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This study examined pre-pandemic (2017-early March 2020) to early-pandemic (Spring 2020) changes in moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary behavior/sleep (SS), by weekday/weekend, and age (preschool, elementary, middle school). We re-enrolled children from two pre-pandemic obesity prevention trials and examined differences in accelerometer-measured PA from pre-pandemic to early-pandemic across age groups using linear mixed models. Children (n = 75) were 51% multiple race/ethnicities, 29% preschool, 28% elementary, 43% middle school, 65% suburban, 21% rural, and 13% urban. Pre-pandemic to early-pandemic changes in weekday MVPA (p = 0.006), LPA (p = 0.018), and SS (p = 0.003) differed by age. On weekdays, middle schoolers’ MVPA decreased 15.36 min/day (p = 0.002) and SS increased 94.36 min/day (p < 0.001) with non-significant changes among preschoolers and elementary schoolers. Compared to elementary schoolers, middle schoolers’ changes in weekday MVPA (b = −16.34, p = 0.036) and SS (b = 63.28, p = 0.039) significantly differed. Declines in weekday MVPA and increases in SS among middle schoolers suggest that, compared with younger children, middle schoolers are dependent on school and recreational facilities for PA, and in their absence engage in more sedentary activities and sleep.

Circadian rhythm disturbances are common among children with cancer, and are associated with poor health outcomes. Social zeitgeber theory suggests that intervening in the cascade of events that disrupt circadian rhythms may improve health outcomes. Light, most potently sunlight, is a “zeitgeber,” or environmental cue instrumental in maintaining entrainment of circadian rhythms. Bright white light (BWL) therapy, a proxy for sunlight, has been used successfully to prevent deterioration of circadian rhythms in adult cancer patients, and to reentrain these rhythms in adolescents with circadian rhythm disorders. This study aimed to develop and assess preliminary feasibility of a BWL therapy intervention for supporting circadian health of adolescent cancer survivors. We hypothesized that adolescents could independently manage BWL in their home, coordinated by nurses using a mail-, phone- and internet-based format, with minimal side effects. Adolescents were instructed to use BWL for 30 minutes daily on awakening, for 28 days. Actigraphs, measuring the circadian activity rhythms of sleep and wake, were worn for 7 days at baseline and Week 4. Adverse events were screened serially. Analyses were descriptive and nonparametric. Eight adolescents participated. On average, BWL was used on 61% of days, for 15 minutes per day. Adverse events were generally mild, although one participant discontinued BWL due to persistent BWL-related nausea. This nurse-guided remote BWL therapy intervention in adolescent cancer survivors demonstrated preliminary feasibility. Future studies with larger samples are required to verify the feasibility of this study, and to determine its safety and effectiveness in supporting circadian activity rhythms.

OBJECTIVES: Overweight/obesity (OO) among preschoolers is a major public health issue that has been linked to many factors. Food neophobia is an important factor in children's diet but has inconsistent associations with obesity. Intersectionality affects the outcome of any childhood events. This study examines: 1) direct association of FN and preschooler OO, 2) whether FN moderates or mediates the caregiver OO-preschooler OO association, and 3) intersectionality of sex and race and preschooler OO. METHODS: Baseline data were gathered from 52 childcare centers participating in a randomized controlled trial to promote healthy dietary habits. The sample included 500 preschoolers and caregivers. Children were weighed and measured; we calculated body mass index percentile (BMIp) and categorized them as OO vs. healthy based on CDC criteria. Caregivers reported their weight, family demographics, and completed the 2-item Household Food Security Scale and the Child Food Neophobia Scale. Logistic Mixed Models (LMM) were used with childcare centers as random effects, adjusting for child age, sex, race, and sociodemographic. Model 1 examined the association between FN and OO. Model 2 added the caregiver OO*FN interaction, and Model 3 examined FN as a mediator in the caregiver OO-preschooler OO association. Model 4 tested the sex*race interaction with preschooler OO. RESULTS: Children's mean age was 48 months (SD = 7.5), 55% boys, and 25.4% OO. Caregiver mean age was 36 years (SD = 5.7), 90% women, 67% educated at bachelor's or higher, 84% employed full-time, 13% food insecure, and 58% OO. In multivariable LMM, compared to normal weight, overweight and obese caregivers were 2.6 (95% CI: 1.6–4.3) and 3.9 (95% CI: 2.1–7.3) times, respectively, more likely to have OO child. FN was not associated with preschoolers’ OO directly or through moderation or mediation. The intersectionality of child race and sex was significant (P = 0.01) in predicting child obesity. Non-White girls had the highest mean BMIp, 69.3. CONCLUSIONS: OO among preschoolers and caregivers was related. FN was not associated with preschooler OO either directly or indirectly. Research into the mechanisms linking caregiver and preschooler OO is needed. The elevated BMIp among non-white preschool girls calls for research focused on this population. FUNDING SOURCES: National Institute Diabetes and Digestive and Kidney Diseases.

During early childhood, caregiver feeding practices (FP) influence children's diet and eating habits. Inconsistent methods of operationalizing FP have resulted in limited evidence regarding simultaneous FP patterns. This study examined the heterogeneity in FP among caregivers of preschoolers, along with the child, caregiver, and family characteristics associated with FP patterns. Caregivers of preschoolers (n = 437, 90% women) enrolled in 50 childcare centers across Maryland completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and provided demographic information and perceptions of their child's size and temperament. Exploratory Factor Analysis of CFPQ identified 13 factors, and latent profile analysis (LPA) empirically identified three FP classes. Using multinomial structural equation models, we regressed FP classes on child sex, race, age, poverty level, food insecurity education, caregiver perception of child size and temperament. The most common FP pattern (69%) reflected high coercive and control with low autonomy and structural practices (Controlling Class). A second pattern (16%) had high coercive control with moderate structural and autonomy practices (Regulating Class). The third pattern (15%) reflected moderate levels of all practices (Balancing Class). Caregivers who desired their child to be heavier (aOR = 0.40, 95% CI = 0.22–0.72), were more financially secure (aOR = 0.80, 95%CI = 0.65–0.98), and were single (aOR = 0.38, 95% CI = 0.18–0.80) were less likely to be in the Balancing versus Controlling class. For each unit increase in child temperament t-score [higher = difficult], caregivers were more likely to be in the Balancing (aOR = 1.04, 95% CI = 1.01–1.07) or Regulating class (aOR = 1.04, 95% CI = 1.01–1.08) compared to the Controlling class. In this statewide sample, many caregivers endorsed controlling behaviors without endorsing empowering behaviors to help children become healthy eaters. Future studies should examine how caregiver feeding practices evolve and relate to children's eating habits, growth, and development over time.

Frontier communities are rural counties that are sparsely populated with limited resources to provide residential long-term care; COVID-19 has heightened these barriers and adversely affected residents, their families and staff. This study describes the feasibility of implementing recommended WE-THRIVE measures in one residential long-term care setting in a frontier community in the rural Midwest, and the capacity for administrative leadership to draw upon results of measures to implement person-centered care post-pandemic. During the COVID-19 pandemic, early efforts to advance person-centered care in the setting were displaced by a focus on infection control and containment. WE-THRIVE measures assess person-centered care following immunization distribution, and are discussed in terms of how to develop a dashboard to ‘de-escalate’ a COVID-19 focus and rebuild momentum towards person-centered care. Particular attention is given to the context of measurement, including data sharing and measurement burden, to inform advancing person-centered long-term care in other frontier communities.

Multimorbidity resilience may mitigate the adverse effects of multiple chronic diseases on older adults’ health. Wister et al.’s (2018) multimorbidity resilience index was developed and tested in a cross-sectional sample of older adults in Canada. Building on these findings, we examined the reciprocal relationships of resilience on outcomes to test these potentially mitigating effects in a community-based, U.S. sample of older adults over time. The study sample includes 1,054 older adults from waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP) study (Waite et al 2020). Wister et al.’s (2018) index was mapped to NSHAP measures, and reciprocal relationships of multimorbidity resilience and health outcomes over a 5-year period was tested using structural equation modeling (SEM). Results indicated significant effects of multimorbidity resilience on self-rated physical health and pain. Interestingly, a better functional resilience at baseline conferred better self-rated physical health at follow-up, while better psychological resilience predicted lower pain level. By contrast, the influence of health outcomes on any domain of multimorbidity resilience was not detectable at all, supporting the direction of these associations from resilience to outcomes. The study systematically investigated the dynamic hypotheses between multimorbidity resilience and health outcomes. That is, whether they are determinants or consequences, or both. Our findings suggest multimorbidity resilience predicts subsequent 5-year change in health outcomes, especially self-rated physical health and pain level, but not vice versa, strengthening the evidence of the importance of resilience in the health of older adults.

OBJECTIVES: During early childhood, eating habits are formed, and excess weight gain may begin. Caregivers' feeding practices (FP) influence childhood obesity and may get influenced by cultural and economic considerations(5 6), as well as caregivers' perception of child's size and temperament(7 8). FP are employed simultaneously, thus influencing each other(9). There is limited evidence on implementing FP simultaneously and what factors are associated with them(2). This study examined (1) the heterogeneity in FP among caregivers and (2) associated child, caregiver, and family factors. METHODS: Caregivers of 466 preschoolers (55.4% boys, mean age of 48 months), enrolled in 50 childcare centers, completed the Comprehensive Feeding Practices Questionnaires (CFPQ), demographic information, and perceptions of their child's weight and temperament. From Exploratory Factor Analysis of the CFPQ items, we identified 13 factors and conducted latent profile analysis (LPA), identifying three classes. We used Structural Equation Modeling to regress the emergent classes on child sex, race, age, family's economic status, and education level, and on caregiver's perception of child weight and temperament. RESULTS: Class 1 had high coercive control and low autonomy practices (69%), Class 2 had high coercive control, but moderate in balance and autonomy practices (16%), and Class 3 were moderate in all practices (15%). Caregiver's perception of child size was associated with classes (P