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Background: We present results of the development and feasibility testing of CATCH Healthy Smiles, a school-based oral health program, among children in grades K-2 in Houston, Texas. Methods: Study design was cross-sectional (N = 2 schools; N = 125 parent-child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016-2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent-reported 24-hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. Results: Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02-1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05-0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09-275.14), greater frequency of consuming sugar-sweetened beverages (AdjOR = 11.53, 95% CI: 2.10-87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74-119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02-0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. Conclusions: These data will be used to conduct a subsequent fully powered cluster randomized controlled trial.

Background: For older Latinos, some benefits of leisure-time physical activity (LTPA) include enhanced cognitive functioning, decreased loneliness, and reduced premature mortality. Despite LTPA benefits, adults ≥50 years are one of the most inactive age groups in the United States. Methods: This qualitative study aimed to add to the limited evidence of LTPA in older Latino adults by exploring the barriers and facilitators for fitness class uptake and park use. Guided by a Social-Ecological Model of Health and Social Determinants of Health theoretical and a phenomenological research design, qualitative research data were collected via 27 personal interviews with Latino adults using a semistructured interview guide. Participants were recruited using purposive sampling strategies in collaboration with community partners. Bicultural data collectors conducted the semistructured interviews over Zoom. Thematic analysis was performed using Dedoose, following an inductive and deductive approach. Results: The main barriers to fitness class attendance and park use were family and/or work commitments, perceived safety, and perceived discrimination. Conversely, the critical facilitators for participation were socialization into a group, social connectedness with group members, fitness instructor characteristics, and exercise history. Conclusions: Findings from this study hold important implications for the design of fitness programming and park-based recreation, including the need to increase the cultural diversity of recreation staff and culturally relevant programming. Future research is needed on time poverty related to family/work commitments and whether discriminatory practices at fitness centers, like ageism and race/ethnicity, influence physical activity behavior. [ABSTRACT FROM AUTHOR]

Introduction We quantified the linear trend in combustible tobacco smoking among adolescents in the United States from 2014 to 2020, and then compared these trends across racial and ethnic categories. We also tested the effect of e-cigarette use on these trends for all-youth and across racial and ethnic categories. Aims and Methods We pooled and analyzed seven years of National Youth Tobacco Survey data for n  = 124 151 middle and high school students from 2014 to 2020. Weighted logistic regression analyses calculated the annual change in combustible tobacco smoking (ie cigarettes, cigars, and hookah) from 2014 to 2020. Stratified analyses examined linear trends for non-Hispanic White (NHW), NH-Black (NHB), Hispanic/Latino, and NH-Other (NHO) youth. All-models controlled for sex, grade level, and past 30-day e-cigarette use. Results Combustible tobacco smoking from 2014 to 2020 dropped by more than 50% for NHW youth, more than 40% for Latino and NHO youth, compared to just 16% among NHB youth. From 2014 to 2020, the odds of combustible tobacco smoking declined by 21.5% per year for NHWs, which was significantly greater than Hispanic/Latinos (17% per year; p  = .025), NHOs (15.4% per year; p  = .01), and NHBs (5.1% per year; p  < .001), adjusting for sex, grade, and e-cigarette use. Trends and disparities in trends by race and ethnicity were observed independent of e-cigarette use. Conclusions Combustible tobacco smoking declined for all-youth but at significantly different rates across races and ethnicities. Notably, declines in combustible tobacco smoking are lagging among NHB youth. Interventions are critically needed to address this disparity. Implications A direct, evidence-based intervention to reduce combustible tobacco smoking among NHB youth is critically needed. Such tobacco control initiatives should follow the Best Practices for Comprehensive Tobacco Control Framework, incorporating sustainable funding for school-based intervention, public health education, and adult cessation. [ABSTRACT FROM AUTHOR]

Background: Being a victim of bullying is associated with greater risk of youth substance use; however, research specifically examining whether tobacco use behaviors differ among adolescents who were bullied at school only, electronically only, or both at school and electronically is limited. Methods: We examined the associations between being a victim of bullying (at school only, electronically only, or both at school and electronically) and use of tobacco products using data from the 2013 national Youth Risk Behavior Survey. Results: Girls who were bullied both at school and electronically reported the highest odds of all tobacco use behaviors (ever use of cigarettes, current use of cigarettes, and current use of any tobacco product) as compared with girls who were not bullied after adjusting for covariates. Conversely, for boys, only the association between being bullied electronically only and ever use of cigarettes remained significant after adjusting for covariates. Conclusions: Results from this study indicate that electronic bullying may differentially influence the odds of tobacco use in high school students as compared with bullying that occurs at school only. Confirmation of these findings could inform interventions to reduce both bullying and tobacco use in high school.

Background: Research suggests that physical activity breaks (ABs) during class increase students' physical activity levels and provide an academic benefit. This study evaluates a 3-year intervention aimed at encouraging teacher AB use. Methods: Thirty central Texas middle schools were assigned to 1 of 3 conditions: training-only ("Basic"), training plus facilitator support ("Basic Plus"), and training/facilitator support and a social marketing campaign ("Basic Plus SM"). Teachers completed surveys at end of years 2 (N?=?1039) and 3 (N?=?831) to assess exposure to program, self-efficacy, and frequency of AB use. Results: At end of year 3, teachers in facilitator-supported conditions reported increased exposure, self-efficacy, and use compared to Basic condition. Only 43.2% of teachers in the "Basic" condition reported receiving training in ABs compared to 84.2% and 90.6% in the "Basic Plus" and "Basic Plus SM" conditions, respectively. Additionally, a greater percentage of teachers in the facilitator-support conditions reported conducting ABs weekly ("Basic"?=?23.3%, "Basic Plus"?=?34.4%, "Basic Plus SM"?=?38.7%, at year 3; p?

Is there anything more important than the health, well-being and education of a nation's children? This paper takes the position that school is the most important place to educate children about health and to develop lifelong health promoting skills. We believe that health promotion programs and activities are integral to the school's educational program, not as extracurricular, but as central to school's educational mission. In this chapter, we highlight the importance of physical education and physical activity as key components of a well-designed coordinated school health program. We also outline the skills that PE teachers must learn to take a leadership role in the school health movement.

Background: The association of physical fitness with cognitive function in children and adolescents is unclear. The purpose of this ecological study was to describe the association between academic achievement, body mass index (BMI), and cardiovascular fitness (CVF) in a large sample of elementary, middle, and high school students in Texas. Methods: FITNESSGRAM® results for 2,550,144 students were matched with standardized composite academic test (TAKS) results from 2008 to 2009. Analyses were conducted on the percent of students meeting TAKS standards by BMI and CVF quintiles. Analyses of variance with Tukey adjustment examined differences between the most favorable 5th quintile (referent) and all other quintiles. Results: The prevalence of students meeting the TAKS standard was significantly higher in the highest fitness category for BMI and CVF compared to all other categories, regardless of sex or grade category (p?< 0.05). Linear modeling suggested a 5% increase in the prevalence of students meeting healthy BMI and CVF standards would result in a 2.25% and 0.65% increase in the prevalence of students meeting the TAKS standard (both p?< 0.05). Conclusion: Findings suggest a healthy BMI and CVF are associated with higher academic achievement, and the need for additional research examining the role of potential confounders and/or effect modifiers longitudinally.

The Central Texas Coordinated Approach To Child Health (CATCH) Middle School Project is a 3.5-year school-based project aimed at promoting physical activity (PA), healthy eating, and obesity prevention among public middle school students in Texas. This article describes the CATCH intervention model and presents baseline findings from spring 2009. CATCH comprises six core components: "CATCH Team," "CATCH PE," "CATCH Classroom," "CATCH Eat Smart Cafeteria," "CATCH Family," and "CATCH Social Marketing." A group randomized serial cross-sectional design is being employed to test the effect of three program support conditions ("n" = 10 schools each) on energy-balance behaviors: "Basic" (training and curriculum only), "Basic Plus" (training and curriculum plus CATCH facilitator support), and "Basic Plus Social Marketing" (all inputs plus social marketing component). The study sample is composed of a cross-sectional sample of eighth-grade students (primary outcome evaluation sample) and sixth- and seventh-grade students (PE process evaluation sample) who are selected and measured each year. At baseline, 37.9% of eight-grade students ("n" = 2,841; 13.9 years) were overweight/obese and 19.2% were obese. Eighth-grade students reported, on average, consuming sugar-sweetened beverages more than two times on the previous day and fruits and vegetables roughly three times on the previous day; only two of five school districts surpassed the recommended 50% cut-point for class time spent in moderate-and-vigorous PA as measured in classes of sixth- and seventh-grade students. Additional behavioral findings are reported. Body mass index and behaviors were comparable across conditions. Baseline findings underscore the need to promote student energy-balance behaviors.

Background: Public schools provide opportunities for physical activity and fitness surveillance, but are evaluated and funded based on students' academic performance, not their physical fitness. Empirical research evaluating the connections between fitness and academic performance is needed to justify curriculum allocations to physical activity programs. Methods: Analyses were based on a convenience sample of 254,743 individually matched standardized academic (TAKS[TM]) and fitness (FITNESSGRAM[R]) test records of students, grades 3-11, collected by 13 Texas school districts. We categorized fitness results in quintiles by age and gender and used mixed effects regression models to compare the academic performance of the top and bottom fitness groups for each test. Results: All fitness variables except body mass index (BMI) showed significant, positive associations with academic performance after adjustment for socio-demographic covariates, with standardized mean difference effect sizes ranging from 0.07 to 0.34. Cardiovascular fitness showed the largest interquintile difference in TAKS score (32-75 points), followed by curl-ups. Additional adjustment for BMI and curl-ups showed dose-response associations between cardiovascular fitness and academic scores (p less than 0.001 for both genders and outcomes). Analysis of BMI demonstrated limited, nonlinear association with academic performance after socio-demographic and fitness adjustments. Conclusions: Fitness was strongly and significantly related to academic performance. Cardiovascular fitness showed a dose-response association with academic performance independent of other socio-demographic and fitness variables. The association appears to peak in late middle to early high school. We recommend that policymakers consider physical education (PE) mandates in middle high school, school administrators consider increasing PE time, and PE practitioners emphasize cardiovascular fitness. (Contains 2 tables and 4 figures.)

The purpose of this study was to identify the psychosocial, environmental and behavioral factors associated with calcium intake, physical activity and bone health in a cohort of adolescent girls. Baseline data (N = 718 girls, mean age: 11.6 plus or minus 0.4 years) from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study conducted in Texas, 2001-03, were utilized for the analyses. Hierarchical linear regression was used to examine the associations of interest. Confounders adjusted for included ethnicity, menarchal status, body mass index and lactose intolerance. Several psychosocial and behavioral factors were significantly associated with bone quality. These included knowledge of calcium content of foods (beta = 0.08, P = 0.016), self-efficacy toward consuming calcium-rich foods (beta = 0.16, P = 0.047), physical activity self-efficacy (beta = 0.20, P = 0.002), physical activity outcome expectations (beta = 0.5, P = 0.004), family encouragement to do physical activity (beta = 0.96, P = 0.027), friend engagement in physical activity (beta = 1.3, P = 0.001) and participation in sports teams (beta = 1.7, P less than 0.001). Self-efficacy, social support and participation in sports teams appear to be strongly associated with bone health in adolescent girls. Future health education/health promotion programs need to address these factors for effective primary prevention of osteoporosis in this population. (Contains 5 tables.)

Objective: To examine diet- and body size-related attitudes and behaviors associated with supplement use in a representative sample of fourth-grade students in Texas. Design: Cross-sectional data from the School Physical Activity and Nutrition study, a probability-based sample of schoolchildren. Children completed a questionnaire that assessed supplement use, food choices, diet-related attitudes, and physical activity; height and weight were measured. Setting: School classrooms. Participants: Representative sample of fourth-grade students in Texas (n = 5967; mean age = 9.7 years standard error of the mean [SEM] = 0.03 years, 46% Hispanic, 11% African-American). Main Outcome Measures: Previous day vitamin supplement consumption, diet- and body size-related attitudes, food choices, demographic factors, and physical activity. Analysis: Multivariable logistic regression models, P less than 0.05. Results: The prevalence of supplement use was 29%. Supplement intake was associated with physical activity. Girls who used supplements were more likely to report positive body image and greater interest in trying new food. Relative to nonusers, supplement users were less likely to perceive that they always ate healthful food, although supplement use was associated with more healthful food choices in boys and girls (P less than 0.001). Conclusions and Implications: The widespread use of supplements and clustering of supplement use with healthful diet and greater physical activity in fourth graders suggest that supplement use be closely investigated in studies of diet-disease precursor relations and lifestyle factors in children. (Contains 3 tables.)

While the epidemiologic trends concerning alprazolam (Xanax[R]) are unknown, the use of benzodiazepines, in general, has increased in popularity among youth within recent years. To shed light on the drug problem, the current pilot study used a qualitative approach to investigate relevant beliefs, norms, and perceived addiction associated with alprazolam initiation among 46 youth who were attending an inpatient drug treatment program during the spring of 2004. Overwhelmingly, most participants stated that addiction to alprazolam occurs as early as initial consumption. Most youth in the study stated that their friends felt it was normal to use alprazolam. In addition, their control beliefs revealed that if someone wanted to stop it would be difficult because of the widespread use in their communities and family social reinforcement involved with its use. In this study, a majority of students stated that medical professionals such as doctors and pharmacists were the greatest facilitator of alprazolam acquisition. Implications for these results are discussed. (Contains 2 tables.)

School-based programs offer an efficient means of promoting the health of a large number of children. The Coordinated Approach to Child Health (CATCH) program was designed to decrease risk factors for chronic disease in elementary school children and includes separate coordinated interventions for child nutrition services, physical education (PE), classroom instruction, and family education. Physical education specialists who attended CATCH training during school years 2000-2003 were surveyed about CATCH PE at their respective schools. The survey included items pertaining to PE barriers, implementation and satisfaction of CATCH PE, and demographic characteristics. A serial cross-sectional study design was used; response rates were 58.6% in 2000, 20.9% in 2001, 38. 7% in 2002, and 57.7% in 2003. The top two rank order barriers to quality PE were large class size and low academic value. Future research should focus on determining characteristics of schools that are achieving quality PE programs.