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BackgroundInsufficient physical activity in the adult population is a global pandemic. Fun for Wellness (FFW) is a self-efficacy theory- and Web-based behavioral intervention developed to promote growth in well-being and physical activity by providing capability-enhancing opportunities to participants. ObjectiveThis study aimed to evaluate the effectiveness of FFW to increase physical activity in adults with obesity in the United States in a relatively uncontrolled setting. MethodsThis was a large-scale, prospective, double-blind, parallel-group randomized controlled trial. Participants were recruited through an online panel recruitment company. Adults with overweight were also eligible to participate, consistent with many physical activity–promoting interventions for adults with obesity. Also consistent with much of the relevant literature the intended population as simply adults with obesity. Eligible participants were randomly assigned to the intervention (ie, FFW) or the usual care (ie, UC) group via software code that was written to accomplish equal allocations to the FFW and UC groups. Data collection was Web based, fully automated, and occurred at three time points: baseline, 30 days after baseline (T2), and 60 days after baseline (T3). Participants (N=461) who were assigned to the FFW group (nFFW=219) were provided with 30 days of 24-hour access to the Web-based intervention. A path model was fit to the data consistent with the FFW conceptual model for the promotion of physical activity. ResultsThere was evidence for a positive direct effect of FFW on transport-related physical activity self-efficacy (beta=.22, P=.02; d=0.23), domestic-related physical activity self-efficacy (beta=.22, P=.03; d=0.22), and self-efficacy to regulate physical activity (beta=.16, P=.01; d=0.25) at T2. Furthermore, there was evidence for a positive indirect effect of FFW on physical activity at T3 through self-efficacy to regulate physical activity at T2 (beta=.42, 95% CI 0.06 to 1.14). Finally, there was evidence for a null direct effect of FFW on physical activity (beta=1.04, P=.47; d=0.07) at T3. ConclusionsThis study provides some initial evidence for both the effectiveness (eg, a positive indirect effect of FFW on physical activity through self-efficacy to regulate physical activity) and the ineffectiveness (eg, a null direct effect of FFW on physical activity) of the FFW Web-based behavioral intervention to increase physical activity in adults with obesity in the United States. More broadly, FFW is a scalable Web-based behavioral intervention that may effectively, although indirectly, promote physical activity in adults with obesity and therefore may be useful in responding to the global pandemic of insufficient physical activity in this at-risk population. Self-efficacy to regulate physical activity appears to be a mechanism by which FFW may indirectly promote physical activity in adults with obesity. Trial RegistrationClinicalTrials.gov NCT03194854; https://clinicaltrials.gov/ct2/show/NCT03194854.

Greenspaces provide several well-being (Dinnie et al., 2013) and psychosocial benefits (Addy et al., 2004). Community-engaged research affords community partners a voice in the project (Cushman et al., 2004). This study assessed Detroit community members' perceived benefits of and suggestions for engaging with the community to support greenspaces. Through qualitative analysis, a three-step process for community-engaged planning was revealed. Findings highlight strategies that involve community members in this process to enhance community engagement and well-being.

A universal approach to characterizing sport-related physical activity (PA) types in sport settings does not yet exist. Young adults (n = 30), 19-33 years, engaged in a 15-min activity session, performing warm-ups, 3-on-3 soccer, and 3-on-3 basketball. Videos were recorded and manually coded as criterion PA types (walking, running, jumping, rapid lateral movements). Participants wore an accelerometer on their right hip. Multiple machine learning models were developed and compared for predicting PA type. Most models underestimated time spent completing the activities performed least commonly. Point estimates for percent agreement, sensitivity, specificity, F-scores, and kappa were similar across models, with Hidden Markov Models (HMMs) being best at classifying rare events. Models detected activity type during sport-related movements with modest accuracy (kappas [less than or equal to] 0.40). Given the better performance of HMMs, incorporating the temporal nature of sport-related activities is important for improving sport-related PA classification.

Research Findings: The present study examined the associations among meeting 24-hour movement behavior recommendations set by the World Health Organization (2019) and young children's self-regulation and quantity estimation skills in a sample of 123 children (n = 65 female; 4.9 ± 0.7 years) in mid-Michigan. Meeting screen time recommendations alone, meeting physical activity recommendations in combination with either sleep or screen time recommendations, meeting more recommendations overall, and being active more days weekly were associated with superior quantity estimation. Meeting more guidelines and accruing more moderate-to-vigorous physical activity daily related to better self-regulation. Improvements in self-regulation partially mediated the relation between physical activity and quantity estimation. Practice or Policy: Our findings identify benefits for adopting specific physical activity guidelines for children (e.g., physical activity, screen time, and sleep duration) and integrating these into early learning standards so both families and schools can support children's capacity to meet 24-hr movement guidelines and thus support cognitive health. An active lifestyle in early childhood may support young children's self-regulation and early educational outcomes, with physical activity promotion efforts during early childhood serving as a viable means to address growing expulsion rates in preschool-aged children.

Background: National adherence to the recess recommendations of the Centers for Disease Control and Prevention (CDC) has not been comprehensively studied in the United States. Methods: Data from 6 nationally representative data sets over the last decade (Classification of Laws Associated with School Students, Early Childhood Longitudinal Study, National Health and Nutrition Examination Survey, National Youth Fitness Survey, School Health Policies and Practices Survey, and the School Nutrition and Meal Cost Study) provided estimates for adherence to CDC recess guidelines. Results: While approximately 65-80% of elementary school-children receive the recommended 20+ minutes of daily recess according to parent-, principal-, and school-report, adherence declines by sixth grade, and little information is available for middle/high school students. Adherence to playground safety was high (90%), but adherence to recommendations about recess before lunch (<50%), withholding recess as punishment (~50%), and training recess staff (<50%) were lower. Conclusions: School policy and practice should align with CDC recommendations, with the aim of providing sufficient quality recess to all youth, K-12th grade. Comprehensive, on-going national surveillance of multiple recess domains is needed to inform policy and ensure equitable provision of recess.

An introduction to articles published within the issue is presented including the developments in high-performance sport in children and adolescents, the role of effective training programs and the role of support systems and technology.

Purpose: Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk. Method: Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS. Results: BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (−0.036; 95% confidence interval, −0.070 to −0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI. Conclusions: BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI. [ABSTRACT FROM AUTHOR]

The childcare environment impacts physical activity participation, but little descriptive information is available in different types of programs. Most studies focus on the schoolyard despite children spending more time indoors. This study identified which learning centers were available, used by children, and promoted physical activity, both inside and on the schoolyard. Teachers (N = 139; licensed centers, n = 59; home-based programs, n = 80) identified available learning centers and ranked locations where children spent free-choice time and participated in physical activity. Indoors, blocks, books, and dramatic play were frequently available, and dramatic play was ranked as an area where children spent time (87%) and were active (63%). Outdoors, open/grassy areas, fixed equipment, sandbox, and seating were available, and open/grassy areas and paved areas for balls/objects were locations where children spent time (73%-100%) and were active (87%-100%). Addition of learning centers that were unavailable but promoted physical activity (e.g. lofts) may be a point of intervention.

In physical education and exercise science, it is common to examine mean differences between groups or to assess change across time. However, before group differences or change can be confidently examined, measurement invariance can be tested. Measurement invariance tests the equivalence of a construct across groups or across time. If measurement invariance is supported, then differences in latent means can more confidently be attributed to individuals' different standings on a construct. Though an important first step to confidently examine group differences and change across time, this technique is sometimes not used in the field. Thus, the purpose of this manuscript was to provide a didactic review and illustration of measurement invariance within the field. We review a methodological approach to measurement invariance, the sequential steps used in this approach, assessing model-data fit, and testing partial invariance. We provide an illustration of the technique and conclude with practical considerations.

Participation in youth sport is positively associated with physical fitness and performance. The purpose of the current study was to examine if physical fitness measures during childhood and early adolescence predicted high school sport participation. Participants included youth in the Michigan State University Motor Performance Study. Measures consisted of the endurance shuttle run, Wells sit-and-reach, jump and reach, standing long jump, agility shuttle run and 30-yard dash. Individual, generalized estimating equation models were used to estimate the association between each measure and the odds of participating in high school sport. For both sexes, the endurance shuttle run and agility shuttle run were related to sport participation. For boys only, the long jump and 30-yard dash were also associated with sport participation. Better physical fitness and performance across several dimensions in childhood, including those related to motor skills, enhanced the likelihood of sport participation in high school.

Excess adipose tissue may impact the motor performance of youth. Therefore, the current study examined: (1) if adiposity influenced performance in the jump and reach and 30-yard dash; and (2) if maturation predicted motor performance. Participants (N = 267) included girls aged 8 to 16 years. Latent growth curves were used to assess changes in motor performance. Sum of skinfolds predicted jump and reach performance from age 8.5 to 10.5 years, 11.5-12.0 years, 13.0 years, and from age 14 to 14.5 years (b = -0.013 to 0.051, p < 0.05). Sum of skinfolds predicted 30-yard dash performance from age 8.5 to 14.0 years and at age 15.5 years (b = 0.003 to 0.005, p < 0.05). Maturation did not predict performance. Future research should examine determinants that explain the link between adiposity and motor performance.

The Michigan State University (MSU) Motor Performance Study (MPS) was initiated in 1967 and was known across the United States for its unique blend of teaching, service, and research. Dr. Vern Seefeldt began the study as a means to begin research with children on-campus. The instructional portion of the program ended in 1999; data collection continued until 2004. The purpose of the MPS was to examine longitudinal relationships among physical growth, biological maturity, and motor skill acquisition in youth. Four distinct eras of research contributed to the design of the MSU MPS: a) The genetics and maturation period; b) The classification period, involving identification of the motor domain and factor structures of movement skills; c) The perceptual-motor era; and d) The physical fitness era. The purpose of this manuscript is to describe how each of the four research areas specifically contributed to the design and conduct of the MSU MPS.

The Michigan State University Motor Performance Study (MPS) was initiated in 1967 and lasted 32 years. Three central components existed: 1) Educational component, in which students experienced applied work with youth; 2) Instructional component, whereby enrolled youth received sport-specific skill instruction; and 3) Research component. The primary goals of the research component of the MPS were to examine: 1) the changes over time that occur in the physical growth, biological maturity, and motor skill acquisition of children and youth; 2) the processes involved in the attainment of basic and complex motor skills; and 3) the influence of changes in the learners' environment on their rates of motor skill acquisition. Several growth and maturation, motor competence, and physical performance/fitness variables were collected, and a follow-up study examined participants' adult physical activity, sport participation, and health outcomes. This manuscript describes methods used in the research component of the MPS and the follow-up.

Research tracking sport participation from youth to adulthood is relatively rare, as is research that tracks youth sport participation with regard to adult physical activity (PA) levels, especially in the United States. Aims of this study were: 1) To investigate the degree to which sport participation tracked across youth, adolescence, and early adulthood in a sample of participants from the Michigan State University Motor Performance Study (MPS), and 2) Determine if differences existed in their levels of adult PA relative to prior sport participation. In total, 256 (60.8%) former participants from the MPS completed follow-up surveys regarding routine sport participation and PA across the previous year. Sport participation tracked consistently from youth to college. Further, regardless of the level of youth sport participation, adult leisure time PA was relatively consistent among groups. Although the study did not directly test the influence of the MPS on subsequent adult outcomes, our findings suggest that participants' past sport participation was not a good predictor of adult PA for those who were involved in a program that emphasized fundamental motor skills in youth. Further investigation of such programs can help to better inform their influence on adult PA.

Background: Physical activity and sedentary behavior may differentially impact health-related quality of life in adults with cerebral palsy. Objective: The present investigation assessed the independent relationships between aspects of physical activity and sedentary behavior related to health related quality of life in adults with cerebral palsy. Methods: Through a cross-sectional online survey of 118 adults with cerebral palsy, participants self-reported the extent of their functional impairments using the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System; while mental and physical health-related quality of life were assessed using the RAND-36. Physical activity and sedentary behavior were quantified using the Physical Activity and Disability Survey—Revised and Sedentary Behavior Questionnaire, respectively. Results: Accounting for potential confounding influences of impairments, neither exercise-related physical activity, leisure time- related physical activity, occupational physical activity, nor sedentary behavior was associated with any characterization of health-related quality of life. However, greater engagement in general lifestyle physical activity was related to superior mental health-related quality of life. Conclusion: These findings provide initial evidence to suggest that focusing public health and therapeutic recommendations for individuals with cerebral palsy on general physical activity engagement throughout the day might incur potential benefits for enhancing mental health- related quality of life in this population. [ABSTRACT FROM AUTHOR]

This study evaluated feasibility, acceptability, and preliminary efficacy of a 12-week "Guys/Girls Opt for Activities for Life" (GOAL) intervention on 10- to 13-year-old adolescents' body mass index (BMI), percent body fat, physical activity (PA), diet quality, and psychosocial perceptions related to PA and healthy eating. Parent-adolescent dyads from two schools were enrolled. Schools were assigned to either GOAL (38 dyads) or control (43 dyads) condition. The intervention included an after-school club for adolescents 2 days/week, parent-adolescent dyad meeting, and parent Facebook group. Intervention adolescents had greater autonomous motivation for PA and self-efficacy for healthy eating than control adolescents (both p < 0.05). Although between-group differences were not significant, close-to-moderate effect sizes resulted for accelerometer-measured moderate-to-vigorous PA and diet quality measured via 24-hr dietary recall (d = 0.46 and 0.44, respectively). A trivial effect size occurred for percent body fat (d = -0.10). No differences emerged for BMI. Efficacy testing with a larger sample may be warranted.

This study developed and evaluated machine learning algorithms to predict children's physical activity category from raw accelerometer data collected at the hip. Fifty participants (mean age = 13.9 ± 3.0 y) completed 12 activity trials that were categorized into 5 categories: sedentary (SED), light household activities and games (LHHAG), moderate-vigorous games and sports (MVGS), walking (WALK), and running (RUN). Random Forest (RF) and Logistic Regression (LR) classifiers were trained with features extracted from the vector magnitude using 10 s non-overlapping windows. Classification accuracy was evaluated using leave-one-subject-out cross validation. Overall accuracy for the RF and LR classifiers was 95.7% and 94.3%, respectively. Classification accuracy was excellent for SED (96.3%-98.1%), LHHAG (92.3%-95.2%), WALK (94.5%-97.1%), RUN (99.5%-99.6%); and MVGS (87.5%-92.7%). The results indicate that classifiers trained on features in the raw acceleration from the hip can be used for activity recognition in young people.

Free-living comparability of wGT3X-BT and GT9X ActiGraphs has not been verified. Participants (n = 34, 35% females, 7-17 y) wore hip-worn monitors for one week. Vector magnitude (VM; 15-s epoch), Mean Amplitude Deviation (MAD) and Euclidean Norm Minus One (ENMO) (5-s epoch), and percent of time spent in each activity intensity (using cut-points) were calculated. At the epoch-level, correlations were strong (r = 0.822-0.963), mean absolute percent difference (MAPD) was 41.5 ± 62.2% (VM), 40.8 ± 52.7% (MAD), and 110.9 ± 74.0%, with moderate (ENMO [kappa] = 0.664-0.789) to strong (VM [kappa] = 0.915) agreement for activity intensity. When collapsed to the individual level, MAPD was 4.2 ± 3.4% (VM), 6.8 ± 3.7% (MAD), and 35.9 ± 26.1% (ENMO), correlations were moderate (ENMO r = 0.618) to high (MAD and VM r = 0.996), but ENMO, MAD, and time spent in activity intensities using ENMO cut-points were not statistically equivalent (using 2 one-sided tests) between monitors. While time spent in activity intensities was often comparable between models, caution is warranted for epoch-level comparisons.

To evaluate the validity of the Pregnancy Physical Activity (PA) Questionnaire (PPAQ) for long-term PA recall. Forty-eight women completed the PPAQ at 21, 32 weeks gestation, and 12 weeks postpartum. These women were emailed three separate PPAQs between two months and eight years after originally completing the questionnaires to recall their PA during those same time periods. Total number of metabolic (MET) minutes per week (MET-min*wk[superscript -1]) and percent time spent in light (%L), moderate (%M), and vigorous (%V) activity were compared between the original and long-term recall PPAQ values. Total MET-min*wk[superscript -1] and %M were significantly underestimated by 3000-4000 MET-min*wk[superscript -1] and 6%, respectively, and %L was overestimated by 4-6% (p < 0.05). Women reported spending little time in vigorous intensity activity (2-4%). Spearman correlations were lower for women who recalled PA [greater than or equal to] five years postpartum compared to women who recalled their PA 0.05).

Background: As the obesity epidemic expands to include younger Americans, there is greater need to understand youth experiences and to identify innovative strategies to promote physical activity in children and adolescents. Connecting children and families with nature-based activities is an example of a strategy that may promote physical activity and other aspects of health and well-being in children and youth. Purpose: It is important to determine which aspects of activity in nature youth (and families) find most and least appealing, as well as characteristics of an ideal program. This study is intended to provide a needs assessment and recommended design for a community outreach program. Methods: Six focus groups were conducted with parents and youth in rural Michigan. Thirty-eight of the 42 participants were female. Results: Content analysis generated three major results: (1) Youth enjoy nature, but could be more active and engaged; (2) Adults appreciate restorative aspects of nature; youth prefer competitive and challenging experiences; and (3) Programs should promote, educate, train and create opportunities for youth to engage in healthy lifelong activities. Discussion: Participants showed interest in outdoor activity, but activities must be provided that are compelling and that address the barriers preventing populations from being more active. Translation to Health Education Practice: More effective programs must have clear objectives, build the confidence of participants, be challenging, and above all, fun. Ideal programs should offer both physical activity and ecologically meaningful nature experiences.

The present study describes the development and pilot testing of the Observation System for Recording Physical Activity in Children-Home version. This system was developed to document physical activity and related physical and social contexts while children are at home. An analysis of interobserver agreement and a description of children's physical activity in various settings are presented. The system, which was shown to be reliable, provides a direct observation tool for researchers who are interested in assessing and intervening in physical activity in the home environment. (Contains 1 table and 4 figures.)

Purpose: The purposes of this article are to: (a) describe the rationale and development of the Youth Compendium of Physical Activities (Youth Compendium); and (b) discuss the utility of the Youth Compendium for audiences in research, education, community, health care, public health, and the private sector. Methods: The Youth Compendium provides a list of 196 physical activities (PA) categorized by activity types, specific activities, and metabolic costs (youth metabolic equivalents of task [METy]) as measured by indirect calorimetry. The utility of the Youth Compendium was assessed by describing ways in which it can be used by a variety of audiences. Results: Researchers can use METy values to estimate PA levels and determine changes in PA in intervention studies. Educators can ask students to complete PA records to determine time spent in physical activities and to identify health-enhancing activities for classroom PA breaks. Community leaders, parents, and health care professionals can identify activity types that promote healthful behaviors. Public health agencies can use the METy values for surveillance and as a resource to inform progress toward meeting national physical activity guidelines. Applications for the private sector include the use of METy in PA trackers and other applications. Conclusion: The National Collaborative on Childhood Obesity Research Web site presents the Youth Compendium and related materials to facilitate measurement of the energy cost of nearly 200 physical activities in children and youth. The Youth Compendium provides a way to standardize energy costs in children and youth and has application for a wide variety of audiences. [This article reflects the content of Barbara Ainsworth's 2018 C. H. McCloy Lecture. Additional funding for this project was provided by the National Collaborative on Childhood Obesity Research--a public-private partnership among the the National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), Robert Wood Johnson Foundation, and the U.S. Department of Agriculture.]

This study examined if accelerometer-based assessments of physical activity were responsive to changes in physical activity level commensurate with performing structured versus unstructured activity in youth. Youth (6-16 years; N = 206) participated in a simulated after-school program that included structured and unstructured games on four occasions over a 3-year period. Recruitment occurred in 2007/2008 and data collection ended in 2011. Participants wore an Actigraph GT1M accelerometer on the hip. The Evenson cut-points were used to determine the time spent in each physical activity intensity, and standardized response means (SRM) were calculated and converted to standard effect sizes to be interpreted according to Cohen's guidelines. SRMs ranged from trivial (0.16) to high (2.07), with the majority (75%) being classified as moderate or high. Our findings suggest that accelerometry was sensitive to differences in physical activity associated with structured compared to unstructured play, supporting the utility of accelerometry in evaluating activity-promoting interventions.

This study investigated the utility of the Study of Health and Activity in Preschool Environments (SHAPES) conceptual model, which targeted physical activity (PA) behavior in preschool children, by examining the relationship between implementation monitoring data and child PA during the school day. We monitored implementation completeness and fidelity based on multiple elements identified in the conceptual model. Comparing high-implementing, low-implementing, and control groups revealed no association between implementation and outcomes. We performed post hoc analyses, using process data, to refine our conceptual model's depiction of an effective preschool PA-promoting environment. Results suggest that a single component of the original four-component conceptual model, providing opportunities for moderate-to-vigorous physical activity through recess for 4-year-old children in preschool settings, may be a good starting place for increasing moderate-to-vigorous physical activity. Interventions that are implemented with optimal levels of completeness and fidelity are more likely to achieve behavior change if they are based on accurate conceptual models. Examining the mechanisms through which an intervention produces its effects, as articulated in the conceptual model that guides it, is particularly important for environmentally focused interventions because they are guided by emerging frameworks. The results of this study underscore the utility of using implementation monitoring data to examine the conceptual model on which the intervention is based.

Spending time outdoors is associated with increased time spent in physical activity, lower chronic disease risk, and wellbeing. Many studies rely on self-reported measures, which are prone to recall bias. Other methods rely on features and functions only available in some GPS devices. Thus, a reliable and versatile method to objectively quantify time spent outdoors is needed. This study sought to develop a versatile method to classify indoor and outdoor (I/O) GPS data that can be widely applied using most types of GPS and accelerometer devices. To develop and test the method, five university students wore an accelerometer (ActiGraph wGT3X-BT) and a GPS device (Canmore GT-730FL-S) on an elastic belt at the right hip for two hours in June 2022 and logged their activity mode, setting, and start time via activity diaries. GPS trackers were set to collect data every 5 seconds. A rule-based point cluster-based method was developed to identify indoor, outdoor, and in-vehicle time. Point clusters were detected using an application called GPSAS_Destinations and classification were done in R using accelerometer lux, building footprint, and park location data. Classification results were compared with the submitted activity diaries for validation. A total of 7,006 points for all participants were used for I/O classification analyses. The overall I/O GPS classification accuracy rate was 89.58% (Kappa = 0.78), indicating good classification accuracy. This method provides reliable I/O clarification results and can be widely applied using most types of GPS and accelerometer devices. [ABSTRACT FROM AUTHOR]

Background: Poor dietary quality is associated with adiposity and other risks of cardiovascular disease (CVD) in children. In Kuwait, although children's food choices are a concern, no studies have evaluated dietary quality relative to the risk of CVD in Kuwaiti schoolchildren. This study hypothesized that dietary quality using the Healthy Eating Index (HEI) is associated with CVD risk factors in children and that there are associated sex differences. Objective: Our main objective was to evaluate the dietary quality of schoolchildren and investigate whether poor HEI scores are associated with CVD risk and if there are sex differences. Methods: This was a cross-sectional study of Kuwaiti fifth graders (n = 313; 53% girls; mean age = 10.4 ± 0.4 years) who completed an adapted Block Kids 2004 food frequency questionnaire. Anthropometric, blood pressure, and biochemical data were also measured. HEI-2010 and HEI-2015 scores were calculated. Statistics: A general linear model and logistic regression were applied, controlling for moderate–vigorous physical activity (MVPA) and screen time (ST). Results: The total HEI-2010 and HEI-2015 scores were 58 and 52 points, respectively; a trend analysis indicated that more girls than boys had poor (≤50 points) HEI-2015 scores (p < 0.063). The maximum scores for total vegetables (p < 0.001), dairy (p < 0.034), and fatty acids (p < 0.01) were significantly higher in girls, while the maximum scores for whole grains (p < 0.046) and protein (p < 0.006), but not sodium (p < 0.009), were higher in boys. Obesity was inversely associated with poor total HEI 2010 and HEI 2015 scores (OR: 0.347, 95% CI: 0.234 - 0.516, p < 0.001 and OR: 0.561, 95% CI: 0.391–0.805, p < 0.002, respectively). However, the correlation was lost after adjustment for possible confounding factors. Conclusions: Dietary quality for children overall in this study was low, and there was only a weak association between poor scores and elevated blood pressure and none between scores and obesity. These findings have public health implications and warrant further investigation and attention. [ABSTRACT FROM AUTHOR]