BACKGROUND Obesity is a major concern among American Indians and Hispanics. The Child Health Initiative for Lifelong Eating and Exercise (CHILE) is an evidence-based intervention to prevent obesity in children enrolled in 16 Head Start (HS) Centers in rural communities. The design and implementation of CHILE are described. METHODS CHILE uses a socio-ecological approach to improve dietary intake and increase physical activity. The intervention includes: a classroom curriculum; teacher and food service training; family engagement; grocery store participation; and health care provider support. RESULTS Lessons learned from CHILE include: the need to consider availability of recommended foods; the necessity of multiple training sessions for teachers and food service; the need to tailor the family events to local needs; consideration of the profit needs of grocery stores; and sensitivity to the time constraints of health care providers. CONCLUSIONS HS can play an important role in preventing obesity in children. CHILE is an example of a feasible intervention that addresses nutrition and physical activity for preschool children that can be incorporated into HS curricula and aligns with HS national performance standards.

N o r m a n R a t c l i f f e , M i k e B e l l , T a r a P e l e m b e , D a v e B o y l e R a y m o n d B e n j a m i n R i c h a r d W h i t e , B r e n d a n G o d l e y J i m S t e v e n s o n and S a r a h S a n d e r s Abstract The introduction of mammal predators to islands often results in rapid declines in the number and range of seabirds. On Ascension Island the introduction of cats in 1815 resulted in extirpation of large seabird colonies from the main island, with relict populations of most species persisting only in cat-inaccessible locations. We describe the eradication of feral cats from this large and populated island.The campaign had to minimize risk to humans and maintain domestic animals in a state that prevented them reestablishing a feral population. Feral cat numbers declined rapidly in response to the strategic deployment of poisoning and live trapping, and cats were eradicated from the island within 2 years. During the project 38% of domestic cats were killed accidentally, which caused public consternation; we make recommendations for reducing such problems in future eradications. Since the completion of the eradication campaign cat predation of adult seabirds has ceased and five seabird species have recolonized the mainland in small but increasing numbers. Breeding success of seabirds at Ascension was low compared to that of conspecifics elsewhere, and the roles of food availability, inexperience of parent birds and black rat predation in causing this warrant further investigation. It is likely that the low breeding success will result in the rate of increase in seabird populations being slow.This paper contains supplementary material that can be found online at

Background Limited research addresses interventions to increase physical activity among American Indian and Hispanic preschool-aged children living in rural areas. We examined the impact of a Head Start-based intervention (Child Health Initiative for Lifelong Eating and Exercise [CHILE]) on physical activity at home. Method Sixteen Head Start centers in predominantly Hispanic or American Indian communities were group randomized to the six-component intervention or a comparison group for 2 years. Structured surveys were administered at four assessment times to a convenience sample of caregivers of 655 children in the study. Multilevel modeling was used to assess the effects of the intervention on physical activity. Results The relative change in physical activity in the intervention group compared with the comparison group over the 2-year period was 1.56 (95% confidence interval [1.02, 2.38]; p = .04). Among specific promoted activities (ball playing, dancing, active games, jumping, and walking), dancing increased significantly in the intervention compared with the comparison group (2.9; 95% confidence interval [1.2, 7.1]; p = .02). Conclusions The CHILE intervention was effective at increasing physical activity at home in preschool children in priority populations. Future research should focus on increasing family involvement and strengthening messaging about physical activity in these populations.

IntroductionDifferences in dietary intake and physical activity may explain the higher prevalence of obesity among adolescents living in rural versus urban settings. The objective of this cross-sectional secondary analysis was to compare baseline dietary intake and physical activity of adolescents by rurality.MethodsWe analyzed data on 940 adolescents who participated in ACTION PAC (Adolescents Committed to Improvement of Nutrition and Physical Activity), an obesity prevention and management intervention trial conducted from 2014 through 2017 in 8 public high schools in the southwestern United States. Dietary intake was assessed with the Block Food Screener, and participants completed an exercise log and wore an accelerometer to provide data on physical activity. We compared data by rural–urban commuting area (RUCA) codes and log population density by using multilevel models, with students nested within zip code and repeated measures for accelerometer analysis.ResultsAfter adjusting for socioeconomic status and ethnicity, accelerometer data indicated that moderate-to-vigorous physical activity was 8.17 min/d (P = .02) higher and sedentary time was 20.42 min/d (P = .02) lower in moderately urban areas than in the urban reference area. Each 1-unit increase in log population density was associated with higher reported intake of whole grains (0.02 ounce equivalents, P = .03), potatoes (0.01 cup equivalents, P = .02), and added sugar (0.37 tsp, P = .02) after adjusting for socioeconomic status and ethnicity.ConclusionDifferences in reported dietary intake and physical activity level by measures of rurality were small and inconsistent in direction to explain the disparities observed in rural versus urban areas.

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Background Studies have shown that data collection by medical record abstraction (MRA) is a significant source of error in clinical research studies relying on secondary use data. Yet, the quality of data collected using MRA is seldom assessed. We employed a novel, theory-based framework for data quality assurance and quality control of MRA. The objective of this work is to determine the potential impact of formalized MRA training and continuous quality control (QC) processes on data quality over time. Methods We conducted a retrospective analysis of QC data collected during a cross-sectional medical record review of mother-infant dyads with Neonatal Opioid Withdrawal Syndrome. A confidence interval approach was used to calculate crude (Wald’s method) and adjusted (generalized estimating equation) error rates over time. We calculated error rates using the number of errors divided by total fields (“all-field” error rate) and populated fields (“populated-field” error rate) as the denominators, to provide both an optimistic and a conservative measurement, respectively. Results On average, the ACT NOW CE Study maintained an error rate between 1% (optimistic) and 3% (conservative). Additionally, we observed a decrease of 0.51 percentage points with each additional QC Event conducted. Conclusions Formalized MRA training and continuous QC resulted in lower error rates than have been found in previous literature and a decrease in error rates over time. This study newly demonstrates the importance of continuous process controls for MRA within the context of a multi-site clinical research study.

The purpose of the present study was to gain a better understanding of the subjective experiences of homebound older individuals living in the community using the interpretive phenomenology approach. The following research questions were examined: (1) What are the daily experiences of this group? (2) How do they manage to remain living in the community; what supports do they access and what needs are not currently being met? Interviews were conducted with nine homebound seniors. Interview transcript content was analysed for themes including: Outlook on Life, Daily Activities, Need for Assistance, Assistive Devices, Transportation, Limitations to Occupational Performance, and Barriers to Participation. Suggestions for future program development within the community are identified.

Background: Reports of physical activity (PA) measured via wrist-worn accelerometers in adolescents are limited. This study describes PA levels in adolescents at baseline of an obesity prevention and weight management trial. Methods: Adolescents (n = 930) at 8 high schools wore an accelerometer for 7 days, with average acceleration values of <50 mg, >150 mg, and >500 mg categorized as sedentary, moderate, and vigorous PA, respectively. In a 3-level mixed-effects generalized linear model, PA was regressed on sex, weight status, and day of week. Daily PA was nested within students, and students within schools, with random effects included for both. Results: Adolescents accumulated a median of 40 minutes daily of moderate to vigorous PA (MVPA). MVPA was significantly different for teens with obesity versus teens with normal weight (−5.4 min/d, P = .03); boys versus girls (16.3 min/d, P < .001); and Sundays versus midweek (−16.6 min/d, P < .001). Average sedentary time increased on weekends (Saturday: 19.1 min/d, P < .001; Sunday: 44.8 min, P < .001) relative to midweek but did not differ by sex or weight status. Conclusions: Interventions to increase PA in adolescents may benefit from focusing on increasing weekend PA and increasing MVPA in girls.