The proportion of obese adolescents in Southern Appalachia is among the highest in the nation. Through funding from the National Institute on Minority Health and Health Disparities — National Institutes of Health, the Team Up for Healthy Living project was a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention. The specific aims of the project were to: 1) develop a peer-based health education program focusing on establishing positive peer norms towards healthy eating and physical activity (PA) among high school students, 2) test program efficacy, and 3) explore mechanisms underlying the program. The study was guided by the Theory of Planned Behavior, which presupposes that human behavior is primarily driven by attitude, subjective norms, perceived behavioral control, and social support. To deliver the intervention, undergraduate students from the disciplines of public health, nutrition, and kinesiology were hired as peer facilitators. Ten area high schools were invited to participate, were matched on demographics and then randomized to intervention or control. The primary outcomes of the study included body mass status, dietary behaviors, PA, and sedentary behaviors which were assessed at baseline and at three and twelve months post baseline. Intervention schools received Team Up for Healthy Living curriculum, which consists of eight 40-minute sessions. The curriculum focused on improving nutrition awareness, PA, leadership and communication. Control schools received their regularly scheduled Lifetime Wellness curriculum. The long-term goal of the study was to establish an effective academia–community partnership program to address adolescent obesity disparity in Southern Appalachia.

BACKGROUND School‐based interventions hold promise for child obesity prevention. Implemented as a part of the Winning With Wellness obesity prevention project, the “Go Slow Whoa” meal pattern (GSW) was designed to promote healthier foods in school cafeterias. This investigation determined perceived program effectiveness and impact on student's food purchases. METHODS A mixed method design was used, including focus groups with cafeteria staff (CS), quantitative analysis of CS and teacher surveys, and pre‐post analysis of cafeteria sales. A total of 37 CS and 131 teachers from 7 schools in northeast Tennessee participated. RESULTS CS recognized the important role of school nutrition services in influencing student choices, yet perceived lack of administrative support for cafeteria‐based interventions and minimal interaction with teachers were barriers. CS also believed that students choose less nutritious options due to family influence. Cafeteria sales indicated that changes were made in menu planning and production, yet students' choices improved minimally. Teachers expressed moderate levels of confidence in GSW as influential in children's dietary habits. CONCLUSIONS Successful implementation of school‐based nutrition programs requires supportive policies, administrators, and teachers. CS should be included in program implementation efforts and the role of school nutrition services should be maximized.

Dr. Robert Pack is Professor of Community and Behavioral Health, Associate Dean for Academic Affairs in the College of Public Health at East Tennessee State University, and Director of the new ETSU Center for Prescription Drug Abuse Prevention and Treatment. The Center grew out of a university and community collaborative that was started in 2012 to address the regional problem of prescription opioid abuse. At least five funded projects and dozens of other academic products have grown out of the Working Group. Dr. Pack is currently PI of the NIH/NIDA-funded Diversity Promoting Institutions Drug Abuse Research Program at ETSU, the research component of which is the five-year set of three studies titled Inter-professional Communication to Prevent Prescription Drug Abuse and Misuse. He was trained in health education/health promotion at the UAB Royals School of Public Health and is experienced in designing, running and disseminating theory-based intervention studies. In 2014, he was trained at the NIH-funded Training Institute for Dissemination and Implementation Research in Health (TIDIRH, Boston, 2014).

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Background. Maternal obesity and physical inactivity have been identified as correlates of overweight and obesity and physical inactivity in older preadolescents; however, no study has explored this relationship in Hispanic preadolescents. Furthermore, the relation between maternal physical activity (PA) and blood pressure (BP) in Hispanic preadolescents has not been examined. Purpose. This study aimed to assess the associations between Hispanic mothers’ PA and body mass index (BMI) and their preadolescents’ PA, screen time, BP, and BMI. Methods. Data of 118 mother-child (aged 2–10 years) dyads enrolled in a crosssectional study of metabolic syndrome in Hispanic preadolescents at a community health center in Johnson City, TN were used. Parent and child questionnaires were used to ascertain mothers’ BMI and PA and preadolescents’ PA and screen time.

The leadership of several health districts in the rural Appalachian region of northeast Tennessee and southwest Virginia has expressed interest in addressing the educational needs of their employees. The majority of these workers have not completed an undergraduate degree, but they desire to further their education. The College of Public Health at East Tennessee State University has begun preliminary discussions with these leaders to identify potential approaches to address these needs. There appear to be four approaches that should be explored by regions facing similar challenges: on-line or on-line/on-site degree completion programs; course clusters provided for academic credit; partnerships with community colleges; and training programs offered for nonacademic credit.

Background Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens. Methods Teenage females (N = 778) aged 12–18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use. Results Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR = 1.82, 95% CI: 1.07–3.10). Age, geographic regions, and race increased the likelihood of IT and STP use. Conclusions Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.

Background: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. Objectives This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Methods: Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. Results: Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. Conclusions: Despite the perceived importance of engaging in PDA communication, HCPs reported that prescription drug abuse communication is uncomfortable, variable, multifactorial, and often avoided. The themes that emerged from this analysis support the utility of communication science and health behavior theories to better understand and improve PDA communication behaviors of both prescribers and pharmacists, and thereby improve engagement in PDA prevention and treatment.

Background: Tobacco-free campus policy is identified as an effective means to address tobacco use on college campuses; however, the prevalence of tobacco-free policies (TFPs) in the United States remains low. This study explores college tobacco users' support for a university's TFP and tobacco-free campuses (TFCs) in general. Methods: A standardized and structured questionnaire was administered to 790 college tobacco users recruited in a university located in a tobacco-growing region of the United States, during April-May 2011, to collect information on support for TFPs and TFCs and sociodemographic-political characteristics. Descriptive and multivariable logistic regression analyses were conducted to identify key factors associated with support for TFPs and TFCs. Results: Approximately 2 of 5 tobacco users favored TFPs and TFCs. Multivariable logistic regression models showed that demographic factors were mostly not significantly associated with attitudes of the college tobacco users. Instead, while knowledge about harmful effects of exposure to secondhand tobacco smoke significantly increased support for both TFPs and TFCs, parental and peer smoking and exposure to tobacco industry promotions significantly decreased the likelihoods of support compared with respective referent groups. Conclusion: Study findings suggest that campus advocacy and education campaigns for campus tobacco policies to pay attention to tobacco use behavior of familial relations, tobacco industry activities, and other political determinants of tobacco users' attitudes. Thus, this study should inform national initiatives to promote TFPs nationwide such as the Tobacco-Free College Campus Initiative.

Background: A diet rich in vegetables, fruits, grains, fat-free or low-fat dairy, and proteins is known to have multiple beneficial health effects. However, a very limited number of studies have characterized food group intake and its association with cardiometabolic risk factors in Hispanic children. Objectives: The objectives of this study were to 1) assess food group intake in a sample of Hispanic children; and 2) examine the association between food group intake and overweight and elevated blood pressure in the same population. Methods: Data came from a pilot study of metabolic syndrome in Hispanic children. The study sample consisted of 116 2-to-10-year-old children receiving well-child care at a community health center in Johnson City, TN, from June 2015 to June 2016. Blood pressure, height and weight were measured using standard protocols. Food group intake was ascertained using the Block Kids Food Screener, a validated instrument. Child’s age, sex, and mother’s educational attainment were included as covariates. Binomial test of proportions was used to compare the study sample with the National Health and Nutrition Examination Survey (NHANES) gender-age group proportions not meeting recommended daily food group intake. Two sample t-test was used to examine differences in mean food intake by outcome variables of elevated blood pressure (>=90th percentile for age and sex) and being overweight (>85th percentile of the 2000 CDC growth charts). Multiple logistic regression was used to examine the association between food group intake and elevated blood pressure and being overweight while accounting for child's sex, age, and mother's educational attainment. Results: Hispanic children exceeded minimum fruit and legume national recommendations. Compared with the corresponding NHANES gender-age groups, a larger proportion of the sample met legume recommendations. However, similar proportions met fruit, vegetable, wholegrain, fiber and dairy recommendations. Children with elevated blood pressure ate less fruits, vegetables, and legumes than children with normal blood pressure. Legume intake (OR: 0.052, 95% CI: 0.04-0.64), dairy intake (OR: 0.61, 95% CI: 0.37-0.99), and fiber intake (OR: 0.88, 95% CI: 0.81-0.96) were protective against elevated blood pressure. In contrast, only fruit intake was protective against overweight (OR: 0.93, 95% CI: 0.87-0.99). Conclusion: Public health nutrition programs aimed at reducing the prevalence of overweight and elevated blood pressure in Hispanic children should consider supporting the intake of legumes, dairy, and fiber (for decreasing elevated blood pressure), and fruits (for reducing overweight).