Examining associations between school-level determinants and the implementation of physical activity opportunities

School-based physical activity (PA) opportunities can help students engage in greater amounts of daily PA, meet PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This exploratory study examined associations between school-level determinants and the implementation of school-based PA opportunities. We analyzed cross-sectional survey data from schools (n = 46) participating in the Healthy Zone School Program (HZSP) (Dallas, Texas, USA) during 2019-2020. Respondents completed an electronic survey that included measures of school-level determinants (e.g. culture, leadership, priority) and the implementation of school-based PA opportunities. We used linear regression models to examine associations between determinants and implementation outcomes (number of PA opportunities delivered, perceived overall success of each PA program/activity used). After adjusting for campus type (i.e. elementary, middle, high, K-12), student race/ethnicity, and percentage of economically disadvantaged students, no constructs were associated with the number of PA opportunities implemented. Linear regression models suggest access to knowledge and information (β = 0.39, P = .012, 95% CI = 0.24-1.44) and implementation climate (β = 0.34, P = .045, 95% CI = 0.02-1.59) were positively associated with the success of school-based PA opportunities. Our findings provide suggestive evidence that access to knowledge and information and a supportive school climate may improve the overall success of PA opportunities provided to students. Future research should examine additional school-level determinants to understand their importance to implementation and inform the development of strategies to improve schools' capacity for implementing PA opportunities successfully.

Using the R = MC2 heuristic to understand barriers to and facilitators of implementing school-based physical activity opportunities: a qualitative study

BACKGROUND

Schools are a key setting for supporting youth physical activity, given their broad reach and diverse student populations. Organizational readiness is a precursor to the successful implementation of school-based physical activity opportunities. The R = MC2 heuristic (Readiness = Motivation x Innovation-Specific Capacity x General Capacity) describes readiness as a function of an organization's motivation and capacity to implement an innovation and can be applied to better understand the implementation process. The purpose of this study was to explore the barriers to and facilitators of implementing school-based physical activity opportunities in the context of organizational readiness.

METHODS

We analyzed interview data from 15 elementary school staff (principals, assistant principals, physical education teachers, and classroom teachers) from a school district in Texas. We focused on factors related to adopting, implementing, and sustaining a variety of school-based physical activity opportunities. We used the Framework Method to guide the analysis and coded data using deductive (informed by the R = MC2 heuristic) and inductive approaches. Themes were generated using the frequency, depth, and richness of participant responses.

RESULTS

Four themes emerged from the data: (1) implementation is aided by the presence of internal and external relationships; (2) physical activity opportunities compete with other school priorities; (3) seeing the benefits of physical activity opportunities motivates school staff toward implementation; and (4) staff buy-in is critical to the implementation process. Themes 1-3 aligned with subcomponents of the R = MC2 heuristic (intra- and inter-organizational relationships, priority, and observability), whereas Theme 4 (staff buy-in) related to multiple subcomponents within the Motivation component but was ultimately viewed as a distinct construct.

CONCLUSION

Our results highlight and explain how key readiness constructs impact the implementation of school-based physical activity opportunities. They also highlight the importance of obtaining staff buy-in when implementing in the school setting. This information is critical to developing readiness-building strategies that help schools improve their capacity to deliver physical activity opportunities effectively.

TRIAL REGISTRATION

Not applicable.

Comparing the Use and Effectiveness of In-Person and Remote Physical Education Delivery During the COVID-19 Pandemic

BACKGROUND

Physical Education is a key component to improve youth health, but there is limited information on Physical Education delivery in different formats.

PURPOSE

We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio.

METHODS

We distributed questionnaires (2020-2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n=216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables.

RESULTS

Among 165 schools, 10% (n=17) offered in-person instruction, 31% (n=51) offered remote instruction, and 59% offered both (n=97). Results revealed higher in-person PE minutes (77.2±7.3) compared to remote minutes (67.1±14.6), but results were not significantly different (p=0.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p<0.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p<0.001).

DISCUSSION

Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE.

TRANSLATION to HEALTH EDUCATION PRACTICE

Efforts are needed to improve remote PE to reinforce high-quality PE in the future.

Examining readiness for implementing practice changes in federally qualified health centers: A rapid qualitative study

Implementing evidence-based interventions remains slow in federally qualified health centers (FQHCs). The purpose of this study is to qualitatively examine the R = MC2 (Readiness = motivation × innovation specific capacity × general capacity) heuristic subcomponents in the context of implementing general and colorectal cancer screening (CRCS)-related practice changes in FQHCs. We conducted 17 interviews with FQHC employees to examine (1) experiences with successful or unsuccessful practice change efforts, (2) using approaches to promote CRCS, and (3) opinions about R = MC2 subcomponents. We conducted a rapid qualitative analysis to examine the frequency, depth, and spontaneity of subcomponents. Priority, compatibility, observability (motivation), intra- and interorganizational relationships (innovation-specific capacity), and organizational structure and resource utilization (general capacity) emerged as highly relevant. For example, organizational structure was described as related to an organization's open communication during meetings to help with scheduling procedures. The results contribute to understanding organizational readiness in the FQHC setting and can be helpful when identifying and prioritizing barriers and facilitators that affect implementation.

Observed and perceived benefits of providing physical activity opportunities in elementary schools: a qualitative study

Introduction

Schools play an important role in promoting physical activity for youth. However, school-based physical activity opportunities often compete with other academic priorities, limiting their implementation. The purpose of this study was to qualitatively explore elementary school teacher and staff perspectives on providing physical activity opportunities and how they impact students and learning.

Methods

We partnered with a school district in Texas to conduct semi-structured individual interviews. We used a purposeful sampling approach to recruit elementary teachers and staff knowledgeable about the physical activity opportunities provided at their school. Interviews included questions about participant opinions of providing physical activity opportunities and the types of opportunities provided. We analyzed data using a directed content analysis and iterative categorization approach.

Results

Fifteen participants (4 teachers, 4 physical education teachers, 3 assistant principals, and 4 principals) completed interviews from 10 elementary schools. Participants discussed observed and perceived benefits when providing physical activity opportunities, which emerged into four themes and subthemes: (1) academic benefits (learning readiness, learning engagement, and academic performance); (2) social-emotional benefits (behavior, interpersonal and social skills, and classroom culture); (3) physical benefits (brain health, skill development, physical health); and (4) instructional benefits (quality teaching time, helpful teaching tools, and teacher-student relationships).

Conclusions

Teachers and staff observed numerous benefits when students had opportunities to be physically active, including the positive impact on academic and social-emotional outcomes. Our findings highlight the alignment of physical activity with other school priorities. Physical activity programming can be used in ways to support academics, learning, behavior, and other important outcomes.

Elementary school staff perspectives on the implementation of physical activity approaches in practice: an exploratory sequential mixed methods study

Introduction

A whole-of-school approach is best to promote physical activity before, during, and after school. However, multicomponent programming is often complex and difficult to deliver in school settings. There is a need to better understand how components of a whole-of-school approach are implemented in practice. The objectives of this mixed methods study were to: (1) qualitatively explore physical activity approaches and their implementation in elementary schools, (2) quantitatively assess implementation levels, and (3) examine associations between school-level physical activity promotion and academic ratings.

Methods

We used an exploratory sequential mixed methods design. We conducted semi-structured qualitative interviews with elementary school staff from a Texas school district and used a directed content analysis to explore physical activity approaches and their implementation. Using qualitative findings, we designed a survey to quantitatively examine the implementation of physical activity approaches, which we distributed to elementary staff district wide. We used Pearson correlation coefficients to examine the association between the amount of physical activity opportunities present in individual schools and school-level academic ratings.

Results

We completed 15 interviews (7 principals/assistant principals, 4 physical educators, and 4 classroom teachers). Elementary school teachers and staff indicated PE and recess implementation was driven from the top-down by state and district policies, while implementation of classroom-based approaches, before and after school programming, and active transport were largely driven from the bottom-up by teachers and school leaders. Teachers and staff also discussed implementation challenges across approaches. Survey respondents (n = 247 from 22 schools) indicated 54.6% of schools were implementing ≥135 min/week of physical education and 72.7% were implementing 30 min/day of recess. Classroom-based approaches were less common. Twenty-four percent of schools reported accessible before school programs, 72.7% reported accessible after school programs, and 27% promoted active transport. There was a direct association between the number of physical activity opportunities provided and school-level academic ratings r(22) = 0.53, p = 0.01.

Conclusion

Schools provided physical activity opportunities consistent with a whole-of-school approach, although there was variability between schools and implementation challenges were present. Leveraging existing school assets while providing school-specific implementation strategies may be most beneficial for supporting successful physical activity promotion in elementary schools.

Using cognitive interviews to improve a measure of organizational readiness for implementation

BACKGROUND

Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC² heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC²) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.

METHODS

We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey.

RESULTS

Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what "better" means).

CONCLUSION

Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.

Evidence-Based Intervention (EBI) Mapping: a systematic approach to understanding the components and logic of EBIs

BACKGROUND

Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. To improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice.

METHODS

We describe EBI Mapping tasks and provide an example of the process. EBI Mapping uses principles from Intervention Mapping, a systematic framework for planning multilevel health promotion interventions. EBI Mapping applies the Intervention Mapping steps retrospectively to help planners understand an existing EBI (rather than plan a new one). We explain each EBI Mapping task and demonstrate the process using the VERB Summer Scorecard (VSS), a multi-level community-based intervention to improve youth physical activity.

RESULTS

EBI Mapping tasks are: 1) document EBI materials and activities, and their audiences, 2) identify the EBI goals, content, and mechanisms of action, 3) identify the theoretical change methods and practical applications of those methods, 4) describe design features and delivery channels, and 5) describe the implementers and their tasks, implementation strategies, and needed resources. By applying the EBI Mapping tasks, we created a logic model for the VSS intervention. The VSS logic model specifies the links between behavior change methods, practical applications, and determinants for both the at-risk population and environmental change agents. The logic model also links the respective determinants to the desired outcomes including the health behavior and environmental conditions to improve the health outcome in the at-risk population.

CONCLUSIONS

EBI Mapping helps program planners understand the components and logic of an EBI. This information is important for selecting, adapting, and scaling-up EBIs. Accelerating and improving the use of existing EBIs can reduce the research-to-practice gap and improve population health.

Applying evidence-based intervention (EBI) mapping to identify the components and logic of colorectal cancer screening interventions

Implementation of evidence-based interventions (EBIs) can help to increase colorectal cancer screening (CRCS). Potential users of CRCS EBIs are often unclear about the specific features, logic, and core elements of existing EBIs, making it challenging to use or adapt them. We used EBI Mapping, a systematic process developed from Intervention Mapping that identifies an EBI's components and logic, to characterize existing CRCS EBIs from the National Cancer Institute's Evidence-Based Cancer Control Programs website. The resulting information can facilitate intervention adoption, adaptation, and/or implementation. Two trained coders independently coded intervention materials to describe intervention components and logic (n = 20). We display CRCS EBI components (potential mechanism of change) using evidence tables and heat maps. All EBIs addressed completion of at least one CRCS behavior (stool-based test, n = 9; stool-based test or another CRCS test, n = 8; colonoscopy, n = 3; colonoscopy or sigmoidoscopy, n = 1). The psychosocial determinants most frequently addressed by these interventions were knowledge (n = 19), attitudes (n = 17), risk perception/perceived susceptibility (n = 16), skills (n = 15), and overcoming barriers (n = 15). Multi-level EBIs (n = 9) attempted to change an average of 2.1 ± 1.1 conditions in the patients' environment (e.g., accessibility of CRCS); only four EBIs used environmental change agents (e.g., providers, nurses). From the heat maps of EBIs, we describe common theoretical change methods' (e.g., facilitation) used for addressing determinants (e.g., overcoming barriers). EBI Mapping can help users identify important components of a CRCS EBI's logic; these proposed mechanisms of action can inform adoption, adaptation, and implementation in new settings, and facilitate scale up of EBIs.

Physical Activity and Healthy Eating Programming in Schools to Support Student's Health-Related Fitness: An Observational Study

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.

Examining the Validity and Reliability of Measures for Individual-Level Constructs related to Implementation of School-Based Physical Activity Approaches

Valid and reliable measures are important to understanding the implementation of physical activity approaches in schools. The study purpose is to examine the psychometric properties of measures of individual-level constructs (knowledge, attitudes, outcome expectations, self-efficacy, innovativeness, and support) in the context of implementing school-based physical activity approaches. We collected data from a sample of elementary school employees (administrators, classroom teachers, physical educators, and support staff) from an urban school district in southeast Texas. Confirmatory factor analysis (CFA) models were used to examine structural validity. We also examined correlations between constructs to assess discriminant and convergent validity. Last, we used a CFA-based approach to examine scale reliability. The analytic sample consisted of 205 employees. CFA results for each individual measure revealed good-fitting models for most measures (χ²(df)>0.05, RMSEA<0.08, CFI>0.90, TLI>0.90, SRMR≤0.07). A combined model that included all the measures also indicated good fit across indices: χ2(306)=485, p<0.001; RMSEA=0.05, CFI=0.93, TLI=0.92, SRMR=0.07. All correlations between constructs were <0.70, and all but one construct (innovativeness) demonstrated moderate correlations with support for classroom-based physical activity approaches (>0.30). In addition, reliability point estimates were all >0.70. The measures tested in this study were found to have good reliability, as well as good structural, discriminant, and convergent validity. These measures are useful in efforts to better understand how individual-level constructs relate to implementation behaviors for physical activity approaches in schools.

Examining the effectiveness of physical activity interventions for children with autism spectrum disorders - A systematic review

Obesity represents a significant threat to quality of life and overall health for typically and a typically developing children with those diagnosed with Autism Spectrum Disorder (ASD) having obesity prevalence at least as high as their typically developing counterparts. A systematic review was conducted on publications describing physical activity interventions with children and adolescents diagnosed with Autism Spectrum Disorder (ASD). We searched Ovid PubMed, Medline, Cochrane Library, PsycINFO, PsycNET, Academic Search Complete, and CINAHL, as well as the citations of publications included in the study. Intervention characteristics such as study design, participant age, sample size, mode, frequency, duration, and intensity of activity were abstracted for review. Sixteen studies were selected for review. Aerobic and anaerobic activities were employed across school and community-based settings. Evidence suggests that increasing physical activity in children and adolescents with ASD is likely to improve BMI and physical fitness.

Examining the Validity and Reliability of Measures for Individual-Level Constructs Related to Implementation of School-Based Physical Activity Approaches

Valid and reliable measures are important to understanding the implementation of physical activity approaches in schools. The study purpose is to examine the psychometric properties of measures of individual-level constructs (knowledge, attitudes, outcome expectations, self-efficacy, innovativeness, and support) in the context of implementing school-based physical activity approaches. We collected data from a sample of elementary school employees (administrators, classroom teachers, physical educators, and support staff) from an urban school district in southeast Texas. Confirmatory factor analysis (CFA) models were used to examine structural validity. We also examined correlations between constructs to assess discriminant and convergent validity. Last, we used a CFA-based approach to examine scale reliability. The analytic sample consisted of 205 employees. CFA results for each individual measure revealed good-fitting models for most measures (χ2 (df) >0.05, RMSEA <0.08, CFI >0.90, TLI >0.90, SRMR≤0.07). A combined model that included all the measures also indicated good fit across indices: χ2(306) = 485, p <0.001; RMSEA = 0.05, CFI = 0.93, TLI = 0.92, SRMR = 0.07. All correlations between constructs were <0.70, and all but one construct (innovativeness) demonstrated moderate correlations with support for classroom-based physical activity approaches (>0.30). In addition, reliability point estimates were all >0.70. The measures tested in this study were found to have good reliability, as well as good structural, discriminant, and convergent validity. These measures are useful in efforts to better understand how individual-level constructs relate to implementation behaviors for physical activity approaches in schools.

The relation between individual-level factors and the implementation of classroom-based physical activity approaches among elementary school teachers

Classroom-based physical activity approaches can improve students' physical activity; however, their implementation remains a challenge. This study examined teacher-level factors associated with implementing two classroom-based physical activity approaches (active learning and physical activity breaks). We collected cross-sectional survey data from classroom teachers (n = 133) from 20 elementary schools in an urban Texas school district. Surveys included questions about theoretical constructs (e.g., knowledge, self-efficacy), personal characteristics (e.g., age, gender), and the implementation of active learning and physical activity breaks. We used linear regression models to assess associations between independent variables and implementation outcomes. We also assessed variable importance by examining the unique variance explained. Knowledge (b = .31, p = .001), outcome expectations (b = .18, p = .015), self-efficacy (b = .40, p ≤ .001), and support (b = .22, p = .028) were directly associated with active learning implementation. Teacher physical activity level (b = .29, p = .004) and grade level (third to fifth had lower levels than kindergarten to second grade, b = -.45, p = .022) were also associated with active learning implementation. In fully adjusted models, self-efficacy explained the most variance (≈5%) in active learning implementation compared to other variables. Knowledge (b = .18, p = 0.026), attitudes (b = .18, p = .019), self-efficacy (b = .15, p = .036), and teacher grade level (third to fifth had lower levels than kindergarten to second grade, b = -.80, p < .001) were associated with activity break implementation. In fully adjusted models, teacher grade level explained the most variance (≈13%) in activity break implementation compared to other variables. Results suggest multiple theoretical constructs and personal characteristics are important to target/consider when developing implementation strategies for classroom-based physical activity approaches. Additionally, self-efficacy and teacher grade level are two factors to prioritize.

Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10545-x.

Y-PATHS: A Conceptual Framework for Classifying the Timing, How, and Setting of Youth Physical Activity

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.

Development of a comprehensive measure of organizational readiness (motivation × capacity) for implementation: a study protocol

BACKGROUND

Organizational readiness is important for the implementation of evidence-based interventions. Currently, there is a critical need for a comprehensive, valid, reliable, and pragmatic measure of organizational readiness that can be used throughout the implementation process. This study aims to develop a readiness measure that can be used to support implementation in two critical public health settings: federally qualified health centers (FQHCs) and schools. The measure is informed by the Interactive Systems Framework for Dissemination and Implementation and R = MC2 heuristic (readiness = motivation × innovation-specific capacity × general capacity). The study aims are to adapt and further develop the readiness measure in FQHCs implementing evidence-based interventions for colorectal cancer screening, to test the validity and reliability of the developed readiness measure in FQHCs, and to adapt and assess the usability and validity of the readiness measure in schools implementing a nutrition-based program.

METHODS

For aim 1, we will conduct a series of qualitative interviews to adapt the readiness measure for use in FQHCs. We will then distribute the readiness measure to a developmental sample of 100 health center sites (up to 10 staff members per site). We will use a multilevel factor analysis approach to refine the readiness measure. For aim 2, we will distribute the measure to a different sample of 100 health center sites. We will use multilevel confirmatory factor analysis models to examine the structural validity. We will also conduct tests for scale reliability, test-retest reliability, and inter-rater reliability. For aim 3, we will use a qualitative approach to adapt the measure for use in schools and conduct reliability and validity tests similar to what is described in aim 2.

DISCUSSION

This study will rigorously develop a readiness measure that will be applicable across two settings: FQHCs and schools. Information gained from the readiness measure can inform planning and implementation efforts by identifying priority areas. These priority areas can inform the selection and tailoring of support strategies that can be used throughout the implementation process to further improve implementation efforts and, in turn, program effectiveness.

Associations between gender, school socioeconomic status, and cardiorespiratory fitness among elementary and middle school students

Background

Schools play an important role in providing access to physical activity opportunities for children. There are common economic and gender disparities in physical activity and health-related fitness among children, which may inform a school’s programming needs. The purpose of this study is to gain a better understanding about gender, school-level socioeconomic status, and children’s cardiorespiratory fitness.

Methods

This observational study used 2017–2018 school year data from schools in the Dallas Metropolitan area participating in the Healthy Zone School (HZS) program. Three data sources were integrated: 1) FitnessGram® data, 2) school-level data from the Texas Education Agency, and 3) HZS survey data. Being in the Healthy Fitness Zone (HFZ) for aerobic capacity was the dependent variable, and gender and the percentage of economically disadvantaged students (at the school-level) were key independent variables. Mixed-effects logistic regression models examined associations between dependent and independent variables. Final models were adjusted for age and type of aerobic test.

Results

There were 67 schools and 15,052 students included in the analysis. When testing main effects, girls had lower odds for being in the HFZ for aerobic capacity than boys (OR = 0.54, CI = 0.47–0.62). Additionally, having a greater percentage of students who were economically disadvantaged was associated with lower odds for being in the HFZ for aerobic capacity (0.98, CI = 0.98–0.99). There was a significant interaction between gender and the percentage of economically disadvantaged students. Results indicated girls had even lower odds (than boys) for being in the HFZ in schools with 90% economically disadvantaged students (OR = 0.44, CI = 0.35–0.55) versus in schools with 15% economically disadvantage students (OR = 0.62, CI = 0.51–0.76).

Conclusions

Results suggest girls in Healthy Zone Schools have lower odds to meet aerobic capacity fitness standards than boys. Additionally, boys and girls in schools serving a greater percentage of economically disadvantaged students have lower odds to meet aerobic capacity fitness standards. Last, girls have even lower odds of meeting HFZ standard when attending a school serving a greater percentage of economically disadvantaged students. Thus, schools need to provide more programs for girls targeting aerobic physical activity. This is especially important for schools serving a high percentage of low-income students.

Organizational Culture and Implications for Workplace Interventions to Reduce Sitting Time Among Office-Based Workers: A Systematic Review

Background: Time spent in sedentary behaviors is an independent risk factor for several chronic diseases (e.g., cardiometabolic diseases, obesity, type 2 diabetes, and hypertension). Recently, interventions to reduce sitting time at work (a prominent sedentary behavior) have been developed and tested. Organizational culture plays a critical role in the success of workplace interventions. However, there are a limited number of studies that have examined the role of organizational culture in reducing sitting time in the workplace.

Objectives: Therefore, in this systematic review, we summarized the empirical literature investigating organizational culture and sedentary behavior in the workplace and identify gaps in the knowledge base.

Methods: We described the procedures of our systematic review and included two study flow diagrams that detailed the step by step process. Combinations of several search terms were used; the databases searched were PubMed, Medline, Academic Search Complete, and Google Scholar. We started with thousands of citations. After applying the inclusion and exclusion criteria, eight relevant articles were identified.

Results: For each identified article, the data extracted included citation, sample, objective, intervention, assessment of organizational culture and workplace sitting, findings, and implications. Each article was rated for risk of bias by population, intervention, comparator, outcomes, and study design (PICOS) analysis. The classification for each study was either: high-, moderate-, or low-quality evidence. Given the paucity of data, no definitive conclusions were presented; however, positive trends were highlighted.

Conclusions: Work place interventions to reduce sitting time at work may benefit from considering elements of organizational culture; however, the evidence to date is sparse and more high-quality studies in this area are needed. To advance the field of workplace health promotion, organizational culture, and interventions to reduce sitting at work, we present 11 recommendations.

Enrichment of cis-regulatory gene expression SNPs and methylation quantitative trait loci among bipolar disorder susceptibility variants

We conducted a systematic study of top susceptibility variants from a genome-wide association (GWA) study of bipolar disorder to gain insight into the functional consequences of genetic variation influencing disease risk. We report here the results of experiments to explore the effects of these susceptibility variants on DNA methylation and mRNA expression in human cerebellum samples. Among the top susceptibility variants, we identified an enrichment of cis regulatory loci on mRNA expression (eQTLs), and a significant excess of quantitative trait loci for DNA CpG methylation, hereafter referred to as methylation quantitative trait loci (mQTLs). Bipolar disorder susceptibility variants that cis regulate both cerebellar expression and methylation of the same gene are a very small proportion of bipolar disorder susceptibility variants. This finding suggests that mQTLs and eQTLs provide orthogonal ways of functionally annotating genetic variation within the context of studies of pathophysiology in brain. No lymphocyte mQTL enrichment was found, suggesting that mQTL enrichment was specific to the cerebellum, in contrast to eQTLs. Separately, we found that using mQTL information to restrict the number of single-nucleotide polymorphisms studied enhances our ability to detect a significant association. With this restriction a priori informed by the observed functional enrichment, we identified a significant association (rs12618769, P(bonferroni)<0.05) from two other GWA studies (TGen+GAIN; 2191 cases and 1434 controls) of bipolar disorder, which we replicated in an independent GWA study (WTCCC). Collectively, our findings highlight the importance of integrating functional annotation of genetic variants for gene expression and DNA methylation to advance the biological understanding of bipolar disorder.

S3-5: Next Generation Sequencing Reveals Co-Activating Events in the MAPK and P13K/AKT Pathways in Metastatic Triple Negative Breast Cancers

INTRODUCTION: The clinical application of next generation sequencing to comprehensively characterize groups of driving mutations in individual metastatic triple negative breast cancer (mTNBC) genomes has the potential to reveal therapeutically relevant pathway dependencies. Towards this end, we harvested tissue from 14 patients with mTNBC and are conducting deep whole genome and transcriptome sequencing for each case to identify mutations that can guide therapeutic targeting within available phase I/II clinical trials.

METHODS: Metastatic tumor tissue was harvested from 14 mTNBC patients, and 7 samples have undergone total genome and transcriptome sequencing with the others currently underway. We are utilizing the Life Technologies SOLiD® system to sequence germline and tumor DNA to sufficient depth to identify somatic genome alterations including point mutations, indels, and structural events including translocations. Furthermore, RNA-seq is being performed on these tumors, along with a series of age- and ethnicity-matched normal breast controls to perform deep differential expression analysis, isoform expression analysis, and fusion transcript detection. Our team of genome scientists and clinical oncologists are evaluating the sequencing findings and are prioritizing the investigational therapeutic options for each patient.

RESULTS: Our whole genome and transcriptome sequencing study has revealed numerous known and novel mutations in mTNBC. However, all patients’ cancers analyzed to date had alterations that would activate the MAPK pathway, but through various mechanisms in different patients. These include BRAF amplification and overexpression, NF1 homozygous deletion, and consistent IQGAP3 overexpression. Furthermore, all patients’ cancers also harbor mutations that would activate the PI3K/AKT pathway including PTEN homozygous deletion or down-regulation, consistent INPP4B down-regulation, FBXW7 homozygous deletion, and ERAS overexpression. Moreover, although we and others show ERBB4 down-regulation in breast tumors, we are the first to report unique somatic genomic events that significantly alter the ERBB4 locus leading to its loss in the majority (5/7) of our patients’ tumors. Importantly, we are beginning to use these insights to prioritize therapeutic targeting and have observed that one chemotherapy-refractory mTNBC patient, with a high-level BRAF amplification/overexpression along with down-regulation of PTEN and INPP4B, had a major response to combined mek plus akt inhibitors on a phase I study.

CONCLUSIONS: Comprehensive genomic and transcriptomic interrogation of mTNBCs has revealed events supporting co-activation of the MAPK and PI3K/AKT pathways in all the tumors albeit by different mutational mechanisms and supports potential effectiveness of combination therapy in the treatment of mTNBC. We plan to treat these patients with combined mek plus akt inhibitors on a new phase I study beginning in August 2011 to determine the effectiveness of co-inhibition of these pathways based on this frequent genomic context.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S3-5.

Genome-wide association study of CSF biomarkers Abeta1-42, t-tau, and p-tau181p in the ADNI cohort

OBJECTIVES

CSF levels of Aβ1-42, t-tau, and p-tau181p are potential early diagnostic markers for probable Alzheimer disease (AD). The influence of genetic variation on these markers has been investigated for candidate genes but not on a genome-wide basis. We report a genome-wide association study (GWAS) of CSF biomarkers (Aβ1-42, t-tau, p-tau181p, p-tau181p/Aβ1-42, and t-tau/Aβ1-42).

METHODS

A total of 374 non-Hispanic Caucasian participants in the Alzheimer's Disease Neuroimaging Initiative cohort with quality-controlled CSF and genotype data were included in this analysis. The main effect of single nucleotide polymorphisms (SNPs) under an additive genetic model was assessed on each of 5 CSF biomarkers. The p values of all SNPs for each CSF biomarker were adjusted for multiple comparisons by the Bonferroni method. We focused on SNPs with corrected p<0.01 (uncorrected p<3.10×10(-8)) and secondarily examined SNPs with uncorrected p values less than 10(-5) to identify potential candidates.

RESULTS

Four SNPs in the regions of the APOE, LOC100129500, TOMM40, and EPC2 genes reached genome-wide significance for associations with one or more CSF biomarkers. SNPs in CCDC134, ABCG2, SREBF2, and NFATC4, although not reaching genome-wide significance, were identified as potential candidates.

CONCLUSIONS

In addition to known candidate genes, APOE, TOMM40, and one hypothetical gene LOC100129500 partially overlapping APOE; one novel gene, EPC2, and several other interesting genes were associated with CSF biomarkers that are related to AD. These findings, especially the new EPC2 results, require replication in independent cohorts.

Genome-wide SNP genotyping study using pooled DNA to identify candidate markers mediating susceptibility to end-stage renal disease attributed to Type 1 diabetes

AIMS

Genetic factors play a major role in the progression of kidney disease in diabetes. To identify candidate single nucleotide polymorphisms (SNPs) with potential effects on susceptibility to end-stage renal disease (ESRD), we performed a whole genome association scan using pooled DNA from Caucasian individuals with Type 1 diabetes.

METHODS

We utilized the Illumina Infinium II HumanHap 550 beadchip platform to genotype 555 352 SNPs in DNA pools comprised of 547 cases with ESRD and 549 control subjects with Type 1 diabetes duration > 20 years and no ESRD. Pooled probe intensity was used to predict mean allele frequency (MAF) for each locus. Individual genotyping was performed using the iPLEX assay in conjunction with the MassARRAY platform (Sequenom).

RESULTS

We identified 2870 markers showing substantial differences in MAF (5.0-10.7%) between pools. To initiate validation of these findings, we genotyped 22 high-ranking markers in 462 individuals with ESRD and 470 unaffected control subjects selected from the genome-wide SNP genotyping study sample. We observed the strongest evidence for association between ESRD and rs1749824, located in the ZMIZ1 gene [OR = 1.47 (1.21-1.78) per copy of T allele; P = 8.1 x 10(-5)] and rs9298190, located in the musculin gene [OR = 1.56 (1.28-1.91) per copy of C allele; P = 1.6 x 10(-5)]. Evidence for nominal association with markers in or near the IRS2, TMPO, BID, KLRA1, ELMO1 and CNDP1 genes was also observed (P < or = 0.0006).

CONCLUSIONS

These findings identify several novel loci which may contribute to ESRD susceptibility in individuals with Type 1 diabetes.

Genome-wide linkage analysis of ADHD using high-density SNP arrays: novel loci at 5q13.1 and 14q12

Previous genome-wide linkage studies applied the affected sib-pair design; one investigated extended pedigrees of a genetic isolate. Here, results of a genome-wide high-density linkage scan of attention-deficit/hyperactivity disorder (ADHD) using an array-based genotyping of approximately 50 K single nucleotide polymorphism (SNPs) markers are presented. We investigated eight extended pedigrees of German origin that were non-related, not part of a genetic isolate and ascertained on the basis of clinical referral. Two parametric analyses maximizing LOD scores (MOD) and a non-parametric analysis for both a broad and a narrow phenotype approach were conducted. Novel linkage loci across all families were detected at 2q35, 5q13.1, 6q22-23 and 14q12, within individual families at 18q11.2-12.3. Further linkage regions at 7q21.11, 9q22 and 16q24.1 in all families, and at 1q25.1, 1q25.3, 9q31.1-33.1, 9q33, 12p13.33, 15q11.2-13.3 and 16p12.3-12.2 in individual families replicate previous findings. High-resolution linkage mapping points to several novel candidate genes characterized by dense expression in the brain and potential impact on disorder-relevant synaptic transmission. Our study provides further evidence for common gene effects throughout different populations despite the complex multifactorial etiology of ADHD.

Structural insights into the mechanical regulation of molecular recognition sites

Intriguing experimental and computational data are emerging to suggest that mechanical forces regulate the functional states of some proteins by stretching them into nonequilibrium states. Using the extracellular matrix protein fibronectin as an example, we discuss molecular design principles that might control the exposure of a protein's recognition sites, and/or their relative distances, in a force-dependent manner. Fibronectin regulates many cellular functions by binding directly to integrins. Although integrins have a key role in the transduction of force across the cell membrane by coupling the extracellular matrix to the cytoskeleton, the studies reviewed here suggest that fibronectin might be one of the molecules responsible for the initial transformation of mechanical force into a biochemical signal.

Regulation of the 2-oxoglutarate dehydrogenase lipoate succinyltransferase complex from cauliflower by nucleotide. Pre-steady state kinetics and physical studies

Analysis of the binding of thiamin pyrophosphate to the 2-oxoglutarate dehydrogenaselipoate succinyltransferase multienzyme complex using pre-steady state kinetic methods revealed that the presence of 2-oxoglutarate is not necessary for binding, although it does stabilize the complex by slowing the rate of dissociation of the holoenzyme. The rate of binding of thiamin-PPi to the enzyme and the subsequent enzyme activation are not limited by a reaction at C-2 of the thiazolium ring of thiamin-PPi since no kinetic isotope effect is observed when 2-D-thiamin-PPi is substituted for the protonated cofactor. The presence of 5'-AMP, which activates the reaction producing both a V and a Km response, causes a significant increase in kon for thiamin-PPi. The AMP analog 1,N6-ethenoadenosine-5'-monophosphate (epsilon-AMP) also activates the reaction, but shows only a K effect, with no influence on V. This effector reduces Kd for the thiamin-PPi2-oxoglutarate dehydrogenase complex by increasing kon. The change in kon for thiamin-PPi in response to changes in hydrogen ion concentration shows pK values which are unaffected by the addition of AMP, in this respect resembling the steady state kinetic response of V/Km and differing from the pH profile of V. The dissociation constant of holoenzyme is relatively insensitive to pH over the range pH 6 to 9, but in the presence of AMP the Kd, which is decreased in the range from pH 7 to 8, increases sharply at higher or lower pH values.

Structural mapping of rabbit muscle phosphofructokinase. Distance between the adenosine cyclic 3',5'-phosphate binding site and a reactive sulfhydryl group

The cAMP binding site of rabbit muscle phosphofructokinase has been labeled with the fluorescent molecule 5'-(p-fluorosulfonylbenzoyl)-2-aza-1,N6-ethenoadenosine. The most reactive sulfhydry- group of this modified enzyme, which is catalytically active, has been labeled with 7-chloro-4-nitrobenzo-2-oxa-1,3-diazole and with N-]4-(dimethylamino)-3,5-dinitrophenyl]maleimide. The calculated distances between the cAMP binding site and the most reactive sulfhydryl group, as determined by resonance energy transfer measurements, are 31 and 26 A, respectively, for the two sulfhydryl group labels. Both steady-state and fluorescent -ifetime techniques were used to measure the energy transfer efficiencies in 50 mM potassium phosphate (pH 8.0) and 1 mM ethylenediaminetetraacetic acid, and a value of 2/3 was assumed for the donor-acceptor orientation factor. If the difference in calculated distances is attributed to a difference in the orientation factor for the two donor-acceptor ,airs, the actual distance between the cAMP ligand binding site and the most reactive sulfhydryl group on phosphofructokinase is shown to be 28 +/- 6 A.

Effects of magnification and observation time on target identification in simulated orbital reconnaissance

When deciding what telescopic power is required to find objects of interest on the ground while flying over the earth at relatively high speeds, the positive value of an increased magnification must be balanced against the negative effects of a decreased observation time and an increased movement rate. The relative trade-off between these two factors—magnification and time—was compared in a series of three studies in which photographic imagery was used to simulate a telescopic view of the earth from a spacecraft orbiting at 175 nautical miles. Target acquisition decreased as image scale factor decreased and as image movement rate increased. When a change in scale factor was inversely proportional to a change in observation time, the positive effects of an increased image scale factor tended to exceed the negative effects of a decreased observation time and increased image movement rate within the limits of this study. The theoretical and practical implications of these and other results are discussed.