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Background: Intervention construct validity procedures test the efficacy of a program to impact on targeted theory constructs. Purpose: To examine the intervention construct validity of the Planning to be Active (PBA) and Mentored Planning to be Active (MPBA) programs on high school youth residing in Appalachia. Methods: Twenty high schools in Appalachia were randomly assigned to either the teacher lead PBA program or the peer mentor led MPBA program. All participants (n = 633) completed a set of valid and reliable instruments assessing SCT variables: social support for exercise friends, social support for exercise family, self-efficacy for exercise and the self-regulation skills (behavioral goal setting, exercise self-monitoring, building social support, overcoming barriers, and self-reward). Results: PBA and MPBA are effective approaches to increasing social support, self-efficacy for exercise and increasing the use of self-regulation skills to increase physical activity. The results identify constructs that were not improved suggesting areas for curriculum refinement. Discussion: PBA and MPBA have established construct validity. Intervention construct validity methods identified program strengths and weaknesses. Translation to Health Education Practice: Intervention construct validity is an evidence-based approach to program improvement. Intervention construct validity establishes a foundation for testing theory impact on health behaviors.

Appalachian youth are highconsumers of added dietary sugar and are very sedentary. "Mentoring to be Active" trains teens to deliver a theoretically based program to promote home-based physical activity (PA) and reduce dietary sugar among rural Appalachian youth. For this pre-test/post-test pilot study, 52 seventh graders from two Appalachian schools participated as mentees. Twenty-two 10th grade students served as peer mentors. The study estimated sedentary activity, and physical activity by accelerometers and dietary sugars (snacks, beverages) during 'out of school' time. Descriptive statistics and effect sizes (ES) were calculated. When the pre-post standard deviations differed, Hedge's g were reported. Sedentary activity decreased 36.7% (ES = 0.798). Moderate activity levels increased 16.5% (ES = 0.359). Vigorous activity increased 88% (ES = 0.359). Sugary-beverages declined over 4 ½ servings. Sugary snacks declined 2 ¼ servings. Peer mentoring is a strategy to promote social support for healthier behaviors among youth at risk for obesity and co-morbidities. Accelerometers rigorously assessed physical activity during 'out of school' time in rural youth. [Written with Ms. Jeffrey.]

Sugar-sweetened beverages (SSBs) are a large source of added sugar in teenagers' diets, comprising 20-25% of daily calories. Despite efforts, teens in rural and southern states continue to have the high SSB consumption rates. Using Teen Advisory Councils (TAC), students designed and delivered school-specific interventions at five Tennessee schools. Using repeated measures models with Bonferroni correction, data were collected on SSBs and water consumption at baseline and 30 days postintervention. The 573 participants ranged from 13 to 19 years; mean age 15.97 years (SD = 1.4). Daily SSB servings decreased from a mean of 2.37 (SD = 2.06) to 1.87 (SD = 1.89; p = 0.024). Weekly SSB behaviors decreased 10%. Daily water consumption increased 19.5% to 4.46 (SD = 2.97) servings (p = 0.03). Student-led efforts supported behavioral changes. TACs were effective at changing lifestyle behaviors. Community-driven solutions may result in manageable changes to sustain behaviors.

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Despite national guidelines for regular physical activity, most adolescents are not physically active. Schools serve an estimated 60 million youth and provide an educational environment to meet the current physical activity guidelines. The obesity epidemic and chronic disease comorbidities associated with physical inactivity are not likely to be reversed without a strong contribution from local schools. This article describes how a structured peer-mentoring method provides a feasible, flexible, and tailored means to meet the current guidelines for best practice in a school setting. Structured peer mentoring using trained high school mentors to support behavior change in younger peers is an innovative method to meeting the "School Health Guidelines to Promote Healthy Eating and Physical Activity." Through structured peer mentoring, adolescents are provided consistent social support in a caring and personalized manner. This support builds skills and competencies enhancing self-efficacy to sustain a lifetime of physical activity behavior.

Background: To better understand the unique challenges of Appalachians, community-based studies are needed to establish benchmark rates. This study compares obesity rates and obesogenic behaviors among Appalachian adolescents to other adolescent populations or clinical recommendations. Methods: This study was conducted in 11 Appalachian schools. Body mass index, body mass index percentile, and body fat percentage were measured using a Tanita DC-430U analyzer. Physical activity was measured using Actigraph wGT3X-BT accelerometers. Sugar-sweetened beverage consumption was self-reported. Pearson's correlations, independent t tests, and multivariate analyses with tests of between-subject effects were conducted. Results: Mean (n = 345) age was 15.23 (SD = 1.02) years. Appalachian adolescents were extremely obese (13.1%) by more than double that of national adolescent rates. Nearly 29% of males and over 55% of females were at increased cardiovascular risk. Only 15% were moderately active for at least 60 minutes a day, but only for 1 day per week. Mean afterschool sedentary time was 4.75 hours. Only 2.1% recorded vigorous activity for a minimum of 10 minutes at 1 day per week. Nearly all regularly consumed sugar-sweetened beverages. Conclusion: Obesogenic health disparities were evident in Appalachia. Rates of obesogenic factors among Appalachian adolescents exceed national rates. Appalachian adolescents were far less active, and extreme obesity is a major health concern. [ABSTRACT FROM AUTHOR]

Sugar-sweetened beverages (SSBs) are a large source of added sugar in teenagers' diets, comprising 20–25% of daily calories. Despite efforts, teens in rural and southern states continue to have the high SSB consumption rates. Using Teen Advisory Councils (TAC), students designed and delivered school-specific interventions at five Tennessee schools. Using repeated measures models with Bonferroni correction, data were collected on SSBs and water consumption at baseline and 30 days postintervention. The 573 participants ranged from 13 to 19 years; mean age 15.97 years (SD = 1.4). Daily SSB servings decreased from a mean of 2.37 (SD = 2.06) to 1.87 (SD = 1.89; p =.024). Weekly SSB behaviors decreased 10%. Daily water consumption increased 19.5% to 4.46 (SD = 2.97) servings (p =.03). Student-led efforts supported behavioral changes. TACs were effective at changing lifestyle behaviors. Community-driven solutions may result in manageable changes to sustain behaviors. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the efficacy of a behavioral skills mentoring program (Mentored Planning to Be Active [MBA]) to a teacher‐led program (Planning to Be Active [PBA]) for increasing physical activity in Appalachian teens on health outcomes (weight loss, body mass index (BMI), and body fat). Methods: Secondary analysis of a larger group‐randomized controlled trial was conducted in 20 rural Appalachian schools. Descriptive Pearson correlations and multivariate analyses with between‐subject effects were conducted. Effect sizes (ES) using Cohen's d and odds ratios (OR) with 95% confidence intervals were calculated. Findings: The obese MBA group lost 77.5% more weight by T3 compared to the PBA group; T2 was (F = 8.51, P =.000) and T3 was (F = 7.62, P =.000). ES was 0.34. OR = 1.45 (95% CI: 0.558‐3.792) at T2 and OR = 3.32 (95% CI: 1.103‐9.978) at T3. Extremely obese in the MBA group lost 80.0% more weight compared to the PBA group; T2 was (F = 5.23, P =.025) and at T3 (F = 6.33, P =.015) ES was 0.58. OR = 4.36 (95% CI: 0.981‐19.34). Extremely obese females lost more weight compared to males (F = 4.75, P =.034). BMI and body fat had similar results; youth in the MBA group had the most improvement. Conclusions: Rural Appalachian youth are disproportionately extremely obese. BMI does not capture adiposity or cardiovascular risk. BMI, BMI percentile, raw weight, fat mass, and percent body fat are more complete analyses of adiposity and cardiovascular risk. [ABSTRACT FROM AUTHOR]