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Background Breakthrough infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well documented. The current study estimates breakthrough incidence across pandemic waves, and evaluates predictors of breakthrough and severe breakthrough infections (defined as those requiring hospitalization). Methods In total, 89 762 participants underwent longitudinal antibody surveillance. Incidence rates were calculated using total person-days contributed. Bias-corrected and age-adjusted logistic regression determined multivariable predictors of breakthrough and severe breakthrough infection, respectively. Results The incidence was 0.45 (95% confidence interval [CI], .38–.50) during pre-Delta, 2.80 (95% CI, 2.25–3.14) during Delta, and 11.2 (95% CI, 8.80–12.95) during Omicron, per 10 000 person-days. Factors associated with elevated odds of breakthrough included Hispanic ethnicity (vs non-Hispanic white, OR = 1.243; 95% CI, 1.073–1.441), larger household size (OR = 1.251 [95% CI, 1.048–1.494] for 3–5 vs 1 and OR = 1.726 [95% CI, 1.317–2.262] for more than 5 vs 1 person), rural versus urban living (OR = 1.383; 95% CI, 1.122–1.704), receiving Pfizer or Johnson & Johnson versus Moderna, and multiple comorbidities. Of the 1700 breakthrough infections, 1665 reported on severity; 112 (6.73%) were severe. Higher body mass index, Hispanic ethnicity, vaccine type, asthma, and hypertension predicted severe breakthroughs. Conclusions Breakthrough infection was 4–25 times more common during the Omicron-dominant wave versus earlier waves. Higher burden of severe breakthrough infections was identified in subgroups.

Background: Extreme heat may discourage physical activity of children while shade may provide thermal comfort. The authors determined the associations between ambient temperature, shade, and moderate to vigorous physical activity (MVPA) of children during school recess. Methods: Children aged 8–10 (n = 213) wore accelerometers and global positioning system monitors during recess at 3 school parks in Austin, Texas (September–November 2019). Weather data originated from 10 sensors per park. The authors calculated shade from imagery using a geographic information system (GIS) and time-matched physical activity, location, temperature, and shade data. The authors specified piecewise multilevel regression to assess relations between average temperature and percentage of recess time in MVPA and shade. Results: Temperature ranged 11 °C to 35 °C. Each 1 °C higher temperature was associated with a 0.7 percentage point lower time spent in MVPA, until 33 °C (91 °F) when the association changed to a 1.5 lower time (P P P P > .05). Children at the park with the most tree canopy spent 6.0 percentage points more time in MVPA (P Conclusions: Children engage in less MVPA and seek shade during extreme heat and engage in more MVPA in green schoolyards. With climate change, schools should consider interventions (eg, organizing shaded play, tree planting) to promote heat safe MVPA.

Background: Active commuting to school (ACS) can be an important source of physical activity for children. Schools are an important setting for policy-related ACS promotion. The purpose of this study was to examine the association between school policies and ACS, and to assess whether this relation varied by grade. Methods: This cross-sectional study used data from schools recruited to the Safe Travel Environment Evaluation in Texas School study (n = 94). The percent of trips made by active travel modes was measured through tallies among third to fifth grade classrooms from 5 school districts in Central Texas in 2018–2019. School ACS policies and practices were measured through 8 survey items aggregated into a score. Linear mixed effects models were used to assess the association between policies and ACS. Results: School health policy surveys and ACS data were collected from 69 elementary schools. An average of 14.6% of trips to/from school was made using active travel modes. Schools with higher numbers of policies had significantly higher percentages of students using active travel modes (P = .03), and for each additional policy, the predicted percentage of trips made by active travel modes was 1.46% higher. There was a significant interaction effect between school policy and grade, with stronger correlations among higher grades (P = .002). Conclusions: Results from this study demonstrate a correlation between the school policies designed to support walking and biking and ACS. Results from this study can be used to justify the use of school-based policy interventions to promote ACS.

The prevalence and attributable risk of disease due to physical inactivity require it to be made a public health priority. Public health planning allows for prioritization and resource allocation, particularly at the state and local levels. The extent to which state planning efforts for physical activity exist in the United States is unknown. The purpose of this paper is to describe the scope in which physical activity is incorporated in state-level public health plans in the United States, with an emphasis on alignment with the national guidelines and the National Physical Activity Plan. A standardized internet search audit was developed and conducted for each of 50 US states and the District of Columbia between May 2017 and January 2018 to determine the prevalence and characteristics of health planning documents that include physical activity. Data abstracted for analysis used a standardized search protocol that included the components of the Physical Activity Guidelines for Americans and the US National Physical Activity Plan. Results found that most states had between 4 and 6 chronic disease prevention and control plans that mention physical activity; however, it was inconsistently aligned with recommendations from both the Guidelines and the National Plan. Only 2 states had stand-alone public health planning documents explicitly dedicated to physical activity promotion. No state planning documents addressed children and adolescents, adults, and older adults simultaneously. To be maximally effective, state public health planning for physical activity should be made a priority and these efforts should align as much as possible with current guidance from the Physical Activity Guidelines for Americans and the US National Physical Activity Plan.

Objective: In this study, we examined physical activity (PA) engagement outside of college physical education (PE) classes using the Transtheoretical Model (TTM). Methods: Overall, 414 university students enrolled in PE classes voluntarily participated in this study. Participants were asked to complete a survey packet to measure 4 core constructs of TTM and their PA level performed outside of PE classes. Among the participants, 150 randomly selected students were asked to wear a triaxial accelerometer for 7 consecutive days to identify their PA level. Descriptive statistics and multivariate analyses of variance were used to determine the association between stages of motivational readiness and other strategic core constructions. Results: We categorized 77% of respondents into either the "action" stage or the "maintenance" stage for engaging in additional PA outside of the classes. Behavioral processes of change showed a graded and significant association with the stages. Both self-efficacy and decisional balance were significantly higher in students at higher stages. Conclusion: Our findings showed that most students enrolled in college PE classes had additional PA outside of the class participation. In addition, behavioral processes may be effective strategies for this specific target group to promote PA.

Background: In response to conflicting findings for activity levels across sociodemographic groups, this study examined differences in adolescents’ in-school, out-of-school, and weekend physical activity (PA) by sociodemographic subgroups using representative US data. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating study. Multiple regression models compared in-school, out-of-school, and weekend PA by gender and race/ethnicity, and examined potential modification of associations by grade (middle vs high school) and socioeconomic status (lower vs higher). Results: Final analytic sample was 1413 adolescents (Mean age = 14.5 y, 51.3% female, 64.5% white). Compared with whites, in-school PA was significantly higher among blacks and those classified as other race/ethnicity for middle school (69.8 and 71.0, respectively, vs 66.4 min/d), and among Hispanics for high school (52.7 vs 48.4 min/d). Hispanics’ (vs whites’) out-of-school PA was significantly lower for middle school (63.7 vs 66.6 min/d), but higher for high school (54.0 vs 51.8 min/d). In-school PA was significantly higher among adolescents of lower (vs higher) socioeconomic status among males and Hispanics (all Ps Conclusions: The relation of race/ethnicity with PA varies by grade and time of day/week. Socioeconomic status findings contradict previously reported findings. Efforts to increase PA based on sociodemographic disparities should consider potential interaction effects.

Background: Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity. Methods: The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children’s and adolescents’ physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation. Results: The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure. Conclusions: The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming.

Background The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning. Methods A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n = 1789), school (n = 62) and district administrators (n = 64), nurses (n = 3), and “other” (n = 522). Results Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”. Conclusion The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.

The purpose of the current investigation was to examine the cross-sectional associations of participation in muscle-strengthening activities (MSAs) with carotid intima–media thickness (CIMT) among older adults. The data are from 2,557 older adult participants enrolled in an observational cohort who reported no history of cardiovascular disease. MSA was determined using a questionnaire. Carotid ultrasound was performed to measure the CIMT of the common carotid artery bilaterally. Logistic regression models were constructed to estimate the association of MSA with CIMT after adjustment for potential confounders. The participants were aged 68.6 ± 7.0 years, and the majority were male (71.7%) and White (96.5%); 18% had abnormal CIMT. Meeting the physical activity guidelines for MSA was inversely associated with abnormal CIMT after adjustment for age and sex. However, this observed inverse relation became statistically null after further adjustment for cardiovascular disease risk factors, including aerobic physical activity.

Resistance exercise guidelines exist for obesity but not for post-metabolic and bariatric surgery (MBS) patients. Therefore, the main goal of the present study is to provide evidence to support resistance exercise guidelines for this population. A secondary goal is to evaluate the available evidence to identify gaps for future research. Nine studies evaluating the effect of resistance exercise post-MBS on strength and body composition were included. Resistance training consistently prevented strength loss and when performed by younger population (~ 35 years) also prevented lean mass loss. Combined exercise, but not strength training independently, was found to promote body fat mass loss. Resistance training should be added to post-MBS exercise programs. Sufficiently powered studies using higher volume resistance training with supportive protein consumption and diverse populations are needed.

The purpose of this study was to examine the association between self-reported physical activity (PA) and mean common carotid artery intima–media thickness (CCA IMT) among older adults. The data are from 1,811 Cooper Center Longitudinal Study participants, who were aged ≥60 years, with no history of cardiovascular disease. A medical history questionnaire was used to assess PA. Carotid ultrasound was performed to measure CCA IMT and the presence of plaque and stenosis. Logistic regression models were constructed to estimate the association between PA and CCA IMT after adjustment for covariates. The participants were aged 69.2 ± 5.9 years, and the majority were male (73.3%) and White (96.7%). The odds ratio of abnormal thickening of CCA IMT was 0.72 (95% confidence interval [0.54, 0.96]) in physically active participants (≥500 metabolic equivalent·min/week) after adjustment for covariates. In the current study, meeting PA guidelines in older adulthood was associated with lower odds of abnormal thickening of CCA IMT.

Past evaluations of Safe Routes to School (SRTS) programs have been relatively small in scope and have lacked objective measurements of physical activity. A 2016 Mobility Bond in Austin, Texas, USA, allocated USD 27.5 million for infrastructure changes to facilitate active commuting to schools (ACS). The Safe TRavel Environment Evaluation in Texas Schools (STREETS) study aims to determine the health effects of these infrastructure changes. The purpose of this paper is to describe the STREETS study design, methods, and selected baseline results. The STREETS study is comprised of two designs: (1) a serial cross-sectional design to assess changes in ACS prevalence, and (2) a quasi-experimental, prospective cohort to examine changes in physical activity. Differences between study arms (Austin SRTS and comparison) were assessed for school demographics, ACS, and school programs. At baseline, 14.3% of school trips were made by ACS, with non-significant differences between study arms. Only 26% of schools implemented ACS-related programs. Some significant differences across SRTS and comparison schools were identified for several school- and neighborhood-level characteristics. Substantial changes are needed across area schools and neighborhoods to promote optimum ACS. STREETS study longitudinal findings will be critical for informing optimal future implementations of SRTS programs.

Understanding the duration of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody Response Survey (Texas CARES) with at least 1 nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n = 4553) with 1 to 3 antibody tests over 11 months (1 October 2020 to 16 September 2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days postinfection, and predicts individuals may remain antibody positive from natural infection beyond 500 days depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not).

Background. Recent data suggest the SARS-CoV-2 Delta (B.1.617.2) variant is more transmissible among children compared to the Alpha (B.1.1.7) variant. The true incidence and longitudinal presence of antibody response to SARS-CoV-2 infection is not known, however. We provided estimates of antibody response using Texas Coronavirus Antibody REsponse Survey (Texas CARES) data, a prospective population-based seroprevalence project designed to assess antibody status over time among the general population throughout the state. Methods. In October 2020 Texas CARES began enrolling adults (aged 20-80 years) and children (aged 5-19 years). Participants were offered a series of three SARS-CoV-2 antibody tests over 6-8 months, or every 2-3 months that includes the immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test). Descriptive characteristics and COVID-19 infection-related symptom status was determined by questionnaire at the time of enrollment and prior to each successive blood draw. This analysis included participants ages 5-to-19 years old who have completed all three antibody assessments. Results. From our sample (n=159; mean age 12.5 years, SD 3.6), 96% of those with evidence of nucleocapsid antibodies at baseline assessment continued to have antibodies > six months later (mean 7.0 months, SD 0.97). There was no difference in the presence of antibodies by symptom status (asymptotic versus symptomatic) or severity (mild-moderate versus severe), sex, age group, or body mass index group (underweight, healthy weight, overweight, obesity) over the three antibody measurement timepoints. Conclusions. These results suggest that infection-induced antibodies persist and thus may provide some protection against future infection for at least half a year. 57.9% of the sample were negative for infection-induced antibodies at their third measurement point, suggesting a significant proportion of children have still not acquired natural infection.

Centers for Disease Control (CDC) guidelines recommend schools use a coordinated health approach to support healthy eating and physical activity. This study examines whether the number of healthy eating and physical activity programs and activities used by schools and their perceived success relate to students’ health-related fitness. This observational study used data from the Healthy Zone Schools Program. Data (collected in 2017–2019) were integrated from three sources: (1) school surveys, (2) FitnessGram®, and (3) the Texas Education Agency. Independent variables were the number of health promotion programs and activities and their perceived success, dependent variables were meeting Healthy Fitness Zone Standards (HFZ) for aerobic capacity and body mass index (BMI). We used mixed-effects logistic regression models. Fifty-six schools were in the analytic sample (n = 15,096 students with aerobic capacity data and n = 19,969 with BMI data). Results indicated the perceived success of physical activity programs/activities was significantly associated with students meeting HFZ standards for aerobic capacity (OR = 1.32, CI = 1.06–1.63). There was a significant direct association between the number of physical activity and healthy eating activities implemented (OR = 1.04, CI = 1.01–1.06) and students meeting HFZ for BMI. Schools using multiple health programs and activities need to balance the number provided with their capacity to maintain success.

Purpose: There is minimal understanding of the potential for coaction, defined as action on one behavior increasing the likelihood of taking action on another behavior, between physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study was to assess the bidirectional coaction between FV intake and PA, as well as self-efficacy for these behaviors, in a racially diverse sample of obese adults. Design: This is a secondary analysis using data collected from the Path to Health study, a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03674229. Sample: Obese adults who completed baseline and 6-month follow-up assessments. Measures: For this study, data on FV intake, leisure time PA, and 7-day accelerometer data were analyzed at baseline and 6-month follow-up. Analysis: We interchanged modeling the FV intake and PA change variables as the independent and dependent variables. We conducted multiple imputation and both linear and multinomial regression. Results: The sample (n = 168) was 59% female and mainly split between white (42%) and African American (42%). Change in self-efficacy for PA was predictive of change in self-efficacy for FV intake and vice versa. When compared with participants with no change in FV intake, someone with a positive change in FV intake was more likely to have a positive change in self-reported PA (adjusted risk ratio [RR] = 6.72, 95% confidence interval [CI] = 1.69-26.68). Likewise, when compared with no change, participants with a positive change in self-reported PA were more likely to report a positive change in FV intake (adjusted RR = 6.79, 95% CI = 1.70-27.17). Conclusion: Findings suggest coaction between self-efficacy for FV intake and PA as well as between FV intake and PA. Coaction could be capitalized on to more effectively promote both energy-balance behaviors.

Recent technological advances allow for field-based data collection of accelerometers in community-based studies. Mail-based administration can markedly reduce the cost and logistic challenges and burden associated with in-person data collection. It necessitates, however, other resources, such as phone calls and mailed reminder prompts, to increase protocol compliance and data recovery. Additionally, lost accelerometers can impact the study’s budget and its internal validity due to missing data. In this article, we present an applied methodological approach used to define thresholds (or cutoff points) at which pursuing unreturned accelerometers is a worthwhile versus futile pursuit. This methodological approach was designed, specifically, to maximize scalability across multiple sectors. We used data from an on-going study that administered accelerometers through the mail to illustrate and encourage investigators to replicate the approach for use in their own studies. In heterogeneous study samples, investigators might consider repeating this approach by study-relevant strata to refine thresholds and improve the return percentages of data collection instruments, minimize the potential missing data, and optimize study staff time and resources.

The purpose of this study was to identify longitudinal correlates of low-income, urban, Latino adults' use of recreational facilities and engagement in physical activity (PA). This secondary data analysis is from a placed-based initiative; the parent study recruited a cohort of parents of kindergarteners from schools in intervention and control communities. Using a self-administered questionnaire, we collected baseline correlates and 1-year follow-up recreational facilities use and PA outcomes. We conducted ordinal logistic regression to assess correlates for recreational facilities use and PA outcomes. Our sample of 273 Latino adults was mostly female and married or living with partners. Meeting PA guidelines at baseline was associated with higher odds of using parks, walking, and moderate- and vigorous-intensity PA. Those who considered PA to be important had higher odds of using trails (adjusted OR = 2.36, 95% CI 1.15-4.84) and of moderate-intensity PA (adjusted OR = 2.68, 95% CI 1.21-5.91). Reported perception that the neighborhood is very safe to walk was associated with higher odds of using trails (adjusted OR 3.45, 95% CI 1.39-8.53) and parks (adjusted OR 2.92, 95% CI 1.19-7.16). Quality of recreational facilities was directly associated with walking (adjusted OR = 1.61 95% CI 1.01-2.57). Speaking English was associated with higher odds of engaging in moderate-intensity PA (adjusted OR = 3.28 95% CI 1.70-6.33). Results from this study of urban, low-income Latinos indicate that promotion is needed not only for sustained use of recreational facilities among current users, but also for concerted efforts to reach less acculturated Latinos and make recreational facilities appealing to currently inactive adults. Both individual-level and neighborhood-level interventions are needed to build positive attitudes towards PA, while also enhancing neighborhood safety and the quality of neighborhood recreational facilities.

BACKGROUND: Improving sidewalks may encourage physical activity by providing safe, defined, and connected walking spaces. However, it is unknown if reduced health care expenditures assumed by increased physical activity offset the investment for sidewalk improvements. METHODS: This cost-effectiveness analysis of sidewalk improvements in Houston, TX, was among adults enrolled in the Houston Travel-Related Activity in Neighborhoods Study, 2013–2017. The 1-year change in physical activity was measured using self-report (n = 430) and accelerometry (n = 228) and expressed in metabolic equivalent (MET) hours per year (MET·h·y(−1)). Cost-effectiveness ratios were calculated by comparing annualized sidewalk improvement costs (per person) with 1-year changes in physical activity. RESULTS: The estimated cost-effectiveness ratio were $0.01 and −$0.46 per MET·h·y(−1) for self-reported and accelerometer-derived physical activity, respectively. The cost-effectiveness benchmark was $0.18 (95% confidence interval, $0.06–$0.43) per MET·h·y(−1) gained based on the volume of physical activity necessary to avoid health care costs. CONCLUSIONS: Improving sidewalks was cost-effective based on self-reported physical activity, but not cost-effective based on accelerometry. Study findings suggest that improving sidewalks may not be a sufficient catalyst for changing total physical activity; however, other benefits of making sidewalks more walkable should be considered when deciding to invest in sidewalk improvements.

Perceived safety remains one of the main barriers for children to participate in active commuting to school (ACS). This ecological study examined the associations between the number of police-reported crimes in school neighborhoods and ACS. The percentage of active travel trips was assessed from a teacher tally survey collected from students across 63 elementary schools that were primarily classified as high-poverty (n = 27). Geographic Information System (GIS) was used to create a detailed measure of police-reported crimes during 2018 and neighborhood covariates that occurred within a one-mile Euclidean buffer of the schools. Statistical analyses included linear fixed effects regressions and negative binomial regressions. In fully-adjusted models, reported crime did not exhibit significant associations with ACS. Medium-poverty schools were indirectly associated with ACS when compared to high- and low-poverty schools in all models (p &lt, 0.05). Connectivity and vehicle ownership were also directly associated with ACS (p &lt, 0.05). Low- and medium-poverty schools were indirectly associated with all types of reported crime when compared to high-poverty schools (p &lt, 0.05). Although reported crime was not associated with school-level ACS, differences in ACS and reported crime do exist across school poverty levels, suggesting a need to develop and promote safe and equitable ACS interventions.

Given the underestimate of seroprevalence in the US due to insufficient testing, accurate estimates of population immunity to SARS-CoV-2 or vaccinations do not exist. Although model-based estimates have been proposed, they require inputting unknown parameters such as viral reproduction number, longevity of immune response, and other dynamic factors. In contrast to a model-based approach for estimating population immunity, or simplistic summing of natural- and vaccine-induced immunity, the current study presents a data-driven statistical procedure for estimating the total immunity rate in a region using prospectively collected serological data along with state-level vaccination data. We present a detailed procedure so that efforts can be replicated regionally to inform policy-making decisions relevant to SARS-CoV-2. Specifically, we conducted a prospective longitudinal statewide cohort serological survey with 10,482 participants and more than 14,000 blood samples beginning on September 30, 2020. Along with Department of State Health Services vaccination data, as of July 4, 2021, the estimated percentage of those with naturally occurring antibodies to SARS-CoV-2 in Texas is 35.3% (95% CI = (33.7%, 36.9%) and total estimated immunity is 69.1%. We conclude the seroprevalence of SARS-CoV-2 is 4 times higher than the state-confirmed COVID-19 cases (8.8%). This methodology is integral to pandemic preparedness.

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity remains uncertain in populations. The state of Texas ranks 2ndin infection with over 2.71 million cases and has seen a disproportionate rate of death across the state. The TX CARES project was funded by the state of Texas to estimate the prevalence of SARS-CoV-2 antibody status in children and adults.Materials and MethodsThe TX CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based convenience sample from the Texas general population that commenced in October 2020. Volunteer participants are recruited across the state to participate in a 3-time point data collection TX CARES to assess antibody response over time. We use the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay to determine SARS-CoV-2 antibody status.ResultsThe crude antibody positivity prevalence in Phase I was 26.1% (80/307). The fully adjusted seroprevalence of the sample was 31.5%. Specifically, 41.1% of males and 21.9% of females were seropositive. For age categories, 33.5% of those 18-34; 24.4% of those 35-44; 33.2% of those 45-54; and 32.8% of those 55+ were seropositive. In this sample,42.2% (89/211) of those negative for the antibody test reported having had a COVID-19 test.ConclusionsIn this survey we enrolled and analyzed data for 319 participants, demonstrating a high survey and antibody test completion rate, and ability to implement a questionnaire and SARS-CoV-2 antibody testing within FQHC clinical settings. We were also able to determine our capability to estimate the cross-sectional seroprevalence within Texas’s FQHC clinical settings. The crude positivity prevalence for SARS-CoV-2 antibodies in this sample was 26.1% indicating potentially high exposure to COVID-19 for FQHC clinic employees and patients. These methods are being used to guide the completion of a large longitudinal survey in the state of Texas with implications for practice and population health.

Background: The extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents at a population level in 2021 remains unclear. Children and adolescents have been considered to play an important role in transmission regardless of presence of symptoms. The objective of this study was to estimate the prevalence of SARS-CoV-2 antibody status in children ages 5-to-19 years in a sample from the State of Texas in the presence and absence of symptoms. Methods: The TX CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based sample from the Texas general population (~29·8 million) that commenced in October 2020. For the current analysis, volunteers ages 5-to-19 years were recruited throughout the state from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural pediatric and family medicine practices, health insurance providers, and a social media campaign. SARS-CoV-2 antibody status measured via the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay. Prevalence of IgM, IgA, or IgG antibodies were adjusted using sampling weights and post-stratification of age and sex. We report here findings from January 1-June 1, 2021. Findings: This analysis that included 503 children ages 5-to-19 years showed 38·7% (95% CI, 34·5-43·1) of the sample was SARS-CoV-2 antibody positive in fully adjusted estimates. A total of 30·1% (95% CI, 29·4-31·5) of adults (N=6992) in the sample were antibody positive. Over half (55·8%) of those with positive antibody status were reportedly asymptomatic. Headache (25·4%), congestion/runny nose (20·8%), and fatigue (20·3%) and were the most frequently reported symptoms among those with a positive antibody result. The odds of having a positive antibody status was 37% higher in 15-to-19 year olds versus adults (OR 1·37, 95% CI, 1·03-1·83). Interpretation: These results highlight that a majority of the pediatric population remains immunologically naive to SARS-CoV-2, emphasizing the important role vaccines may play in reaching whole population herd immunity. Funding: Texas Department of State Health Services. Declaration of Interest: We declare no competing interests. Ethical Approval: All protocols were reviewed and approved by the University of Texas Health Science Center at Houston Institutional Review Board (IRB), but also deemed public health practice by the Texas Department of State Health Services IRB.

Background Latinx children in the United States are at high risk for nature-deficit disorder, heat-related illness, and physical inactivity. We developed the Green Schoolyards Project to investigate how green features—trees, gardens, and nature trails—in school parks impact heat index (i.e., air temperature and relative humidity) within parks, and physical activity levels and socioemotional well-being of these children. Herein, we present novel methods for a) observing children’s interaction with green features and b) measuring heat index and children’s behaviors in a natural setting, and a selection of baseline results. Methods During two September weeks (high temperature) and one November week (moderate temperature) in 2019, we examined three joint-use elementary school parks in Central Texas, United States, serving predominantly low-income Latinx families. To develop thermal profiles for each park, we installed 10 air temperature/relative humidity sensors per park, selecting sites based on land cover, land use, and even spatial coverage. We measured green features within a geographic information system. In a cross-sectional study, we used an adapted version of System for Observing Play and Recreation in Communities (SOPARC) to assess children’s physical activity levels and interactions with green features. In a cohort study, we equipped 30 3rd and 30 4th grade students per school during recess with accelerometers and Global Positioning System devices, and surveyed these students regarding their connection to nature. Baseline analyses included inverse distance weighting for thermal profiles and summing observed counts of children interacting with trees. Results In September 2019, average daily heat index ranged 2.0 °F among park sites, and maximum daily heat index ranged from 103.4 °F (air temperature = 33.8 °C; relative humidity = 55.2%) under tree canopy to 114.1 °F (air temperature = 37.9 °C; relative humidity = 45.2%) on an unshaded playground. 10.8% more girls and 25.4% more boys interacted with trees in September than in November. Conclusions We found extreme heat conditions at select sites within parks, and children positioning themselves under trees during periods of high heat index. These methods can be used by public health researchers and practitioners to inform the redesign of greenspaces in the face of climate change and health inequities.