkability and cardiorespiratory fitness. For females, we also found an indirect effect for walkability and cardiorespiratory fitness through the LPA pathway. All mediation estimates were small in magnitude and neighbourhood greenness did not show evidence of mediation from any pathways.

Conclusions: Neighbourhood walkability may positively influence your cardiorespiratory fitness and negatively influence muscular fitness. However, this influence is small in application and, therefore, needs to be weighed against the evidence indicating that neighbourhood walkability supports other health outcomes.

Assessment of Dietary Behaviors Among West African Immigrants in Relation to Acculturation Level and Length of Time in the U.S.

Oluwafikayo Adeyemi-Benson, MPH1; Presenting and Corresponding author.
Isa Adamu, MPH1; Co-author
Susan Aguiñaga, PhD1; Co-author
Naiman Khan, PhD1; Co-author
Andiara Schwingel, PhD1; Co-author
Chelsea R. Singleton, PhD, MPH2: Co-author and Corresponding author.

Author Affiliations:
1.) Department of Kinesiology & Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
2.) Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA

ISBNPA Abstract Submission 2024: https://annualmeeting.isbnpa.org/call-for-abstracts/

Purpose: Acculturation and length of time in the U.S. have been linked to adverse changes in dietary behavior among immigrant populations. Information on the dietary behaviors of African immigrants is scarce. This study aimed to evaluate the dietary behaviors (e.g., intake of fruits, vegetables, whole grains, and added sugar) of West African immigrants to determine if they vary by the acculturation level and length of time in the U.S.

Methods: A cross-sectional survey was conducted among 354 adults (28.3% ≥45 years old; 53.4% female) who self-identified as West African immigrants living in Chicago, IL. Participants self-reported their socio-demographic information and length of time in U.S. They completed validated screeners for acculturation level and dietary intake in the past 30 days. Logistic regression was used to determine if the odds of consuming a high volume of fruit (cups), vegetables (cups), whole grains (ounces) and added sugar (teaspoons) varied by acculturation level or length of time in the U.S.

Results: Findings indicated that fruit, vegetable, and whole grain consumption was low among survey respondents with few meeting daily recommended amounts. After adjusting for age, sex, marital status, annual income, and number of household members, those who have lived in the U.S. ≤5 years (OR: 2.56; 95% CI: 1.03-6.42) and between 6 to 10 years (OR: 3.22; 95% CI: 1.52 - 6.84) had greater odds of consuming >1 cup of fruit/day compared to the reference group (>10 years). In addition, those with a low acculturation level had lower odds of consuming >12 teaspoons of added sugar per day compared to those with a high acculturation level (OR: 0.46: 95% CI: 0.22-0.93). There were no differences in consumption of whole grains or vegetables detected by acculturation level or length of time in the U.S.

Conclusion: It appears that acculturation level and length of time in the U.S. may influence some dietary behaviors of West African immigrants, but not all behaviors. These findings highlight the importance of studying the differential effects of acculturation on immigrant populations. Future studies should evaluate how indicators of acculturation influence dietary intake across the African diaspora in the U.S.

Purpose: Intentions to eat healthy have been found to be strong predictors of healthy diet. Few studies have examined how exposure to community violence and stress impact intentions. Pervasive racial disparities in rates of diet-related diseases underscores the need to improve understanding of barriers to healthy eating intentions among racially marginalized populations. This study addresses these gaps in knowledge by examining associations between self-reported exposure to violence, stress, and intention to eat healthy among Black adults in the U.S.

Method: A cross-sectional survey was completed online by 502 Black adults (mean age: 47.23; 39.64% male) in the U.S. Participants reported their socio-demographic information and responded to two validated screeners: Self-Reported Exposure to Community Violence (SECV) and Perceived Stress Scale (PSS). Logistic regression models were used to evaluate associations between SECV and PSS scores and having intentions to eat healthy in the next two months while controlling for covariates: age, gender, income, marital status, education level. Interaction terms were generated to understand how the interaction of violence exposure and stress influence odds of reporting intention to eat healthy.

Results: Descriptive analysis revealed that 295 (58.76%) participants reported having intentions to eat healthy in the next two months. Adjusted models indicated that individuals in the highest quartile of SECV score were less likely to report having intentions to eat healthy than those in the lowest quartile (OR: 0.46; 95% CI:0.26-0.80). Individuals in the highest stress tertial were less likely to report having intentions to eat healthy compared to those in the lowest (OR: 0.53; 95% CI: 0.31-0.90). Among all the SEVC x PSS combinations, individuals with the highest scores for exposure to community violence and stress were the least likely to report having intentions to eat healthy (OR: 0.19; 95% CI: 0.07-0.49).

Conclusion: Living in a violent community and experiencing great stress may put individuals at a disadvantage when engaging in health promoting behaviors such as healthy eating. Future studies should examine how stressors influence dietary behaviors, particularly in communities with chronic disinvestment as these areas often have high rates of crime and fewer economic opportunities which may contribute to increased stress.

Approximately half of Americans do not drink water from the tap. Even in the absence of water quality violations, members of the public may not readily trust their tap water. A variety of factors, including perception of water quality and trust in water, may contribute to avoiding tap water. The present analysis used cross-sectional data to investigate the extent to which beliefs about water predict the preferred source of drinking water among 817 adults living in the state of Virginia, USA. Using logistic regression, the odds of drinking water directly from the faucet compared to filtered or bottled water were compared across four water beliefs that are hypothesized predictors of preferred drinking water source: quality of the water from the faucet, trust in the water from the faucet, trust in the water utility provider, and awareness that the water utility frequently test water – measured on a Likert scale. Models were adjusted for relevant covariates including region in Virginia, recruitment method, age, race/ethnicity, gender, education, and housing status. Respondents were mostly homeowners (60%) and white (72%), and many were college graduates (49%), and 15.8% indicated that their preferred source of water was the water from their faucet. In the adjusted regression, trust in the water at the faucet was the only water belief that significantly increased the odds of choosing tap as the preferred source of water, where levels of trust were “not at all”, “not too much”, “some”, “a lot”, or “I don't have an opinion”. Compared to those that reported no trust at all, those that had a lot of trust (OR: 19.4; 95% CI upper, lower: 13.6, 27.8; p= 0.003) as well as those that had no opinion (OR: 9.8; 95% CI upper, lower: 2.6-17.8; p= 0.03) had significantly higher odds of preferring water directly from the faucet. The finding that neither tap water quality rating nor the beliefs associated with the water utility increased the odds of preferring water directly from the faucet highlights the need to identify factors that can be targeted, in conjunction with trust, to develop interventions to increase tap water consumption.

Purpose: Efforts such as Health-for-All Policies, acknowledge that including health in policies improves public health and has important co-benefits. Transport policy is an opportunity to include a health perspective and promote public health as well as reduce car dependency to facilitate environments for safe active transport, and pleasant and safe neighborhoods for social interactions. Whether or not such measures are enacted, however, is a matter of political decision making, but the specific policy dynamics that precede these decisions are not well understood. Therefore, this study aimed to identify the dynamics and factors involved in decision making, using the case of 20 miles per hour (mph) speed limits, and the role of dynamics and factors as being facilitative and/or obstructive. Since policy making and agenda setting are multilayered processes, involving various stakeholders and perspectives, we adopted a systems dynamics approach.

Methods: In this qualitative study, 13 semi-structured interviews were carried out among 5 policy makers, 5 researchers and 3 advocates from five European countries (i.e. UK, Switzerland, Spain, Ireland and Austria) in cities that successfully implemented 20mph. Data was coded in MAXQDA according to barriers and facilitators of policy dynamics. We created a causal loop diagram (CLD) to identify reinforcing and balancing feedback loops in order to understand policy dynamics of successful policy enactment.

Results: Data saturation was reached after 9 interviews. The CLD provided insight in balancing dynamics including measurement and evaluation and political leadership. For example, a balancing feedback loop around measurement and evaluation suggested that data collection and evaluation during incremental policy implementation might decrease the fear of unwanted outcomes among opposition groups, which in turn could decrease the policy makers fear of the public’s reaction and has the potential to increase the political leadership to implement these policies. Moreover, reinforcing feedback loops were identified around public acceptance and topic normalization. This suggested that incremental policy implementation could lead to higher public acceptance, reducing policy makers fear and potentially increase their leadership to implement policies.

Conclusions: These insights help to understand the dynamics underlying successful policy enactment and helps to identify key stakeholder groups to enhance policy enactment.

Purpose: Programming and policies to support food insecure college students have expanded but utilization is often limited. This scoping review aimed to summarize the barriers to accessing college student food insecurity programming guided by the social ecological model (SEM) framework.

Methods: Literature Search: An electronic search was conducted in MEDLINE, ERIC, and PubMed databases, with a secondary search in Google Scholar. Inclusion Criteria: College students at all levels attending an institution of higher education in the United States were the target population. The concept of interest was college student barriers when accessing food assistance programming or resources, and articles needed to include the perspective of the student. Articles had to be published between January 2009 and December 2022. Of the 137 articles identified, 18 articles met eligibility criteria and were included. Methods of Analysis: Authors used a three-step process to review the articles; title review, abstract review, and full-text review. Authors met to discuss any discrepancies between articles that should be kept or removed during the title and abstract review phases. Barriers to college student food security were organized by level of the SEM framework.

Results: Articles primarily encompassed organizational (17/18) level barriers, followed by individual (15/18), relationship (15/18), community (9/18), and policy (6/18) levels. Individual barriers included seven themes: Knowledge of Process, Awareness, Limited Time/Schedules, Personal Transportation, Internal Stigma, Perception of Need, and Type of Student. Four relationship barriers were identified: External Stigma, Comparing Need, Limited Availability Causes Negative Perceptions, and Staff. Ten barrier themes comprised the organizational level: Application Process, Operational Process, Location, Hours of Operation, Food Quality, Food Quantity, Food Desirability/Variety of Food, Marketing Materials, Awareness of the Program, and COVID-19 Restrictions. Two barrier themes were identified at the community level, Public Transportation and Awareness of SNAP, while one barrier theme, SNAP Eligibility and Process, encompassed the policy level.

Conclusions: Higher education stakeholders should seek to overcome these barriers to the use of food programs as a means to address college student food insecurity. This review offers recommendations to overcome these barriers at each SEM level.