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Objective:To describe relationships among baseline characteristics, engagement indicators and outcomes for rural participants enrolled in SIPsmartER, a behavioural intervention targeting sugar-sweetened beverage (SSB) intake.Design:A secondary data analysis. Bivariate analyses determined relationships among baseline characteristics (e.g. age, gender, race, education, income), engagement indicators (completion of 6-month health screening, class attendance, call completion) and SSB outcomes (SSB ounce reduction (i.e. US fluid ounces; 1 US fl. oz = 29·57 ml), reduced ≥12 ounces, achieved ≤8 ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and of baseline characteristics and engagement indicators on SSB outcomes.Setting:South-west Virginia, USA, a rural, medically underserved region.Participants:Participants’ (n 155) mean age was 41 years; most were female (81 %), White (91 %) and earned ≤$US 20 000 per annum (61 %).Results:All final models were significant. Engagement models predicted 12–17 % of variance, with age being a significant predictor in all three models. SSB outcome models explained 5–70 % of variance. Number of classes attended was a significant predictor of SSB ounce reduction (β = −6·12, P < 0·01). Baseline SSB intake significantly predicted SSB ounce reduction (β = −0·90, P < 0·001) and achieved ≤8 ounce intake (β = 0·98, P < 0·05).Conclusions:The study identifies several participant baseline characteristics that may impact engagement in and outcomes from a community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with greater reduction in overall SSB intake; yet engagement variables did not predict other outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.

Background Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S. populations. Methods Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8). Results A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance. Conclusions We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities. Trial registration The review protocol was registered with PROSPERO: CRD42019116308.

Prediabetes affects 84.1 million adults, and many will progress to type 2 diabetes (T2D). The objective of this proof-of-concept trial was to determine the efficacy of inulin supplementation to improve glucose metabolism and reduce T2D risk. Adults (n = 24, BMI: 31.3 ± 2.9 kg/m2, age: 54.4 ± 8.3 years) at risk for T2D were enrolled in this controlled feeding trial and consumed either inulin (10 g/day) or placebo (maltodextrin, 10 g/day) for six weeks. Assessments included peripheral insulin sensitivity, fasting glucose, and insulin, HOMA-IR, in vivo skeletal muscle substrate preference, Bifidobacteria copy number, intestinal permeability, and endotoxin concentrations. Participant retention was 92%. There were no baseline group differences except for fasting insulin (p = 0.003). The magnitude of reduction in fasting insulin concentrations with inulin (p = 0.003, inulin = Δ-2.9, placebo = Δ2.3) was attenuated after adjustment for baseline concentrations (p = 0.04). After adjusting for baseline values, reduction in HOMA-IR with inulin (inulin = Δ-0.40, placebo=Δ0.27, p = 0.004) remained significant. Bifidobacteria 16s increased (p = 0.04, inulin = Δ3.1e9, placebo = Δ-8.9e8) with inulin supplementation. Despite increases in gut Bifidobacteria, inulin supplementation did not improve peripheral insulin sensitivity. These findings question the need for larger investigations of inulin and insulin sensitivity in this population.

The Pan American Health Organization (PAHO) Strategic Plan 2020–2025 committed to reduce children’s consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO’s Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives (n = 35) to complete a 28-item web-based survey (January to July 2020). Capacity-building needs were assessed using an adapted version of the World Health Organization’s government capacity-building framework with three modules: public health infrastructure, policies and information systems. Notable achievements for the PAHO’s Plan of Action were identified. State representatives reported strong infrastructure and information systems, however, policy improvements are needed to increase comprehensive national responses. These include using a constitutional health and human rights approach within the policies, policies that document conflict of interest from non-state actors, and strengthening regulatory oversight for digital media platforms. These findings provide baseline data and we suggest priorities for further action to strengthen national governments’ capacity-building and to accelerate the development, implementation, and monitoring systems to restrict the marketing of HFSS food and non-alcoholic beverages to children in the region of the Americas.

Drugs of abuse induce persistent remodeling of reward circuit function, a process thought to underlie the emergence of drug craving and relapse to drug use. However, how circuit-specific, drug-induced molecular and cellular plasticity can have distributed effects on the mesolimbic dopamine reward system to facilitate relapse to drug use is not fully elucidated. Here, we demonstrate that dopamine receptor D3 (DRD3)-dependent plasticity in the ventral pallidum (VP) drives potentiation of dopamine release in the nucleus accumbens during relapse to cocaine seeking after abstinence. We show that two distinct VP DRD3(+) neuronal populations projecting to either the lateral habenula (LHb) or the ventral tegmental area (VTA) display different patterns of activity during drug seeking following abstinence from cocaine self-administration and that selective suppression of elevated activity or DRD3 signaling in the LHb-projecting population reduces drug seeking. Together, our results uncover how circuit-specific DRD3-mediated plasticity contributes to the process of drug relapse. NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01MH108594, R01DA049787, U01MH114829]; Canadian Institutes of Health Research (CIHR) postdoctoral fellowshipCanadian Institutes of Health Research (CIHR); TobaccoRelated Disease ResearchProgram (TRDRP) postdoctoral fellowship; NIH T32 training grantUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA; American Heart Association predoctoral fellowshipAmerican Heart Association Published version We thank Dr. Shannan McClain for technical assistance, Dr. Daniel Knowland for helpful discussions, Dr. Sung Han for assistance with pyPhotometry, and Dr. Adrian Lozada and Dr. Christie Fowler for advice on jugular vein catheter surgeries and selfadministration protocols. This work was supported by NIH grants R01MH108594, R01DA049787, and U01MH114829. H.P. was supported by a Canadian Institutes of Health Research (CIHR) postdoctoral fellowship. S.S. was supported by a TobaccoRelated Disease ResearchProgram (TRDRP) postdoctoral fellowship. E.H.W. was supported by an NIH T32 training grant and an American Heart Association predoctoral fellowship.

Diseases related to impaired blood flow such as peripheral artery disease (PAD) impact nearly 10 million people in the United States alone, yet patients with clinical manifestations of PAD (e.g., claudication and limb ischemia) have limited treatment options. In ischemic tissues, stress kinases such as c-Jun N-terminal kinases (JNKs), are activated. Here, we show that inhibition of the JNK3 (Mapk10) in the neural compartment strikingly potentiates blood flow recovery from mouse hindlimb ischemia. JNK3 deficiency leads to upregulation of growth factors such as Vegfa, Pdgfb, Pgf, Hbegf and Tgfb3 in ischemic muscle by activation of the transcription factors Egr1/Creb1. JNK3 acts through Forkhead box O3 (Foxo3a) to suppress the activity of Egr1/Creb1 transcription regulators in vitro. In JNK3-deficient cells, Foxo3a is suppressed which leads to Egr1/Creb1 activation and upregulation of downstream growth factors. Collectively, these data suggest that the JNK3-Foxo3a-Egr1/Creb1 axis coordinates the vascular remodeling response in peripheral ischemia., Stress kinases are activated in peripheral ischemic tissues in the presence of vascular diseases. Here the authors show that inhibition of the neural JNK3 kinase improves recovery from hind limb ischemia in animals through activation of the transcription factors Egr1/Creb1 and upregulation of growth factors.

Colorectal cancer is the third leading cause of cancer death in the USA, yet is highly preventable and detectable at an early stage through screening. Virginia Cooperative Extension (VCE) implemented a worksite colon cancer awareness program to increase colorectal cancer screening rates and preventive lifestyle behaviors among its employees. The Colon Cancer–Free Zone program is designed using best practice principles of worksite health programs and includes information sessions covering the topics of colorectal cancer, screening guidelines, insurance coverage, and preventive lifestyle behaviors. It is conducted in a campaign format that includes a strategic communication strategy targeting relevant screening barriers and facilitators, peer champions, and incentives. The program was implemented with VCE employees statewide utilizing a web-based system for the information sessions, and resulted in broad participation, a significant increase in screening self-efficacy (4.15 ± 0.64 vs 3.81 ± 0.76, ρ = 0.006), changes in diet and physical activity (50% and 40% of participants, respectively), and a 20.6% increase in the employee colorectal cancer screening rate. A Colon Cancer–Free Zone toolkit was developed for use by Extension Agents to implement the program at worksites in their service communities. Electronic supplementary material The online version of this article (10.1007/s13187-019-01569-4) contains supplementary material, which is available to authorized users.

Interventions to discourage sugary beverages and encourage water consumption have produced modest and unsustainable behavioral changes to reduce obesity and noncommunicable disease risks. This systematic scoping review examined media campaigns to develop a typology to support healthy hydration nonalcoholic beverage behaviors. Our three-step methodology included the following: (1) review and summarize expert-recommended healthy beverage guidelines; (2) review six English-language electronic databases guided by PRISMA to describe existing campaign types by issue, goal and underlying theory; and (3) develop a media campaign typology to support policies, systems and environments to encourage healthy hydration behaviors. Results showed no international consensus for healthy beverage guidelines, though we describe expert-recommended healthy beverage guidelines for the United States. Of 909 records identified, we included 24 articles describing distinct media campaigns and nine sources that defined models, schemes or taxonomies. The final media campaign typology included: (1) corporate advertising, marketing or entertainment; (2) corporate social responsibility, public relations/cause marketing; (3) social marketing; (4) public information, awareness, education/ health promotion; (5) media advocacy/countermarketing; and (6) political or public policy. This proof-of-concept media campaign typology can be used to evaluate their collective impact and support for a social change movement to reduce sugary beverage health risks and to encourage healthy hydration behaviors. Published version

Sugar-sweetened beverages (SSBs) are a primary source of added sugars in the American diet. Habitual SSB consumption is associated with obesity and noncommunicable disease and is one factor contributing to U.S. health disparities. Public health responses to address marketing-mix and choice-architecture (MMCA) strategies used to sell SSB products may be required. Thus, our goal was to identify original research about stocking and marketing practices used to sell SSB in U.S. food stores. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the World Health Organization (WHO) protocol for rapid reviewing. We searched six databases and Google Scholar using key terms focused on store type and SSB products. We characterized results using an MMCA framework with categories place, profile, portion, pricing, promotion, priming or prompting, and proximity. Our search resulted in the identification of 29 articles. Most results focused on profile (e.g., SSB availability) (n = 13), pricing (e.g., SSB prices or discounts) (n = 13), or promotion (e.g., SSB advertisements) (n = 13) strategies. We found some evidence of targeted MMCA practices toward at-risk consumers and differences by store format, such as increased SSB prominence among supermarkets. The potential for systematic variations in MMCA strategies used to sell SSB requires more research. We discuss implications for public health, health equity, and environmental sustainability. USDA National Institute of Food and AgricultureUnited States Department of Agriculture (USDA) [1024670] USDA National Institute of Food and Agriculture, Grant/Award Number: Hatch project 1024670; Healthy Eating Research

BackgroundThere is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers’ situatedness within participatory processes. As an implementation scientist, addressing one’s own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process.MethodsWe developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative.ResultsAnalysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers’ lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers’ experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research.ConclusionBuilding on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one’s values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.

This commentary describes insights from Star Trek's fictional television series to understand how state and non-state actors address conflicts of interest (COIs) through global nutrition governance. I examine the findings of Ralston and colleagues for 44 state and non-state actors who responded to the World Health Organization's (WHO's) consultation for a COI risk-assessment tool, developed for member states to engage effectively with non-state actors to address malnutrition in all forms. Star Trek reveals that actor engagement is inevitable in a shared universe. The Prime Directive is a non-interference principle reflecting a moral commitment to reduce harm, respect autonomy and protect rights. Engagement principles are relevant to all actors who influence nutrition policies and programs, and must be held accountable when their actions undermine healthy and sustainable food systems. Certain actors use COI to justify non-engagement with commercial actors yet competing interests, biases, corruption and regulatory capture are distinct challenges to manage. Finally, Star Trek's characters serve as allegories to understand actors' motives and actions to promote healthy and sustainable food systems. Unlike non-state actors, states are legally required to achieve their commitments and targets in the United Nations' (UN) Decade of Action on Nutrition (2016-2025) and Sustainable Development Goals (SDGs) 2030 Agenda. Published (Publication status)

Community-based participatory research is an approach to creating research in partnership between communities and researchers (see Israel, Eng, Schulz, & Parker, 2012; Wallerstein, Duran, Oetzel, & Minkler, 2018). An integral part of the process is action to address community-identified needs. Our team implemented the SEED Method in a rural Virginia community to address an issue of great concern to the community: high rates of opioid misuse and overdoses. The opioid crisis was already a focus of concern in the community, and there were ongoing efforts to address it. Community stakeholders, who knew about a previous project completed by our community-based participatory research (CBPR) team using the SEED Method, asked if we could start a project on the opioid issue in their community. Our previous work using this method focused on developing and prioritizing research questions, but we knew that community members wanted to develop strategies and potential solutions. Here we describe an adaptation of the SEED Method that occurs in two parts. Part I focuses on working with diverse community stakeholders to develop and prioritize potential strategies for addressing the health problem. Part II brings together stakeholders to develop and implement community action plans based on those strategies. The process resulted in a list of potential strategies developed by stakeholder participants. In two subsequent community action planning meetings, stakeholders selected four of these strategies and formed four work groups for the action phase of planning and implementation. Published (Publication status)

Older adults are frequently cited as an at-risk population for vitamin D deficiency that may in part be due to decreased cutaneous synthesis, a potentially important source of cholecalciferol (vitamin D3). Previous studies found that cutaneous D3 production declines with age, however, most studies have been conducted ex vivo or in the photobiology lab. The purpose of this study was to characterize the response of vitamin D metabolites following a 30-min bout of sun exposure (15-min each to the dorsal and ventral sides) at close to solar noon in younger and older adults. Methods: 30 healthy individuals with skin type II/III were recruited, a younger cohort, aged 20&ndash, 37 (n = 18) and an older cohort (n = 12), age 51&ndash, 69 years. Exposure was at outer limits of sensible sun exposure designed to enhance vitamin D synthesis without increasing risk of photo ageing and non-melanoma skin cancer. Serum D3 concentration was measured at baseline, 24, 48 and 72 h post-exposure. Serum 25(OH)D was measured at baseline and 72 h post-exposure plus 168 h post-exposure in the older cohort. Results: D3 increased in response to sun exposure (time effect, p = 0.002) with a trend for a difference in D3 between cohorts (time*group, p = 0.09). By regression modeling of continuous data, age accounted for 20% of the variation in D3 production. D3 production decreased by 13% per decade. Despite changes in D3, however, serum 25(OH)D did not change from baseline to 72 or 168 h post exposure (p &gt, 0.10). Conclusions: Serum D3 concentration increased significantly in response to outdoor sun exposure in younger and older adults. While ageing may dampen cutaneous synthesis, sunlight exposure is still a significant source of vitamin D3.

Obesity and insulin resistance are risk factors for nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease worldwide. Because no approved medication nor an accurate and noninvasive diagnosis is currently available for NAFLD, there is a clear need to better understand the link between obesity and NAFLD. Lipid accumulation during obesity is known to be associated with oxidative stress and inflammatory activation of liver macrophages (LMs). However, we show that although LMs do not become proinflammatory during obesity, they display signs of oxidative stress. In livers of both humans and mice, antioxidant nuclear factor erythroid 2– related factor 2 (NRF2) was down-regulated with obesity and insulin resistance, yielding an impaired response to lipid accumulation. At the molecular level, a microRNA-targeting NRF2 protein, miR-144, was elevated in the livers of obese insulin-resistant humans and mice, and specific silencing of miR-144 in murine and human LMs was sufficient to restore NRF2 protein expression and the antioxidant response. These results highlight the pathological role of LMs and their therapeutic potential to restore the impaired endogenous antioxidant response in obesity-associated NAFLD. Published (Publication status)

In 2010, 193 Member States of the World Health Organization (WHO) endorsed World Health Assembly Resolution WHA63.14 to restrict the marketing of food and beverage products high in fat, sugar and salt (HFSS) to children to prevent obesity and non-communicable diseases (NCDs). No study has examined HFSS marketing policies across the WHO regional office countries in the Americas. Between 2018 and 2019, a transdisciplinary team examined policies to restrict HFSS food and beverage product marketing to children to develop a responsible policy index (RESPI) that provides a quality score based on policy characteristics and marketing techniques. After designing the RESPI, we conducted a comprehensive literature review through October 2019 to examine policies in 14 countries in the WHO Americans Region. We categorized policies (n = 38) as either self-regulatory or statutory and calculated the RESPI scores, ranked from 0 (lowest) to 10 (highest). Results showed Brazil, Canada, Chile, and Uruguay had the highest RESPI scores associated with statutory policies that restricted point of sale, cartoon, licensed media characters and celebrities, and HFSS products in schools and child care settings, and broadcast and print media. Policymakers can use the RESPI tool to evaluate marketing policies within and across geopolitical boundaries to protect children&rsquo, s diet and health.

Background Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported. Methods Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures. Results Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p

Published version

In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers, (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents, (3) Organizational: communication, signage, and cessation support was perceived as a need, (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers, and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.

Athletes&rsquo, commitments to nutrition practices can set them apart in their field. Few studies have investigated the impact of hydration practices on golfers&rsquo, performance who compete for up to eight hours a day, and none have studied female golfers. In this pilot, randomized crossover study, female elite golfers (n = 6) completed 4 simulated golf holes in both euhydrated and dehydrated states. Euhydration was attained by following NCAA (National Collegiate Athletic Association) hydration guidelines, dehydration was attained by a 12-h overnight fluid fast. Before any fluid intervention, five out of six participants were dehydrated at baseline using urinary specific gravity (USG) classifications for euhydration (USG &lt, 1.010) and dehydration (USG &gt, 1.010). No significant condition by time interactions were found between hydration conditions. Although not significant, participants in a dehydrated state demonstrated lesser mean 7-iron distance (141.9 &plusmn, 10.0 vs 144.2 &plusmn, 8.0 m), lower putting accuracy (2.4 &plusmn, 1.0 vs 2.7 &plusmn, 10.0 putts made out of 4 attempts), and greater perceived effort (10.9 &plusmn, 2.1 vs 10.5 &plusmn, 1.6) as compared to their euhydrated state. The finding of one participant out of six with significant dehydration (USG = 1.021) during attempted euhydrated state may suggest the need for alternative methods to promote adequate hydration in future studies and possibly in golf practice.

Background: Maternal stress is implicated in obesity and obesity-related chronic disease. This can have consequences for their children’s weight status and disease development. Interventions are needed that target both psychological stress and diet using evidence-based approaches. Objective: The objective of this study was to evaluate the perceived impact of the Slow Down intervention on participants’ self-efficacy for practicing mindfulness and the barriers and perceived benefits to adopting intervention target behaviors. The ways that knowledge was brokered and transferred provided guidance on the translation of mindfulness within dietary interventions. Design: This was a qualitative evaluation of a mixed-methods quasi-experimental pilot intervention. A focus group was conducted post-intervention and a follow-up semi-structured individual interview took place 4–6 weeks post-intervention. Results: Self-efficacy for practicing mindfulness skills was generally high or described as mixed by participants. Reported benefits from participating in the intervention included increased social support, improved sleep, and improved reaction to stressors, among others. Participants reported barriers to making changes, including family or partner buy-in. Participants cited several ways that knowledge was gained and transferred throughout the intervention that could improve the translation of mindfulness research into practice. Conclusions: With increasing evidence supporting the use of mindfulness in public health nutrition interventions, there are gaps in describing the benefits of participation in mindfulness interventions and the barriers to making health behavior changes as a result of participation. This study demonstrates the potential for nutrition interventions that include psychological health and provides guidance on how to implement mindfulness practice into public health practice settings.

Celebrity endorsement used to promote energy-dense and nutrient-poor (EDNP) food and beverage products may contribute to poor dietary habits. This study examined celebrity endorsement of branded food and beverage products and marketing campaigns in the United States (US) from 1990 to 2017. Celebrity endorsement data were collected from peer-reviewed and grey literature. Interactive data visualizations were created for the endorsement relationships between celebrities, companies and products whose nutritional profiles were compared with the US Department of Agriculture&rsquo, s (USDA&rsquo, s) Smart Snacks Standards. Logistic regression was used to explore associations between celebrities&rsquo, demographic profiles and the nutritional profiles of products. Results showed 542 celebrities were associated with 732 endorsements representing 120 brands of 59 companies across 10 food and beverage categories. Two thirds (67.2%, n = 80) of the brands represented EDNP products that did not align with the USDA&rsquo, s Smart Snacks Standards. Logistic regression analysis indicated that Millennial (p = 0.008) and male celebrities (p = 0.041) were more likely to endorse EDNP products than Generation Z teen and female celebrities, respectively. No statistical significance was observed for celebrities of other demographic profiles. This study may inform future policies and actions of the US government, industry, researchers and consumer advocacy organizations to use celebrity endorsement to promote healthy food environments for Americans.

Background Community-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings. This mixed-methods study aimed to characterize implementation of a community-based cancer prevention program using the Consolidated Framework for Implementation Research (CFIR), determine if implementation was related to participant outcomes, and identify barriers and facilitators to implementation that could be addressed. Methods This study utilized quantitative participant evaluation data (n = 115) and quantitative and qualitative data from semi-structured interviews with program instructors (N = 13). At the participant level, demographic data (age, sex, insurance status) and behavior change intention were captured. Instructor data included implementation of program components and program attendance to create a 7-point implementation score of fidelity and reach variables. Degree of program implementation (high and low) was operationalized based on these variables (low: 0–4, high: 5–7). Relationships among degree of implementation, participant demographics, and participant outcomes (e.g., intent to be physically active or limit alcohol) were assessed using linear or ordinal logistic mixed effects models as appropriate. Interview data were transcribed and coded deductively for CFIR constructs, and constructs were then rated for magnitude and valence. Patterns between ratings of high and low implementation programs were used to determine constructs that manifested as barriers or facilitators. Results Program implementation varied with scores ranging from 4 to 7. High implementation was related to greater improvements in intention to be physically active (p

Transnational restaurant chains sell food and beverage products in 75 to 139 countries worldwide linked to obesity and non-communicable diseases (NCDs). This study examined whether transnational restaurant chains reformulated products and standardized portions aligned with healthy dietary guidelines and criteria. Firstly, we describe the transnational restaurant industry structure and eating trends. Secondly, we summarize results from a scoping review of healthy dietary guidelines for restaurants. Thirdly, we describe a systematic review of five electronic databases (2000–2018) to identify studies on nutrient profile and portion size changes made by transnational restaurants over 18 years. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, identified 179 records, and included 50 studies conducted in 30 countries across six regions. The scoping review found a few expert-recommended targets for restaurants to improve offerings, but no internationally accepted standard for portions or serving sizes. The systematic review results showed no standardized assessment methods or metrics to evaluate transnational chain restaurants’ practices to improve menu offerings. There was wide variation within and across countries, regions, firms, and chains to reduce energy, saturated and trans fats, sodium, and standardized portions. These results may inform future research and encourage transnational chain restaurants to offer healthy product profiles and standardized portions to reduce obesity and NCD risks worldwide. Published version

Exercise mitigates chronic diseases such as diabetes, cardiovascular diseases, and obesity; however, the molecular mechanisms governing protection from these diseases are not completely understood. Here we demonstrate that exercise rescues metabolically compromised high fat diet (HFD) fed mice, and reprograms subcutaneous white adipose tissue (scWAT). Using transcriptomic profiling, scWAT was analyzed for HFD gene expression changes that were rescued by exercise. Gene networks involved in vascularization were identified as prominent targets of exercise, which led us to investigate the vasculature architecture and endothelial phenotype. Vascular density in scWAT was found to be compromised in HFD, and exercise rescued this defect. Similarly, angiogenic capacity as measured by ex vivo capillary sprouting was significantly promoted with exercise. Together, these data demonstrate that exercise enhances scWAT vascularization and functional capacity for angiogenesis, and can prevent the detrimental effects of HFD. The improvement in these indices correlates with improvement of whole-body metabolism, suggesting that scWAT vascularization may be a potential therapeutic target for metabolic disease. Published version

Background To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. Methods A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). Results Bright Bodies rated highest on program characteristics and adoptability (p’s

Plain English summary There is a need for methods that engage lay people and other stakeholders, such as patients and healthcare providers, in developing research questions about health issues important to them and their communities. Involving stakeholders helps ensure that funding goes to research that addresses their concerns. The SEED Method engages stakeholders in a systematic process to explore health issues and develop research questions. Diverse groups of stakeholders participate at three levels: as collaborators that lead the process throughout, as participants who use their expertise to develop the questions, and as consultants who provide additional perspectives about the health topic. We used the SEED Method to engage 61 stakeholders from different socioeconomic and professional backgrounds to create research questions on lung cancer outcomes. Participants included cancer patients and caregivers, healthcare providers and administrators, and policymakers from a rural Virginia community. They developed causal models that diagrammed factors that influence lung cancer outcomes and the relationships between them. They used these models to develop priority research questions. The questions reflect the participants' diverse perspectives and address different areas of inquiry related to lung cancer outcomes, including access to care, support systems, social determinants of health, and quality of care. Participants felt well prepared to perform the project tasks because they had the opportunity to review lung cancer information, receive causal model and research question development training, and participate in facilitated group activities. The SEED Method can be used in a variety of settings and applied to any health topic of interest to stakeholders. Abstract Background Engagement of stakeholders in prioritization of health research can help ensure that funding is directed to research that reflects their concerns and needs. The Stakeholder Engagement in quEstion Development and Prioritization (SEED) Method is a multi-stakeholder methodology that uses principles of community engagement and causal modeling to develop health research questions that reflect the priorities of patients, clinicians, and other community stakeholders. We conducted a demonstration of the SEED Method to generate research questions on lung cancer outcomes, and to evaluate the process, outcomes, and effectiveness of the method for generating a research agenda that reflects diverse stakeholder perspectives. Methods The SEED Method engages community members at three levels: collaboration, participation, and consultation. We conducted a demonstration project from November, 2015 to July, 2016, in a rural Virginia community that was experiencing a significant disparity in lung cancer outcomes. A community research team led the project and selected three distinct stakeholder groups (Topic groups, TG) for participatory engagement in analysis of the health issue, causal modeling, and research question development. We evaluated the quality of stakeholder engagement and compared TG causal models and research questions to evaluate the diversity of stakeholder perspectives resulting from the methodology. Results The resulting research agenda poses questions on how a broad range of topics including access to care, support systems and coping mechanisms, social determinants of health, and quality of care impacts lung cancer outcomes. Participants felt well prepared for the tasks they were asked to perform due to the technical trainings and facilitated modeling and question development activities that are part of the SEED Method. The causal models and research questions developed by the Topic Groups reflected the diverse perspectives of the stakeholders. Conclusions The SEED Method has the potential to generate relevant stakeholder-centered research agendas on a variety of health-related topics, and to create community capacity for sustained research engagement. Published version

Background SIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER’s previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER’s execution was supported by consultee-centered implementation strategies. Methods In this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded. Results Delivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy. Conclusions In-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health.

Background Altering food store environments is a promising approach to encourage healthy product purchases by consumers to improve their diet quality and health. Food store owners and managers are intermediaries to ensure that environmental changes are enacted. Despite their role as gatekeepers to implement and sustain healthy food environment changes, no systematic review has been published that examines food store owner and manager (retailer) data. Thus a review of retailer information available within the expansive United States (US) food environment literature was the purpose of this research. Methods The PRISMA protocol was used. A search strategy, including published articles from years 1980–2017, was applied to six databases to locate relevant articles that addressed the perspective of food store retailers in the US. Data were extracted, organized, and agreed upon between two authors based on pre-designed constructs: (1) a social-ecological model to capture factors that influence retailer decision making; and (2) a marketing-mix and choice-architecture framework to examine perspectives of applied (or the prospective application of) strategies at the store-level. Study quality was assessed using quality criteria checklists for qualitative and quantitative research. Results Thirty-one articles met inclusion criteria and most studies (n = 22) were qualitative and conducted in urban food stores (n = 23). Multiple social-ecological factors influenced retailer decision making and ability or willingness to use marketing-mix and choice-architecture strategies to improve consumers’ healthy choices to support dietary quality. These factors included: conflicting training outcomes to enhance retailers’ knowledge and skills (individual, n = 9); the importance of trust (interpersonal, n = 8); views about marketing-mix and choice-architecture strategies in the food environment (n = 25); consumer demand or demographics (community, n = 19); supplier and food store management variables (systems or sectors, n = 18); local and federal policy (n = 8); and support for community health (norms/values, n = 8). Conclusions Research partnerships can support favorable business and public health outcomes to align with retailers’ business models and available resources. A participatory and translational approach to food environment research will likely maximize public health impact. Urban and rural food store retailers are important actors for future research to inform the feasibility of store retailers to apply MMCA strategies that are profitable and promote health. Electronic supplementary material The online version of this article (10.1186/s12966-019-0767-8) contains supplementary material, which is available to authorized users.

Many community-based lifestyle interventions targeting African Americans have reported positive effects on participants' dietary choices and physical activity habits. However, these effects vary and not all participants will have outcome changes. Moderation analysis can help explain differential effects observed, but are not often reported. Hence, the objective of this secondary analysis was to explore potential moderators of intervention dose effects on diet quality and physical activity outcomes in an effective lifestyle intervention. Delta Body and Soul III, conducted from 2011 to 2012, was a 6-month, church-based, multicomponent, educational intervention designed to improve diet quality and increase physical activity in rural Southern African American adults. Generalized linear mixed models were used to determine associations among indicators of intervention dose received by participants, potential moderators and health outcome changes. Results indicated only three baseline characteristics-employment status, food shopping frequency and individual with primary responsibility for meal preparation-moderated the effects of education session attendance on diet quality changes. No evidence for moderation of exercise class attendance effects on physical activity changes was found. Thus, this culturally targeted, multicomponent lifestyle intervention did induce positive health changes in participants with a range of sociodemographic characteristics and food shopping and eating behaviors. US Department of Agriculture, Agricultural Research ServiceUnited States Department of Agriculture (USDA) [6401-51000-001-00D]; US Department of Health and Human Services, Health Resources Services Administration [6 U1FRHA07411] This work was supported by the US Department of Agriculture, Agricultural Research Service (project 6401-51000-001-00D); and the US Department of Health and Human Services, Health Resources Services Administration (6 U1FRHA07411). The views expressed are solely those of the authors' and do not reflect the official policy or position of the US government. Public domain – authored by a U.S. government employee

The gut microbiome metabolizes choline and carnitine to release trimethylamine (TMA), which subsequently undergoes hepatic conversion to trimethylamine N-oxide (TMAO). Elevated TMAO levels are associated with cardiovascular disease and all-cause mortality risk. Dietary flavanols modulate the composition and function of the gut microbiome. Therefore, the possibility exists that these compounds could reduce intestinal TMA production and lower circulating TMAO. However, this hypothesis has never been tested in humans. A secondary analysis was performed on blood samples from a clinical study in which obese subjects at risk for insulin resistance consumed tea or cocoa flavanols in a randomized crossover design while consuming a controlled diet. These subjects generally had elevated TMAO levels (approximate to 5 M) compared to levels previously measured in healthy subjects (approximate to 1 M). None of the interventions significantly altered TMAO levels. Individual variability for choline and carnitine was relatively low. However, TMAO exhibited somewhat greater inter-individual variability. No differences in mean TMAO concentrations observed across interventions were seen based on separating subjects by glycemic status, body mass index (BMI), race, age, or gender. However, subject minimum and maximum values observed across the interventions appeared to be more strongly associated with glycemic status and age than mean values across interventions, suggesting that average TMAO values over time may be less useful than maximum or minimum values as markers of disease risk. Traditional physiological characteristics do not appear to predict TMAO responsiveness to flavanol interventions. However, African-American subjects appeared less responsive compared to non-Hispanic white subjects for both green tea and high cocoa treatments, and female subjects appeared less responsive than males for the high cocoa treatment. The present results suggest that a short-term flavanol intervention does not generally reduce fasting TMAO levels in subjects with elevated circulating TMAO. Virginia Agricultural Experiment Station; Hatch Program of the National Institute of Food and Agriculture, U.S. Department of Agriculture; U.S. Department of AgricultureUnited States Department of Agriculture (USDA); Virginia Tech Translational Obesity Research Interdisciplinary Graduate Education program (TOR IGEP) Funding for the present work was provided, in part, by the Virginia Agricultural Experiment Station and the Hatch Program of the National Institute of Food and Agriculture, U.S. Department of Agriculture (APN, KPD). Funding for the original study was provided by the U.S. Department of Agriculture (DJB, JAN). Funding for LEG was provided by the Virginia Tech Translational Obesity Research Interdisciplinary Graduate Education program (TOR IGEP). Public domain – authored by a U.S. government employee

Type 2 diabetes (T2D) is a progressive metabolic disease that is increasing in prevalence globally. It is well established that insulin resistance (IR) and a progressive decline in functional β-cell mass are hallmarks of developing T2D. Obesity is a leading pathogenic factor for developing IR. Constant IR will progress to T2D when β-cells are unable to secret adequate amounts of insulin to compensate for decreased insulin sensitivity. Recently, a considerable amount of research has been devoted to identifying naturally occurring anti-diabetic compounds that are abundant in certain types of foods. Flavonoids are a group of polyphenols that have drawn great interest for their various health benefits. Results from many clinical and animal studies demonstrate that dietary intake of flavonoids might be helpful in preventing T2D, although cellular and molecular mechanisms underlying these effects are still not completely understood. This review discusses our current understanding of the pathophysiology of T2D and highlights the potential anti-diabetic effects of flavonoids and mechanisms of their actions. Published version

The RE-AIM Framework is a planning and evaluation model that has been used in a variety of settings to address various programmatic, environmental, and policy innovations for improving population health. In addition to the broad application and diverse use of the framework, there are lessons learned and recommendations for the future use of the framework across clinical, community, and corporate settings. The purposes of this article are to: (A) provide a brief overview of the RE-AIM Framework and its pragmatic use for planning and evaluation; (B) offer recommendations to facilitate the application of RE-AIM in clinical, community, and corporate settings; and (C) share perspectives and lessons learned about employing RE-AIM dimensions in the planning, implementation, and evaluation phases within these different settings. In this article, we demonstrate how the RE-AIM concepts and elements within each dimension can be applied by researchers and practitioners in diverse settings, among diverse populations and for diverse health topics. ACL SUSTAIN for Better Health and Health Care for Older Adults [90CS0065-01]; Great Plains IDEA CTR [U54 GM115458-01]; IMPlementation to Achieve Clinical Transformation (IMPACT): the Colorado Training Program from the NIH [K12 HL137862] The authors would like to acknowledge all members of the National Working Group on RE-AIM Planning and Evaluation Framework (www.re-aim.org). The authors would also like to acknowledge funding support for author contributions: MO and MS contributions supported through ACL SUSTAIN for Better Health and Health Care for Older Adults 90CS0065-01. PE contributions supported by Great Plains IDEA CTR U54 GM115458-01. RE contributions partially supported by IMPlementation to Achieve Clinical Transformation (IMPACT): the Colorado Training Program from the NIH K12 HL137862.

Objective The peptide hormone adropin regulates fuel selection preferences in skeletal muscle under fed and fasted conditions. Here, we investigated whether adropin treatment can ameliorate the dysregulation of fuel substrate metabolism, and improve aspects of glucose homeostasis in diet-induced obesity (DIO) with insulin resistance. Methods DIO C57BL/6 mice maintained on a 60% kcal fat diet received five intraperitoneal (i.p.) injections of the bioactive peptide adropin34-76 (450 nmol/kg/i.p.). Following treatment, glucose tolerance and whole body insulin sensitivity were assessed and indirect calorimetry was employed to analyze whole body substrate oxidation preferences. Biochemical assays performed in skeletal muscle samples analyzed insulin signaling action and substrate oxidation. Results Adropin treatment improved glucose tolerance, enhanced insulin action and augmented metabolic flexibility towards glucose utilization. In muscle, adropin treatment increased insulin-induced Akt phosphorylation and cell-surface expression of GLUT4 suggesting sensitization of insulin signaling pathways. Reduced incomplete fatty acid oxidation and increased CoA/acetyl-CoA ratio suggested improved mitochondrial function. The underlying mechanisms appear to involve suppressions of carnitine palmitoyltransferase-1B (CPT-1B) and CD36, two key enzymes in fatty acid utilization. Adropin treatment activated pyruvate dehydrogenase (PDH), a rate-limiting enzyme in glucose oxidation, and downregulated PDH kinase-4 (PDK-4) that inhibits PDH. Along with these changes, adropin treatment downregulated peroxisome proliferator-activated receptor-gamma coactivator-1α that regulates expression of Cpt1b, Cd36 and Pdk4. Conclusions Adropin treatment of DIO mice enhances glucose tolerance, ameliorates insulin resistance and promotes preferential use of carbohydrate over fat in fuel selection. Skeletal muscle is a key organ in mediating adropin's whole-body effects, sensitizing insulin signaling pathways and altering fuel selection preference to favor glucose while suppressing fat oxidation., Graphical abstract

Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories. Published version

The addition of orange-fleshed sweet potato (OFSP) to the food environment is an effective nutrition-sensitive agricultural approach to improve vitamin A intakes. However, the adoption of this biofortified crop merits further study. The objective of our research was to understand factors that affect Mozambican farmers' adoption and retention of OFSP varieties, with a specific interest in the retention of planting material. Field research was conducted in three provinces of Mozambique during 2015. Provinces with different OFSP intervention histories were selected to allow for the identification of site-specific factors and the impact of variable approaches over time. Qualitative inquiry was used to assess participants' progress through the five stages of the Innovation-Decision process in the Diffusion of Innovations Theory. Ninety-five producers, consumers, and market stakeholders of OFSP participated in semi-structured in-depth interviews and focus groups. Results indicate that diverse factors influenced the adoption and retention of OFSP, including organoleptic qualities, taste preferences, access to planting material, agronomic traits, environmental conditions, lack of capital for inputs and labor, unstable markets, and limited sharing of information and planting material across farmer networks. Current OFSP varieties were acceptable to Mozambican farmers and consumers, but there are several remaining challenges to reaching a critical mass such as lack of access to planting material, perceptions of superior drought tolerance of white-fleshed sweet potato (WFSP), and the belief that OFSP requires additional effort to cultivate (e.g. weed removal, measuring space between plants). Key recommendations which may be considered in future planning for OFSP interventions in Mozambique and other countries include enabling decentralized vine multipliers to provide vines to community members at no cost, continued focus on breeding and distribution of more drought tolerant varieties of OFSP, and training on the similarities in agronomic practices required for producing and preserving OFSP and WFSP. Fulbright U.S. Student Program; National Institute of General Medical Sciences of the National Institutes of Health [P20GM103474, 5P20GM104417]; Montana State University Research presented in this publication was supported by funding from the Fulbright U.S. Student Program. Partial funding for the study was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number P20GM103474 and Award Number 5P20GM104417. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. Funding for Open Choice publication was provided by the Montana State University Open Access Author Fund. The staff at the International Potato Center (CIP) provided in-country support for this research in Mozambique. The authors would like to thank the farmers who shared their time, their experiences, and their stories.

Background It is recommended for women to have a healthy body mass index before conception. However, there is limited research on appropriate preconception interventions for weight loss. Furthermore, there is a lack of knowledge on providers’ willingness to refer to particular behavioral interventions and the degree to which patients would attend those interventions. Methods A cross-section of 67 patients and 21 providers completed surveys related to their demographics and willingness to refer/attend a number of interventions for weight loss. A case study of three patients from the target audience was used to elicit detailed feedback on preconception weight status and weight loss intervention. Results Overall, patients were willing to attend a variety of interventions, regardless of BMI category. Focus group participants shared that weight loss prior to conception would be beneficial for them and their child, but cited barriers such as time, location, and the way providers encourage weight loss. Providers were willing to refer to a number of behavioral interventions, and were less willing to prescribe weight loss medications than other intervention options. Conclusions A number of intervention strategies may be well received by both patients and providers in preconception care to assist with weight loss prior to conception. Future research is needed on intervention effects and sustainability. Published version

This investigation examined the effects of reduced muscle glycogen on exercise performance and muscle fatigue. Male rats were assigned to a low glycogen group (LG) that participated in a protocol of exercise and fasting, a high glycogen group (HG) that exercised but were allowed free access to food, or control group (CON) that did not exercise but were allowed free access to food. Following the protocol, muscle glycogen content of the LG animals was reduced by 45%. The LG animals also performed 79 and 81% less voluntary treadmill exercise than the HG and CON groups. At exhaustion, the LG group had lower blood glucose than HG and CON but exhibited no reduction in sarcoplasmic reticulum (SR) function. During 30 min of in situ stimulation, the rates and magnitudes of muscle fatigue were not significantly different between groups, and fatigue-induced reductions in SR function were similar between groups. The results indicate that reduced muscle glycogen markedly impairs voluntary exercise performance but does not appreciably affect isolated muscle function. It is likely that exercise exhaustion due to reduced muscle glycogen is due, in large part, to hypoglycemia and central fatigue as opposed to peripheral mechanisms.

Challenges inherent with the transition to col- lege are often accompanied by weight gain among college freshmen. Weight gain and dura- tion of obesity increase metabolic syndrome and cardiovascular disease risk in young adulthood, which supports the need for weight loss inter- ventions tailored to college students. The pur- pose of this investigation was to conduct a mixed methods pilot trial to determine the effi- cacy and acceptability of a semester long Inter- net- and incentive-based weight loss interven- tion for overweight/obese college freshmen. Par- ticipants (n = 27, aged >18 yrs, BMI >25) were randomly assigned to a 12-week social cognitive theory (SCT)-based intervention (Fit Freshmen [FF]) or a health information control group. The FF intervention also included modest financial incentives for weight loss. Primary outcomes included body weight/composition, dietary and physical activity (PA) behaviors, and psychoso- cial measures (i.e. self-efficacy, self-regulation) associated with diet, PA, and weight loss. Stu- dents in the FF intervention participated in focus groups to provide qualitative feedback on pro- gram structure and design. FF participants demonstrated significant reductions (all group differences p < 0.10) in body weight (−1.2 kg), fat mass (−0.6 kg), dietary energy (−673 kcal/d), fat (−37 g/d) and added sugar intake (−41 g/d), and increases in diet and PA-related self-regulatory skills at week 12 compared to control partici- pants (+1.0 kg, +1.1 kg, −334 kcal/d, −15 g/d, −13 g/d, respectively). No changes in PA were noted, but FF participants demonstrated increases in self-efficacy to overcome barriers to PA relative to control participants. Themes for content im- provement from focus groups included reducing email contact and increasing in-person interac- tions. Program characteristics that were posi- tively evaluated included incentives for weight loss and access to an onsite weigh station kiosk. Overall, this efficacious SCT Internet- and incen- tive-based weight loss intervention was well received and can be adapted for larger-scale use in the college population.

Obesity and impaired glucose homeostasis in older adults place these individuals at risk for diabetes. Dehydration, glucose homeostasis, and insulin resistance are related; while aging and dehydration are associated with decreased glucose tolerance, weight loss can improve glycemia. For older adults following hypocaloric diets, additional water consumption may lead to greater weight loss. Further more, research sug- gests an association between insulin resistance and the body water retention hormone, arginine vasopressin (AVP). Analysis of the association between plasma copeptin (an AVP derivative) and fasting glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA- IR) may provide further insight into the rela- tionship between dehydration and diabetes risk. Our objective was to investigate the possibility that increased water consumption among older adults (n = 29, BMI = 31 ± 1 kg/m², age = 62 ± 1 years) could improve glucose homeostasis be- yond that observed with weight loss, as well as associations between plasma copeptin and dia- betes risk. This retrospective analysis utilized data from a previous investigation, in which obese/overweight older adults were assigned to one of two groups: 1) Water: consume 500 ml of water prior to three daily meals over a 12-week hypocaloric diet intervention, or 2) Non-water: hypocaloric diet alone. In the present analysis, fasting plasma glucose and insulin, HOMA-IR, and plasma copeptin were evaluated, and com- pared to urinary specific gravity (USG), drinking water consumption, and body weight. Analyses performed using group assignment, volume of drinking water consumed or among a subgroup pair-matched for weight loss and sex did not reveal significant differences between groups. However in the full sample, plasma insulin concentration was associated with USG (r = 0.512, P < 0.01) and copeptin (r = 0.389, P < 0.05), and HOMA-IR was associated with USG (r = 0.530, P < 0.01) at week 12. Improvements in fasting insulin for water group participants (−8.5 +/− 4 pmol/L) were also detected. Associations be- tween hydration and insulin resistance support the need for future investigations addressing hydration status and diabetes risk.

ObjectiveEvaluating an intervention’s theoretical basis can inform design modifications to produce more effective interventions. Hence the present study’s purpose was to determine if effects from a multicomponent lifestyle intervention were mediated by changes in the psychosocial constructs decisional balance, self-efficacy and social support.DesignDelta Body and Soul III, conducted from August 2011 to May 2012, was a 6-month, church-based, lifestyle intervention designed to improve diet quality and increase physical activity. Primary outcomes, diet quality and aerobic and strength/flexibility physical activity, as well as psychosocial constructs, were assessed via self-report, interviewer-administered surveys at baseline and post intervention. Mediation analyses were conducted using ordinary least squares (continuous outcomes) and maximum likelihood logistic (dichotomous outcomes) regression path analysis.SettingChurches (five intervention and three control) were recruited from four counties in the Lower Mississippi Delta region of the USA.SubjectsRural, Southern, primarily African-American adults (n 321).ResultsBased upon results from the multiple mediation models, there was no evidence that treatment (intervention v. control) indirectly influenced changes in diet quality or physical activity through its effects on decisional balance, self-efficacy and social support. However, there was evidence for direct effects of social support for exercise on physical activity and of self-efficacy for sugar-sweetened beverages on diet quality.ConclusionsResults do not support the hypothesis that the psychosocial constructs decisional balance, self-efficacy and social support were the theoretical mechanisms by which the Delta Body and Soul III intervention influenced changes in diet quality and physical activity.

Despite excessive consumption of sugar-sweetened beverages (SSB), little is known about behavioral interventions to reduce SSB intake among adults, particularly in medically-underserved rural communities. This type 1 effectiveness-implementation hybrid RCT, conducted in 2012–2014, applied the RE-AIM framework and was designed to assess the effectiveness of a behavioral intervention targeting SSB consumption (SIPsmartER) when compared to an intervention targeting physical activity (MoveMore) and to determine if health literacy influenced retention, engagement or outcomes. Guided by the Theory of Planned Behavior and health literacy strategies, the 6 month multi-component intervention for both conditions included three small-group classes, one live teach-back call, and 11 interactive voice response calls. Validated measures were used to assess SSB consumption (primary outcome) and all secondary outcomes including physical activity behaviors, theory-based constructs, quality of life, media literacy, anthropometric, and biological outcomes. Targeting a medically-underserved rural region in southwest Virginia, 1056 adult participants were screened, 620 (59 %) eligible, 301 (49 %) enrolled and randomized, and 296 included in these 2015 analyses. Participants were 93 % Caucasian, 81 % female, 31 % ≤ high-school educated, 43 %

In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 - by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries - to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030.En mai 2010, 192 États membres ont ratifié la Résolution WHA63.14 pour restreindre, à l'échelle internationale, la commercialisation des produits alimentaires et boissons non alcoolisées riches en graisses saturées, en acides grasEn mayo de 2010, 192 Estados Miembros aprobaron la Resolución WHA63.14 para limitar la promoción de alimentos y bebidas no alcohólicas con elevadas cantidades de grasas saturadas, ácidos grasos trans, azúcares libres y/o sal dirigida a los niños y adolescentes de todo el mundo. Se examinaron las medidas tomadas entre 2010 y principios de 2016 por parte de grupos de la sociedad civil, la Organización Mundial de la Salud (OMS) y sus sedes regionales, otras organizaciones de las Naciones Unidas, instituciones filantrópicas e industrias transnacionales para contribuir a la reducción de la prevalencia de la obesidad y enfermedades no contagiosas relacionadas con la alimentación entre los jóvenes. Mediante las directrices y herramientas políticas y técnicas correspondientes ofrecidas a los Estados Miembros, la OMS y otras organizaciones de las Naciones Unidas han ayudado a proteger a los jóvenes de la promoción de productos alimentarios y bebidas de marca con elevadas cantidades de grasa, azúcar y/o sal. Los progresos realizados por los otros participantes investigados parecen ser desiguales y, en general, menos sólidos. Nuestra sugerencia es que el progreso hacia la implementación completa de la Resolución WHA63.14 se acelere limitando aún más la promoción de productos alimentarios y bebidas insanos y se invierta en la promoción de productos altamente nutritivos. Esto debería ayudar a los jóvenes a alcanzar los objetivos nutricionales recomendados por los gobiernos. Todas las estrategias y medidas eficaces deberían ajustarse a la meta de la OMS de reducir la mortalidad prematura provocada por enfermedades no contagiosas en un 25% en 2015 y el objetivo de las Naciones Unidas de garantizar una vida sana para todos en 2030.شهد شهر مايو/أيار من عام 2010 تأييد القرار رقم WHA63.14 من جانب 192 دولة من الدول الأعضاء، والذي يقضي بفرض القيود على تسويق المنتجات الغذائية والمشروبات غير الكحولية التي تحتوي على نسب عالية من الدهون المشبعة، والدهون المشبعة المتحولة، والسكريات الحرة و/أو الملح للأطفال والمراهقين على مستوى العالم. ولقد بحثنا في الإجراءات التي اتخذت بين عامي 2010 وأوائل عام 2016 – من قبل منظمات المجتمع المدني، ومنظمة الصحة العالمية ومكاتبها الإقليمية، والمنظمات الأخرى التابعة للأمم المتحدة، والمؤسسات الخيرية، والصناعات عبر الوطنية – للمساعدة في التخفيف من معدلات انتشار البدانة والأمراض غير المعدية ذات الصلة بالنظام الغذائي في أوساط الصغار. وقد ساعدت منظمة الصحة العالمية والمنظمات الأخرى التابعة للأمم المتحدة في حماية الشباب من مخاطر تسويق المنتجات الغذائية والمشروبات ذات العلامات التجارية والتي تحتوي على نسب عالية من الدهون والسكر و/أو الملح، من خلال تقديم توجيهات وأدوات فنية تتعلق بالسياسات للدول الأعضاء. أما التقدم الذي أحرزته الأطراف الفاعلة الأخرى التي تحرينا عنها فيبدو متباينًا وأقل فعالية بشكل عام. وفي هذا الصدد، فإننا نقترح الإسراع من وتيرة التقدم المحقق باتجاه التنفيذ الكامل للقرار رقم WHA63.14 عن طريق فرض المزيد من القيود على تسويق المنتجات الغذائية والمشروبات غير الصحية، وعن طريق الاستثمار في الترويج لمنتجات غنية بالمواد المغذية. هذا الأمر من شأنه مساعدة الصغار على تحقيق الأهداف الغذائية الموصى بها من الحكومة. وينبغي على أي استراتيجيات وإجراءات فعالة أن تكون متوازية مع هدف منظمة الصحة العالمية للحد من الوفيات المبكرة بسبب الأمراض غير المعدية بنسبة 25‏% بحلول عام 2025 وهدف الأمم المتحدة لضمان تمتع جميع البشر بحياة صحية بحلول عام 2030.2010 年 5 月，192 个会员国通过了 WHA63.14 决议，在全球范围内限制向儿童和青少年推销含有大量饱和脂肪、反式脂肪酸、游离糖和/或盐的食品和非酒精饮料。 我们对 2010 年至 2016 年初，民间社会组织、世界卫生组织 (WHO) 及其地区办事处、其他联合国 (UN) 机构、慈善机构和跨国性行业所采取的相关措施进行了审查。这些措施旨在降低年轻人群的肥胖症以及与膳食相关的非传染性疾病的发生率。 通过向会员国提供相关技术、政策指导以及工具，世界卫生组织 (WHO) 和其他联合国 (UN) 机构协助会员国限制向年轻人群推销高脂肪、高糖和/或高盐的品牌食品和饮料产品。 通过调查我们发现，其他活动方取得的进展变数较大，且通常不够强劲。 我们建议可通过进一步限制不健康食品和饮料的推销以及加大对高营养产品的推广，加快推进全面贯彻 WHA63.14 决议所取得的进展。 这将有助于年轻人群达到政府推荐的膳食目标。 任何有效策略和措施均应该以世界卫生组织 (WHO) 的目标为准——到 2025 年，将由非传染性疾病导致的过早死亡率降低 25%，同时应符合联合国 (UN) 的到 2030 年确保所有人过上健康生活的目标。.В мае 2010 года 192 государства-участника поддержали Резолюцию WHA63.14, ограничивающую сбыт пищевых продуктов и безалкогольных напитков с высоким содержанием насыщенных жиров, трансжирных кислот, свободных сахаров и/или соли детям и подросткам во всем мире. Авторы проанализировали мероприятия, проведенные в период между 2010 годом и началом 2016 года группами гражданского общества, Всемирной организацией здравоохранения (ВОЗ) и ее региональными отделениями, другими организациями ООН, благотворительными учреждениями и транснациональными предприятиями. Эти мероприятия были нацелены на снижение распространенности ожирения и неинфекционных заболеваний, связанных с нарушением питания, среди молодых людей. Предоставив необходимые технические и стратегические руководящие указания и инструменты государствам-участникам, ВОЗ и другие организации ООН совершили вклад в защищенность молодых людей от сбыта фирменных пищевых продуктов и напитков с высоким содержанием жиров, сахара и/или соли. В результате исследования было обнаружено, что другие действующие субъекты достигли переменного и в целом менее устойчивого успеха. Авторы предполагают, что ускорить прогресс в плане выполнения Резолюции WHA63.14 во всех ее аспектах позволило бы дальнейшее ограничение сбыта нездоровых продуктов питания и напитков и инвестирование в популяризацию продуктов с высоким содержанием питательных веществ. Благодаря этому молодые люди смогут достичь целей в области питания населения, рекомендованных государством. Все эффективные стратегии и меры должны быть согласованы с целью ВОЗ снизить преждевременную смертность от неинфекционных заболеваний на 25% к 2025 году и целью ООН обеспечить здоровый образ жизни для всех к 2030 году.

ObjectivesThe objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to HEI-2005 components. Demographic differences in HEI-2005 scores were also explored.DesignDiet quality was evaluated using HEI-2005. Demographic differences in HEI-2005 scores were investigated using multivariable regression models adjusting for multiple comparisons. The top five dietary sources contributing to HEI-2005 components were identified by estimating and ranking mean MyPyramid equivalents overall and by demographic characteristics.SettingDietary data, based on a single 24 h recall, from the Foods of Our Delta Study 2000 (FOODS 2000) were used in the analyses.SubjectsFOODS 2000 adult participants 18 years of age or older.ResultsYounger age was the largest determinant of low diet quality in the LMD with HEI-2005 total and seven component scores declining with decreasing age. Income was not a significant factor for HEI-2005 total or component scores. The top five dietary sources differed by all five of the demographic variables, particularly for total vegetables and energy from solid fats, alcoholic beverages and added sugars (SoFAAS). Soft drinks were the leading source of SoFAAS energy intake for all demographic groups.ConclusionsThe assessment of diet quality and identification of top dietary sources revealed the presence of demographic differences for selected HEI-2005 components. These findings allow identification of food patterns and culturally appropriate messaging and highlight the difficulties of treating this region as a homogeneous population.

Findings on maternal 25-hydroxyvitamin D (25[OH]D) and neonatal anthropometry are inconsistent, and may at least be partly due to variations in gestational week (GW) of 25(OH)D measurement and the lack of longitudinal 25(OH)D measurements across gestation. The aim of the current study was to examine the associations of longitudinal measures of maternal 25(OH)D and neonatal anthropometry at birth. This study included 321 mother&ndash, offspring pairs enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies&ndash, Singletons. This study was a prospective cohort design without supplementation and without data on dietary supplementation. Nevertheless, measurement of plasma 25(OH)D reflects vitamin D from different sources, including supplementation. Maternal concentrations of total 25(OH)D were measured at 10&ndash, 14, 15&ndash, 26, 23&ndash, 31, and 33&ndash, 39 GW and categorized as &lt, 50 nmol/L, 50&ndash, 75 nmol/L, and &gt, 75 nmol/L. Generalized linear models were used to examine associations of 25(OH)D at each time-point with neonate birthweight z-score, length, and sum of skinfolds at birth. At 10&ndash, 14 GW, 16.8% and 49.2% of women had 25(OH)D &lt, 50 nmol/L and between 50&ndash, 75 nmol/L, respectively. The association of maternal 25(OH)D with neonatal anthropometry differed by GW and women&rsquo, s prepregnancy BMI (normal (&lt, 25.0 kg/m2), overweight/obese (25.0&ndash, 44.9 kg/m2)). All analyses were stratified by prepregnancy BMI status. Among women with an overweight/obese BMI, 25(OH)D &lt, 50 nmol/L at 10&ndash, 14 GW was associated with lower birthweight z-score (0.56, 95% CI: &minus, 0.99, &minus, 0.13) and length (&minus, 1.56 cm, 3.07, &minus, 0.06), and at 23&ndash, 31 GW was associated with shorter length (&minus, 2.77 cm, 13.38, &minus, 4.98) and lower sum of skinfolds (&minus, 9.18 mm, 4.98). Among women with a normal BMI, 25(OH)D &lt, 14 GW was associated with lower sum of skinfolds (&minus, 2.64 mm, 5.03, &minus, 0.24), at 23&ndash, 31 GW was associated with larger birthweight z-scores (0.64, 95% CI: 0.03, 1.25), and at 33-39 GW with both higher birthweight z-score (1.22, 95% CI: 0.71, 1.73) and longer length (1.94 cm, 95% CI: 0.37, 3.52). Maternal 25(OH)D status during pregnancy was associated with neonatal anthropometric measures, and the associations were specific to GW of 25(OH)D measurement and prepregnancy BMI.

To address obesity and diet-related chronic diseases in the United States, organizations such as the Robert Wood Johnson Foundation and the Institute of Medicine have encouraged the use of voluntary engagement strategies among stakeholders. By using public-private partnerships as well as networks, alliances, and coalitions, voluntary engagement can translate evidence-informed dietary recommendations into effective policies and actions and into innovative products and services. We offer six guiding principles and a decision-making framework that stakeholders can use to ensure that partnerships are accountable and effective in their pursuit of health-related goals. We apply the principles and framework to four national partnerships of US food, beverage, and food retail industry stakeholders working to prevent child obesity and to promote healthy food environments through product reformulation and healthy food retail incentives. We conclude that partnerships should be evaluated for their synergy, accountability, and effectiveness at achieving the partners' objectives. Independent evaluations will help build credibility and public trust in the capacity of voluntary engagement strategies to promote healthy food environments and positively influence public health.

Background The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. Methods In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. Results Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. Conclusions The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance. Electronic supplementary material The online version of this article (doi:10.1186/s13643-015-0141-0) contains supplementary material, which is available to authorized users.

University teaching and learning of vitamins and minerals has been limited to a nutrient by nutrient approach. However, most vitamins and minerals play extensive roles in and interact with multiple body systems. Researchers from Virginia Tech, James Madison, and George Mason Universities are developing a Reusable Learning Object (RLO) for the study of micronutrients needed by the skeletal system. The RLO will be a freely accessible platform and be designed as a layered human body to highlight different micronutrient actions in target systems. Links to scientific research articles, government Dietary Reference Intakes, and other web-based factual information will be provided. Undergraduate and graduate students enrolled in vitamins and minerals courses across the three institutions will serve as the control group (no exposure to RLO) in 2014 and treatment group (exposure to RLO) in 2015. This presentation will address the design of the RLO and provide results from year one regarding type of student learners as well as interest and perceived utility of digital objects. As the RLO can be applied to teach various concepts, this session will be of interest to faculty across the university, particularly science instructors and those who teach online courses., Innovations in Teaching & Learning Conference Proceedings, Vol 7 (2015): The Science of Learning: Using Research to Improve Teaching

Background: Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action. Objective: Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT). Methods: This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a "5 As"-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome. Results: Sedentary participants (n=452; 34.7% participation rate) without a gym membership (mean age 58.57 years; 59% female, 78% white, 12% black, 11% Hispanic) completed a baseline assessment and an interactive computer session. PA increased across the study sample (F-1,F-441= 30.03, P

Background The purpose of this study was to review state regulations promoting increased physical activity and decreased sedentary behaviors in infants in child care and to assess consistency with recent Institute of Medicine (IOM) recommendations. Methods We compared existing state and territory licensing and administrative regulations to recent IOM recommendations to promote physical activity and decrease sedentary time in very young children attending out-of-home child care (both child care centers and family child care homes). Three independent reviewers searched two sources (a publicly available website and WestlawNext™) and compared regulations with five IOM recommendations: 1) providing daily opportunities for infants to move, 2) engaging with infants on the ground, 3) providing daily tummy time for infants less than six months of age, 4) using cribs, car seats and high chairs for their primary purpose, and 5) limiting the use of restrictive equipment for holding infants while they are awake. We used Pearson chi-square tests to assess associations between geographic region, year of last update, and number of state regulations consistent with the IOM recommendations. Results The mean (SD) number of regulations for states was 1.9 (1.3) for centers and 1.6 (1.2) for homes out of a possible 5.0. Two states had regulations for all five recommendations, Arizona for centers and Virginia for homes. Six states and territories had zero regulations for child care centers and seven states and territories had zero regulations for family child care homes. There were no significant associations between geographic region and number of regulations consistent with IOM recommendations. Conclusions Out-of-home child care settings are important targets for optimal early child health interventions. While most states had some regulations related to the promotion of physical activity among infants, few states had regulations for more than three of the five IOM recommendations. Enhancing state regulations in child care facilities could aid in early childhood obesity prevention efforts. Published version

Introduction The worksite environment may influence employees’ dietary behaviors. Consumption of water and sugar-sweetened beverages (SSBs) affect weight management; however, little research has evaluated the influence of worksite factors on beverage consumption. Our purpose was to determine whether individual and worksite factors are associated with water and SSB intake among overweight and obese employees. Methods Data were collected as part of baseline assessments for a worksite-based, weight-management intervention trial. Height and weight of participants (N = 1,482; 74% female; mean age = 47 y [standard deviation (SD) = 11y]; mean weight = 208 lbs [SD = 46 lbs]) were assessed, and participants completed a validated beverage intake questionnaire. Environmental characteristics of worksites (N = 28) were audited. A qualitative comparative analysis (QCA) was used to identify worksite conditions that may support healthier beverage intake patterns. Results Most participants were white (75% of sample) with at least some college education or a college degree (approximately 82% of sample). Mean water and SSB intake were 27 fl oz (SD = 18 fl oz) and 17 fl oz (SD = 18 fl oz), respectively; SSB intake (191 kcal [SD = 218 kcal]) exceeded the recommended discretionary energy intake. Statistical models did not identify any significant predictors of water intake. Female sex and increasing level of education and household income were associated with lower SSB intake; baseline body weight and greater number of worksite water coolers and vending machines were associated with higher SSB intake. The QCA identified worksite type (ie, not manual labor) as a condition necessary for healthier beverage consumption; a worksite break policy of 2 or more per day may lead to unhealthy beverage consumption. Lower SSB consumption was noted among older participants, female participants, and among participants with higher education and income levels. Conclusion Workplace factors influence beverage consumption among overweight employees. Limiting vending machine availability and implementing policies that promote weight management may improve employee health. Published version