Healthy Kids Research Articles

The 2022 India Report Card on physical activity for children and adolescents

Background/ObjectiveWith strong evidence of physical inactivity's link to chronic disease and economic burden – particularly with childhood active living behaviors tracking into adulthood – it is imperative to promote physical activity among children and adolescents in India. ObjectivesTo evaluate active living patterns among Indian children and adolescents. MethodsThe India Report Card (IRC) team, which consists of experts in India and Canada, systematically collected and appraised evidence on 11 indicators of active living, including 5 behavioral (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior), 2 individual-level (Physical Fitness, Yoga) and 4 sources of influence (Family and Peers, School, Community and Built Environment, Government). Peer-reviewed articles were appraised based on national representativeness, sample size, and data quality. Grey literature was appraised based on comprehensiveness, validity of the sources, and representativeness. All indicators were assessed against parameters provided by the Active Healthy Kids Global Alliance. ResultsActive Transportation and Government Strategies were ranked highest with a B- and C+ grade, respectively. Overall Physical Activity and Schools were assigned a C grade, while Sedentary Behavior and Community and Built Environment were given D grades. Yoga was the lowest ranking indicator with a D- grade. Organized Sport Participation, Active Play, Family and Peers, and Physical Fitness were all graded incomplete. ConclusionsActive Transportation, Government Strategies, and Overall Physical Activity have improved since the 2018 IRC, a positive trend that needs to be translated to other indicators. However, Sedentary Behavior has consistently worsened, with grades C, C-, and D-, in 2016, 2018, and 2022, respectively. Evidence generated by the 2022 IRC suggests opportunities for improvement not only in India, but also the 56 other countries taking part in Global Matrix 4.0.

Report card grades on physical activity for children and adolescents from 18 Asian countries: Patterns, trends, gaps, and future recommendations

Background/ObjectivePhysical inactivity is a persistent and worsening population health concern in Asia. Led by the Active Healthy Kids Global Alliance, Global Matrix (GM) initiative provides an opportunity to explore how regional and cultural differences across 18 Asian countries relate to physical activity (PA) participation among children and adolescents. The purpose of study was to synthesize evidence from the GM2.0 to GM4.0 (2016–2022) in Asian countries. MethodsReport Card grades on behavioral/individual and sources of influence indicators were reported from 18 Asian countries. Letter grades were converted into numerical values for quantitative analyses. Based on this, cross-sectional and longitudinal analyses were conducted to investigate patterns and trends. Qualitative evidence synthesis was performed based on Report Card grades and published papers to identify gaps and suggest future recommendations. ResultsIn total, 18 countries provided grades for at least one round of GM, 12 countries provided grades for at least two rounds, and seven countries provided grades for all three GMs. Of possible grades, 72.8%, 69.2%, and 76.9% of the grades were assigned from GM 2.0 to GM 4.0, respectively. In terms of the Report Card grades, there was a slight decrease in behavioral/individual indicators from “D+” in GM 2.0 to “D-” in GM 3.0 but this reverted to “D” in GM 4.0. For the sources of influence, a “C” grade was given in all three rounds of GM. Longitudinal observation of seven Asian countries that provided grades in all three rounds of GM revealed that grades are generally stable for all indicators with some country-specific fluctuations. In future GM initiatives and research, considerations should be made to provide more accurate and rich data and to better understand contextual challenges in evaluating certain indicators such as Active Transportation, Active Play, and Physical Fitness in particular. Further, macro level factors such as socioeconomic/cultural disparities and gender-specific barriers, ideology, or climate change should also be proactively considered in future research as these factors are becoming increasingly relevant to indicators of GM and United Nation's Sustainable Development Goals. ConclusionsParticipation from Asian countries in GM has increased over the years, which demonstrates the region's enthusiasm, capacity, and support for global PA promotion efforts. The efforts to promote a physically active lifestyle among children and adolescents should be a collective interest and priority of the Asia region based on the gaps identified in this paper.

Results from the Singapore 2022 report card on physical activity for children and adolescents

Background/ObjectiveWhile it has been established that physical activity (PA) is key to promote overall health and well-being, insufficient physical activity among children and adolescents is a global problem, including Singapore. It is important to understand the local PA landscape among children and adolescents to decrease surveillance gaps and identify areas for improvement in promoting PA. The present article provides an overview of the development of the 2022 Active Healthy Kids Singapore Report Card and the results, as well as underscore limitations and gaps in the available evidence related to PA among children and adolescents in Singapore. MethodsFollowing the Global Matrix 4.0, the available data between July 2010 to July 2020 was synthesized for all 10 indicators by the work group and reviewed by a panel of experts. Data sources included published scientific articles, government and non-government reports, national surveys, and unpublished data from on-going research studies. Where possible, grades were informed by nationally representative surveys or large-scale longitudinal studies. ResultsThe grades assigned were: Overall Physical Activity (C-), Organized Sport and Physical Activity (B-), Active Play (C-), Active Transportation (C), Sedentary Behaviours (C-), Physical Fitness (Incomplete), Family and Peers (C-), School (Incomplete), Community and Environment (A+), Government (B). ConclusionThis is the first comprehensive evaluation of PA among children and adolescents in Singapore. It provides baseline grades valuable for future comparison. It also illustrates gaps in the existing evidence which can inform future surveillance, facilitate international comparisons and enable global efforts in promoting physical activity.

Results from the Lebanese 2022 report card on physical activity for children and youth

Background/ObjectiveThe Lebanese Active Healthy Kids Work Group (LAHKWG) synthesized literature published on physical activity (PA) indicators among ages 5- to 17- year-olds, using a recommended harmonized process by the Active Healthy Kids Global Alliance (AHKGA), to explore Lebanon's performance since its previous report card publication. MethodsPeer reviewed literature, national surveys, and gray literature published since 2017, on 10 common AHKGA and two LAHKWG recommended indicators were examined. Common indicators included overall PA, organized sport and PA, active play, active transportation, community and environment, sedentary behaviors, physical fitness, family and peers, school, and government. LAHKWG recommended indicators were sleep and weight status. LAHKWG members reviewed 764 records, of which 28 were selected for full review. A grade was assigned for each indicator using AHKGA's grading rubric and established benchmarks on data from nationally representative samples for children and youth. ResultsData from one nationally representative sample were available for ages 13–17 years (i.e., no data <13 years). Five indicators received “Incomplete” (organized sport and PA; active Play; physical fitness; family and peers; community and environment); overall PA received a D-; active transportation and sleep received a D+; school and government received a D; sedentary behaviors received a C; and weight status received a B-. ConclusionThe LAHKWG strongly encourages stakeholders to take concrete actions towards prioritizing PA promotion at a national level especially in the education sector. Offering more quality PA opportunities for Lebanese children and youth will be beneficial for their physical and mental health in any context.

Collateral consequences of the school-to-prison pipeline: Adolescent substance use and developmental risk

ObjectiveThe adolescent health consequences of the school-to-prison pipeline remain underexplored. We test whether initiating components of the school-to-prison pipeline—suspensions, expulsions, and school policing—are associated with higher school-average levels of student substance use, depressed feelings, and developmental risk in the following year. MethodWe linked 2003–2014 data from the California Healthy Kids Survey and the Civil Rights Data Collection from over 4,800 schools and 4,950,000 students. With lagged multi-level models, we estimated relationships between the school prevalence of total discipline, out-of-school discipline, and police-involved discipline, and standardized school-average levels of 6 substance use measures and 8 measures of developmental risk, respectively. ResultsThe prevalence of school discipline predicted subsequent school-mean substance use and developmental risk. A one-unit higher prevalence of total discipline predicted higher school levels (in standard deviations) of binge drinking alcohol (0.14, 95% CI: 0.11, 0.17), drinking alcohol (0.15, 95% CI: 0.12, 0.18), smoking tobacco (0.09, 95% CI: 0.06, 0.12), using cannabis (0.16, 95% CI: 0.14, 0.19), using other drugs (0.17, 95% CI: 0.14, 0.21), and violence/harassment (0.16, 95% CI: 0.12, 0.2). Total discipline predicted lower levels of reported community support (−0.07, 95% CI: −0.1, −0.05), feeling safe in school (-0.12, 95% CI: −0.16, −0.09), and school support (−0.16, 95% CI: −0.19, −0.12). Associations were greater in magnitude for more severe out-of-school discipline. Findings were inconsistent for police-involved discipline. ConclusionExclusionary school discipline and school policing—core elements of the school-to-prison pipeline—are previously unidentified population predictors of adolescent substance use and developmental risk.

Comparing Substance Use and School-Based Stressors Among Black and Latinx Transgender Youth and Peers With Shared Minoritized Identities

PurposeThe aim of this study is to compare substance use and school-based stressors among Black and Latinx transgender youth (trans BLY), White transgender youth (trans WY), and Black and Latinx cisgender youth (cis BLY) and identify associations between substance use and stressors among trans BLY. MethodsWe analyzed 2015–2017 Biennial California Healthy Kids Survey data with a weighted sample of the state’s secondary school population. The analytic sample included 9th and 11th grade trans BLY, trans WY, and cis BLY. Past 30-day and lifetime substance use (cigarettes, e-cigarettes/vaping, marijuana, and alcohol) and school-based stressors (victimization, race-, gender-, and sexuality-based harassment) were compared between cohorts via logistic regression. For trans BLY, associations between substance use and stressors were assessed via logistic regression. ResultsThe analytic sample (n = 19,780) included 252 trans BLY, 104 trans WY, and 19,424 cis BLY. Among trans BLY, estimated prevalence of 30-day (and lifetime) use of cigarettes, e-cigarette/vaping, marijuana, and alcohol were 13% (23%), 19% (39%), 27% (42%), and 29% (48%), respectively. Trans BLY had similar odds of 30-day and lifetime use of all substances compared to trans WY but higher odds of use compared to cis BLY. For trans BLY, race- and gender-based harassment and higher victimization levels were associated with higher odds of 30-day and lifetime use of all substances. Sexuality-based harassment was associated with higher odds of 30-day and lifetime marijuana and alcohol use. DiscussionTrans BLY have high prevalence of substance use, comparable with trans WY but higher than cis BLY. Substance use among trans BLY is associated with school-based stressors.

Results from the Philippines' 2022 report card on physical activity for children and adolescents

Background/ObjectiveThe 2022 Philippine Report Card on Physical Activity for Children and Adolescents provides a comprehensive assessment of physical activity and other related behaviors, including the various factors and settings that influence these behaviors. It serves as an advocacy tool to increase awareness of the physical activity situation among children and young people in the country. This article describes the development and results of the first Philippine Report Card on Physical Activity for Children and Adolescents. MethodsFollowing a systematic process provided by the Active Healthy Kids Global Alliance, a team consisting of 25 sports and physical activity specialists identified and reviewed the best available nationally representative data related to physical activity indicators. These data were then used to inform the grades of the ten (10) physical activity indicators. ResultsSufficient data were identified to assign grades to five (5) indicators: Overall Physical Activity (F), Active Transportation (D), Sedentary Behavior (B), School (C-), and Government (B). Insufficient data existed to assign grades to the remaining five (5) indicators: Organized Sport and Physical Activity, Active Play, Physical Fitness, Family and Peers, and Community and Environment. ConclusionDespite government policies related to physical activity in the country, the majority of children and adolescents in the Philippines do not meet the recommended amount of physical activity for health. More work is needed to improve the translation of these policies into measurable programs, highlighting the need to create better physical activity opportunities and develop national surveillance mechanisms.

Team sports participation, depression, and suicidal ideation in lesbian, gay, bisexual, transgender, and questioning adolescents

AbstractRates of depression and suicide are rising in adolescents, with lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth experiencing higher rates. We examined the relationship between team sports participation, depression, and suicidal ideation among a representative sample of adolescents (n = 46,537) in the Healthy Kids Colorado Survey. Logistic regression models using team sports participation to predict depression and suicidal ideation for heterosexual; lesbian, gay, bisexual, and questioning (LGBQ); cisgender; and transgender youth demonstrated that team sports participation was associated with reduced likelihood of depression in all groups and reduced likelihood of suicidal ideation in all groups except for LGBQ youth. These findings indicate that LGBTQ youth may experience similar mental health benefits of team sports participation as heterosexual and cisgender youth, supporting the importance of inclusive sports policy and programming.

P03-05 State of the Evidence of Active Living among Children and Youth in India: A Scoping Review Informing the Global Matrix 4.0

BackgroundThere is strong evidence of physical inactivity's link to global disease and economic burden. Physical inactivity among Indian children and youth has particular consequences for the global economy, as youth in India make up a substantial proportion of the world's workforce. As part of the 60-country Active Healthy Kids Alliance Global Matrix 4.0 initiative, a systematic scoping review was conducted to appraise the current state of evidence of active living among children and youth in India.MethodsA systematic search of peer-reviewed and grey literature published over the last decade was conducted for 11 indicators of active living: overall physical activity, organized sport participation, active play, active transportation, sedentary behavior, family and peers, school programs and policies, community and built environment, government strategies, physical fitness, and yoga. Data sources included national, state (i.e., province) and city-level surveys, as well as primary data from ongoing longitudinal studies. Relevant grey literature, including government reports and school board policies, were also reviewed.ResultsPhysical activity levels vary widely across India, with children and youth in rural settings accumulating greater moderate-to-vigorous activity and lower screen time compared to their urban counterparts. The majority of Indian children and youth report active transportation, however; they are not meeting recommended physical activity and sedentary behaviour guidelines. Despite the availability of many non-profit and organized programs, several indicators of active living including organized sports, active play, and yoga programming have not been evaluated for uptake or impact. Physical activity type and levels varied significantly across gender and socioeconomic status, with girls belonging to lower socioeconomic status having the greatest disadvantage due to cultural and safety perceptions.ConclusionsWhile the vast majority of Indian children and youth are not accumulating recommended physical activity levels, there are encouraging signs of active transportation and active play?a phenomenon that needs to be further explored in India and other high-, middle- and low-income countries. The findings point to widespread disparities in access to active living resources and infrastructure between urban and rural settings. Targeted programs, policies, and resource allocation are necessary to improve built environment and safety for children and youth.

The short and long-term impact of the healthy kids initiative on depressed mood in youth living with obesity

PurposeThe purpose of this study is to determine the effect of a free, comprehensive program with social support on depressed mood in youth (aged 11–17 years) living with obesity in a prospective, longitudinal, community-based study. MethodsYouth living with obesity (BMI > 30), residing in three cities in Saskatchewan, Canada, were eligible to participate in a 12-week program designed to facilitate behavioural change with five physical activity sessions a week, one dietary session a week, and one group cognitive behavioural session per week offered by health care professionals. Baseline data were collected on depressed mood (Centre for Epidemiological Studies-Depression 12 or CES-D 12), health-related quality of life (SF-12), and self-esteem (NLSCY) at baseline, 12-weeks, and at 52-weeks ResultsOverall, 2598 youth started and 2292 (88.2 %) completed the 12-week program with 1703 (74.3 %) of participants presenting for 52-week follow-up. Depressed mood improved significantly over the course of the program: 79.2 % of participants had depressed mood at the start of the program and this decreased to 64.7 % at the end of 12-weeks; which was an overall relative reduction of 18.4 % (Cohen’s d = 0.94). The mean CES-D 12 score at one-year was significantly lower than the mean baseline score (17.90 compared to 21.11, p < .001). By depressed mood severity, 58.7 % of participants had severe depressed mood at baseline, which reduced to 31.6 % at 12 weeks, and 27.9 % at 52 weeks. Age and maternal occupation were initially significantly associated with depressed mood at 52-week follow-up (unadjusted). However, after binary logistic regression was used to determine the independent risk factors for having depressed mood at 52-week follow up, only older age (OR 1.88, 95 % CI 1.52–2.34, p < .001) was significant. ConclusionThe Healthy Kids Initiative lends more evidence that healthy behavioural interventions can have a positive impact on depressed mood among youth living with obesity.

Flavored Tobacco Sales Restrictions and Teen E-cigarette Use: Quasi-experimental Evidence From California.

Flavored tobacco sales restrictions (FTSRs) are implemented to reduce access to flavored tobacco products. We examined the association between seven cities with local FTSRs implemented in 2018/2019 and e-cigarette use among high school students in the California Bay Area. We analyzed data from the California Healthy Kids Survey using a difference-in-differences (D-I-D) strategy. We compared pre- and post-policy changes one year after implementation in current and ever e-cigarette use among students attending school in a city with a FTSR (exposed) (n = 20 832) versus without (unexposed) (n = 66 126). Other outcomes included ever marijuana use in an e-cigarette and ease of access to e-cigarettes. Pre- to post-policy, the adjusted odds of current and ever e-cigarette use did not significantly change among students exposed and unexposed to a FTSR. In the adjusted D-I-D analysis, the odds of current (aOR: 1.25, 95% CI: 0.95, 1.65) and ever e-cigarette use (aOR: 1.06, 95% CI: 0.89, 1.26) did not significantly change by exposure group. However, one year post-implementation, the odds of ease of access to e-cigarettes significantly increased among exposed (aOR: 1.57, 95% CI: 1.27, 1.95) and unexposed students (aOR: 1.54, 95% CI: 1.39, 1.70). Similarly, the odds of ever using marijuana in an e-cigarette significantly increased among exposed (aOR: 1.35, 95% CI: 1.19, 1.53) and unexposed students (aOR: 1.29, 95% CI: 1.20, 1.39). Local FTSRs in the California Bay Area were not associated with a change in e-cigarette use one year post-implementation. Increased ease of access and marijuana use may be explanatory factors. FTSRs were not associated with a decrease in current or ever e-cigarette use among high school students in the California Bay Area one-year post-implementation. Potential explanatory factors are that ease of access to e-cigarettes and using marijuana in an e-cigarette increased. More research is needed to understand the influence of these factors on youth access and behaviors. To address the youth e-cigarette epidemic, a comprehensive approach is needed, including policies, media campaigns, education programs, and cessation tools targeted to youth.

Physical Activity Policies for Children and Adolescents in Brazil: Analysis for the Report Card Brazil on Physical Activity for Children and Adolescents.

The aim of this study was to investigate physical activity (PA) policies in Brazil through current actions/programs to promote PA for children and adolescents. All 23 official websites of federal government agencies in Brazil [eighteen ministries, two secretariats (linked to ministries) and three ministry equivalent agencies] were visited. All programs/actions were analyzed according to indicators of the Global Matrix project from the Active Healthy Kids Global Alliance (AHKGA) and the Health Enhancing PA Policy Audit Tool, version 2, recommended by the World Health Organization. Furthermore, we used the analysis of “Strengths, Weaknesses, Opportunities and Threats” (SWOT) for the policies. Seventeen programs/actions included the promotion of PA for children and adolescents in Brazil, however, none of them had this as their main objective, and none were planned as a public policy action aimed at the promotion of PA. The overall score of the assessment instrument was 37 (out of a total of 100), which classifies Brazil as having a D+ grade according to AHKGA criteria. Brazil needs to define PA as a state policy so that the actions identified in this study can have positive effects on children and adolescents.

Lesbian, Gay, and Bisexual Students Experiencing Homelessness and Substance Use in the School Context: A Statewide Study.

This study explored differences between lesbian, gay, and bisexual (LGB)-housed and homeless students regarding substance use patterns on and off school grounds and the unique contribution of homelessness to substance use in school. Data were from the 2013-2015 California Healthy Kids Survey, a statewide survey of school protective factors and risk behaviors. A representative sample of 9th- and 11th-grade students (N=20,337) was used. Comparisons between housed (n=19,456) and homeless (doubled up: n=715; acute homeless: n=166) LGB students were conducted. We used chi-square tests to compare rates of lifetime, past-30-day, and in-school substance use and conducted multivariate logistic regression models for each substance use variables. Chi-square test results indicated significant differences in rates of substance use among students experiencing homelessness (both categories) and housed LGB students. Lesbian, gay, and bisexual students experiencing homelessness were more likely to report substance use off and on school grounds. Results from logistic regression analyses indicated that LGB students who experience homelessness were significantly more likely to report recent and in-school substance use. For example, students experiencing acute homelessness were about 3 times as likely to report heavy episodic drinking (adjusted odds ratio [AOR]=3.13; 95% confidence interval [CI]=2.13, 4.26) and more than 5 times as likely to smoke marijuana in school (AOR=5.38; 95% CI=3.46, 8.36), compared to housed LGB students. LGB students who experience homelessness are at higher risk than housed LGB students of substance use on and off school grounds. Findings highlight the need to provide support in the school context for this subpopulation.

Binge drinking disparities by gender identity, race, and ethnicity in California secondary schools

Our objective was to estimate disparities in binge drinking among secondary school students in California at the intersection of gender identity, race, and ethnicity, without aggregating racial and ethnic categories. We combined two years of the statewide middle and high school California Healthy Kids Survey (n = 951,995) and regressed past month binge drinking on gender identity (i.e., cisgender, transgender, or not sure of their gender identity), race (i.e., white, American Indian or Alaskan Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, or multiracial), and ethnicity (i.e., Hispanic/Latinx or non-Hispanic/Latinx), and their interaction. Transgender students had greater odds of reporting past month binge drinking than cisgender students, with greater magnitudes among students with minoritized racial or ethnic identities compared to non-Hispanic/Latinx white students. For example, among non-Hispanic/Latinx white students, transgender students had 1.3 times greater odds (AOR = 1.30, 95% CI = 1.12—1.50), whereas among Hispanic/Latinx Black or African American students, transgender students had 5.3 times greater odds (AOR = 5.33, 95% CI = 3.84—7.39) of reporting past month binge drinking than cisgender students. Transgender adolescents, particularly those with minoritized racial or ethnic identities, may be at disproportionate risk of binge drinking. Interventions that address systemic racism and cisgenderism from an intersectional perspective are needed.

Results from Scotland's 2021 report card on physical activity and health for children and youth: Grades, secular trends, and socio-economic inequalities

Background/ObjectivesThe 2021 Active Healthy Kids Scotland Report Card aimed to identify secular trends and socio-economic inequalities, and to assess the physical activity and health of children and youth prior to COVID-19. MethodsAn expert panel searched for data published in 2018–2020. Grades were assigned to nationally representative data using the Active Healthy Kids Global Alliance methodology. ResultsThe expert panel, following national consultation, awarded the following grades: Community/Environment B-, Organized Sport and Physical Activity B-, Government/Policy C-/C+, Active Transportation C-, Family/Peers D-, Recreational Screen Time F. Five indicators were graded inconclusive (INC): Overall Physical Activity; Active Play; Physical Fitness; Diet; Obesity. Grades have remained stable or declined, and surveillance has reduced, increasing the number of INC grades. There were marked socio-economic inequalities for eight indicators (Recreational Screen Time; Overall Physical Activity; Organized Sport & Physical Activity; Active Transportation; Diet; Obesity; Family/Peers; Community/Environment). ConclusionsDespite a decade of favorable policy, physical activity and health of children and youth has not improved, and marked socio-economic inequalities continue to persist in Scotland. There is a clear need for greater monitoring of physical activity and health, and improved policy implementation and evaluation, particularly as many indicators and related inequalities may have worsened following the COVID-19 pandemic.

Novel Methods of Cannabis Use and Lower Sleep Duration Among High School Students.

The general use of cannabis in adolescence is associated with various sleep deficits. While traditional smoking remains the most common form of cannabis consumption amongst adolescents, novel methods of administration are becoming more popular and available due to legalization. The association of these novel methods of use with sleep in adolescence has yet to be studied and research is needed to inform public health initiatives. High school (9th-12th grade) students from the Healthy Kids Colorado Survey with current cannabis use (n= 4,637) reported on numerous demographic variables, method of cannabis use (flower, edibles, dabs, and vaporizers) and average sleep duration on weeknights. Logistic regression assessed the relationship between novel methods of use (edibles, dabs, and vaporizers) and sleep duration in comparison to cannabis flower. Use of any edible, dab, or vaporizer product in the past 30-days was associated with being male and current tobacco use. Reporting a novel method of use as the most common mode of cannabis use was associated with current tobacco use and higher mothers' education. Students who used any novel method products in the past 30 days or reported these products as the usual mode of cannabis use, were more likely to sleep 7 hours or fewer a night. Novel methods of cannabis administration such as edibles, dabs, and vaporizers are associated with getting less sleep than recommended (7 or less hours), in comparison to those who smoked flower. Sleep outcomes should be a focus of study for novel cannabis products amongst high school adolescents.

WALES 2021 Active Healthy Kids (AHK) Report Card: The Fourth Pandemic of Childhood Inactivity.

This is the fourth Active Healthy Kids (AHK) Wales Report Card. The 2021 card produced grades on children and young people’s physical activity (PA) using pre-COVID-19 data that were not used in previous versions. Eleven quality indicators of PA were graded through expert consensus and synthesis of the best available evidence. Grades were assigned as follows: Overall PA—F; Organised Sport and PA—C; Active Play—C+; Active Transportation—C−; Sedentary Behaviours—F; Physical Fitness—C−; Family and Peer Influences—D+; School—B−; Community and the Built Environment—C; National Government and Policy—C; and Physical Literacy—C−. All but three grades remained the same or decreased from the 2018 AHK-Wales Report Card (Active Play increased from C− to C+; Active Transportation, D+ to C−; Family and Peers, D to D+). This is concerning for children’s health and well-being in Wales, particularly given recent evidence that PA has further decreased during the COVID-19 pandemic. The results from the Report Card should be used to inform the decision making of policy makers, practitioners and educators to improve children and young people’s PA levels and opportunities and decrease PA inequalities.

Lead Toxicity and Environmental Health Justice Stories in Black and White Woodcut Portraits.

Omaha, Nebraska, has a lead-contaminated superfund site and substandard housing that pose risks for childhood lead exposure. Healthy Housing Omaha (formerly, Omaha Healthy Kids Alliance), an environmental health nonprofit, partnered with the fourth author, an artist, and a newspaper to raise awareness about lead poisoning by publishing portraits and stories of affected community members. The authors analyzed an interview with the artist, photographs of portraits published in a local newspaper, and quotations from portrait sitters. Shared stories of lead exposure and poisoning conveyed in the portraiture and printmaking processes revealed structural racism as an emergent theme. Arts-based research methods, such as portraiture, can be scaled and applied to support national and international community engagement efforts to advocate for environmental justice and public health.

Early Weaning and Milk Substitutes Affect the Gut Microbiome, Metabolomics, and Antibody Profile in Goat Kids Suffering From Diarrhea.

Early weaning and milk substitutes increase the incidence of diarrhea in young ruminants, which may modify their gut microbiota, metabolism, immunity, and health. The aim of the study was to determine if early weaning and milk substitutes affect the gut microbiota, metabolism, and immunological status of goat kids suffering from diarrhea. The 16S rRNA gene and metagenomic sequencing in feces and serum metabolomics of early-weaned and artificially reared goat kids suffering from diarrhea (DK group) and healthy goat kids reared by their mothers (HK group) were analyzed. The serum biochemistry and immunoglobulin concentration were also determined. Several probiotics, such as Streptococcus and Lactobacillus, were higher in the feces of the DK group than in feces of the HK group. Ruminococcus sp. was elevated in the feces of HKs, likely being a biomarker for goat health. Taking all the carbohydrate-active enzyme (CAZyme) families into consideration, 20 CAZyme families were different between the groups. Compared with the DK group, the relative quantity of glycoside hydrolases (GH) and glycosyltransferase (GT) families in the HK group decreased. GT70 was only identified in HK kids participating in the activity of β-glucuronosyltransferase during the carbohydrate metabolism. Overall, 24 metabolites were different between the groups, which were mainly involved in protein digestion and absorption, cyanoamino acid metabolism, and cholesterol metabolism. The concentrations of immunoglobulins G and M were significantly lower in the DK than in the HK group. In conclusion, our study characterized the fecal microbiota, metabolism, and immunological status of early-weaned and artificially reared goat kids suffering from diarrhea.

School Garden Prevalence Before and After the Implementation of the Healthy Hunger-Free Kids Act.

The Healthy Hunger-Free Kids Act (HHFKA) of 2010 supported implementation of school gardens for promoting fruit and vegetable consumption. We examined school garden prevalence over time by school-level factors during the period before and after the implementation of HHFKA. Using data from the New Jersey Child Health Study, conducted in 4 low-income New Jersey cities, prevalence of school gardens among K-12 schools (n=148) was assessed between school year 2010-2011 and 2017-2018. Multivariable analysis estimated changes in garden prevalence over time adjusting for school-level factors. Overall, the sample included 97 elementary and 51 middle/high schools. Multivariable logistic regression showed that compared to 2010-2011 (19%) a higher proportion of schools reported having a garden in 2013-2014 (32%, p=0.025). Over the entire study period, schools with majority Hispanic student enrollment had approximately half the odds of having a garden compared to schools with majority Black students (p=0.036). School garden prevalence increased in the year immediately following the implementation of the HHFKA but this increase was not sustained over time. Future research should investigate the reasons for this decline and potential disparities by race/ethnicity.