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Secondary school ATs (SSATs) are uniquely positioned healthcare providers at an optimal public health intersection where they can provide equitable healthcare to low socioeconomic status (SES) adolescents. SSATs face similar challenges to physicians in treating low SES patients, but their strategies may be different compared to other medical professions. However, the consequences of low SES population healthcare delivery by SSATs have not been explored. SSATs were asked to share what challenges, if any, they encounter with providing care for their low SES patients and what strategies they find most effective to overcome these challenges. Data were collected via semi-structured interviews and reflective field notes and analyzed using a four-step, interpretative phenomenological analysis (IPA) guided theme development. Data saturation was met, and the sample size aligned with other IPA studies. Trustworthiness was established with research triangulation and Yardley’s four principles. Three interrelated themes emerged: (a) mechanisms for identifying SES, (b) the impact of SES on care, and (c) navigating SES challenges. SSATs described many strategies that were gained through their clinical experiences to overcome healthcare barriers. SSATs have the potential to decrease health disparities through their role as a liaison and advocates for their low SES patients.

Objective Despite growing numbers of initiatives designed to address increasing diabetes prevalence in the U.S., the need remains for effective programs. Because family history is a diabetes risk factor, family focused programs may be a potential strategy to improve the health of the entire family. We present the development process and pretest results of a lifestyle change program for rural-dwelling mothers at risk for diabetes and their children. Methods We completed semistructured interviews with mothers (N = 17) focusing on program content and activities. Findings informed program development by identifying specific barriers motivators and potential leverage points such as focusing on the intrinsic incentives of health activities. The resulting program was pretested with rural-dwelling mothers (N = 5) who completed program activities with their families and provided feedback via semistructured interviews. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Results While pretest results showed that the program was generally acceptable and feasible, feedback was used to further refine the program. The revised program consists of 8 group sessions with family focused content around physical activity, healthy eating, and making connections while engaging in health activities. Between sessions, mothers tracked the family goals, activity levels, and mood, and documented barriers to discuss during the sessions. Conclusions Our development process engaged intended program users to codesign a program that focuses on wellness and intrinsic incentives of engaging in health-enhancing activities as a family. By providing strategies to change behaviors as a family, this program aims to improve the mother's health while developing healthy habits in their children.

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. Cross-sectional study. Online survey. National Athletic Trainers' Association SSATs (6.7% response rate). Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.

Background/Objectives: Although there is a need for evidence-based physical activity programs in rural communities, evaluating such programs is often challenging due to access-related barriers and measurement tools that are not designed for rural contexts. This study aimed to explore and better understand the day-to-day experiences of rural-dwelling children using wrist-worn PA trackers as part of a study to develop a health promotion program. Methods: Ten caregivers and child dyads were enrolled (n = 20). The children wore accelerometers pre- and post-intervention. Semi-structured interviews were completed post-intervention and were audio recorded, transcribed, and summary reports were generated based on recurring themes. Results: The children had a mean age of 8.7 (SD = 1.4) years and the majority were male (80%). The caregivers were female, white, and had a mean age of 43.6 (SD = 8.5) years, with an annual income of ≥USD 40,000. Factors contributing to device wear times included low caregiver burden, device functioning as a watch, and device interactivity. The children reported that the devices were acceptable, but may have changed their physical activity behaviors, with children regularly checking their step count. The caregivers preferred devices that monitored the children’s activity levels without sharing location data. Conclusions: Identifying acceptable and feasible strategies to measure physical activity is vital to developing effective health promotion efforts. The lessons learned may help develop evaluation plans for implementing rural physical activity programming.

Cognitive behavioral therapy (CBT) programs have the potential to improve quality of life in individuals with chronic pain and diabetes. Rural communities often lack the infrastructure necessary to implement such programs. CBT traditionally requires trained therapists, who are rarely available in these areas. An alternative may be programs delivered by community health workers (CHWs). We present an iterative developmental approach that combined program adaptation, pretesting, and CHW training processes for a CBT-based diabetes self-care program for individuals living with diabetes and chronic pain. Collaborative intervention refinement, combined with CHW training, is a promising methodology for community-engaged research in remote, underresourced communities.

Background: Reducing sedentary behavior is a promising intervention target for improving health for older adults; however, few interventions include African American communities. The purpose of this research was to extend the reach of an effective sedentary behavior intervention to African American elders. Methods: Two pilot studies assessed the feasibility (retention, adherence, and safety) and acceptability (participant and leader perspectives) of a 4-wk \"Stand Up and Move More\" (SUMM) intervention. Sedentary behavior (self-reported and monitor-derived), function (short physical performance battery), and quality of life (SF-36) were measured at baseline (wk0), postintervention (wk4), and follow up (wk12; study 1) to examine preliminary effectiveness of the intervention. Participants (N=26) attended SUMM or an attention-matched stress management intervention (study 2). The magnitude of treatment effects were determined using Hedge’s g effect size calculations [small (g=0.20 to 0.49), moderate (g=0.50 to 0.79), large (g>0.80)]. Results: Retention and adherence rates ranged from 50%-100% and 80%-100%, respectively. There were no adverse events. Participants expressed high satisfaction, and the leader of the SUMM intervention indicated that the intervention content was beneficial. Hedges’ g revealed negligible to small changes in sedentary behavior (g<0.50) following SUMM. There were moderate to large improvements in function (g=0.51-0.82) and quality of life (g=0.54-1.07) from wk0 to wk4 in study 1; and moderate to large improvements in function (g=0.51-0.88) from wk0 to wk4 in study 2. There was a moderate improvement in quality of life (SF-36 emotional role limitations g=0.54) in the SUMM group only. Conclusion: Given its feasibility, safety, and acceptability, SUMM may be a promising intervention to improve functioning and well-being among African American elders.

Sport specialization has been assumed to have psychosocial ramifications for athletes, especially autonomous motivation, which has been associated with continued sport participation. Sport dropout is common in youth athletes, yet it is unknown how sport specialization may affect this population psychosocially. To determine the association of sport specialization with autonomous and controlled motivation and amotivation in middle school-aged athletes. Cross-sectional study. An anonymous online questionnaire was distributed to athletes via schools, club sports, and social media. A total of 178 athletes (male = 59%; private school = 51%; grade: sixth = 20%, seventh = 32%, eighth = 48%) completed the questionnaire. The questionnaire assessed demographics, sport participation, and motivation using the Youth Behavioral Regulation in Sport Questionnaire. Sport specialization was defined using a modified 3-point scale (low, moderate, or high) and multisport versus single-sport athletes. Nonparametric tests were used to analyze the differences among the types of motivation and specialization levels and between multisport and single-sport athletes. Sport specialization categories were not significantly associated with autonomous motivation, controlled motivation, or amotivation. No significant associations were present between multisport or single-sport athletes and any type of motivation. However, multisport athletes had higher scores for intrinsic motivation, a subscale of autonomous motivation, compared with single-sport athletes (single sport: median = 5.00, 25th-75th quartile = 4.50-5.00; multisport: median = 5.00, 25th-75th quartile = 5.00-5.00; P = .04). Sport motivation did not differ between sport specialization groups in middle school athletes. Dropout from sport is common in this age group but is multifactorial in nature. A lack of sport motivation could be a factor for some athletes, but all specialization groups appeared to have similar outcomes. Our exploratory analysis suggests that clinicians may consider having an open dialogue with single-sport athletes, their parents or guardians, and coaches to ensure that athletes are enjoying their sport.

ContextSport specialization has been assumed to have psychosocial ramifications for athletes, including on autonomous motivation which has been linked with continued sport participation. Sport dropout is common in youth athletes, yet it is unknown how sport specialization may affect this population psychosocially.ObjectiveTo determine the association of sport specialization with sport autonomous and controlled motivation and amotivation in middle school-aged athletes.Study DesignCross-sectional.SettingAn anonymous online questionnaire was distributed to athletes via schools, club sports, and social media.Patients or Other ParticipantsA total of 178 athletes (Male=59%, private school=51%, grade: 6th=20%, 7th=32%, 8th=48%) completed the questionnaire.Main Outcome MeasuresThe questionnaire assessed sport participation, motivation using the Youth Behavioral Regulation in Sport Questionnaire, and demographics. Sport specialization was defined using a modified 3-point scale (low, moderate, and high) and multisport versus single-sport athletes. Non-parametric tests were used to analyze the differences between the types of motivation and specialization levels and multisport versus single sport athletes.ResultsSport specialization categories were not significantly associated with autonomous motivation, controlled motivation, or amotivation. There were no statistically significant associations between multisport or single sport athletes with any type of motivation. However, exploratory analysis revealed multisport athletes had significantly higher scores for intrinsic motivation, a subscale of autonomous motivation, compared to single sport athletes (single sport: median=5.00 25th–75th quartile=4.50–5.00; multisport: median=5.00 25th–75th quartile=5.00–5.00; p=0.04).ConclusionsSport motivation did not differ between sport specialization groups in middle school athletes. Dropout of sport is common in middle school-aged athletes but is multifactorial in nature. Lack of sport motivation could be a factor for some athletes, but all specialization groups appeared to have similar outcomes. Out exploratory analysis suggests that clinicians may consider having an open dialogue with single-sport athletes, their parents/guardians, and coaches to ensure athletes are enjoying their sport.

In addition to the role of physical activity (PA) in the prevention of chronic disease and premature death, PA may have psychosocial benefits. We examined the association between four different domains of PA and three outcomes that may contribute to the emotional and mental well being of individuals. This is a secondary analysis of community dwelling adults with diabetes and chronic pain in which we examined the association between four domains of PA and learning (measured using diabetes knowledge, self efficacy in diabetes and pain management), pain coping strategies, perceived stress, and depression. Regression models were used to model changes in PA and outcome variables, with generalized estimating equations to account for clustered sampling. Results indicated that increases in PA assessed by change in perception of one’s own PA levels compared to others were associated with improvement in pain management self efficacy but not diabetes knowledge or diabetes management self efficacy. Increases in several domains of PA were associated with improvements in pain coping strategies. Finally, increases in usual daily PA levels were associated with decreases in the levels of perceived stress but not depressive symptoms. Reframing the benefits of PA to include affective benefits such as improvements in self efficacy, coping, and stress may be a potential strategy to promote PA.

Long-term and high-precision measurements of the mole fraction of greenhouse gases (GHG), together with their isotopic composition, are of fundamental importance to understand land–atmosphere interactions. Current flask monitoring programs have important information gaps in large regions of the Earth, particularly in the southern hemisphere and in continental tropical regions. Here, we report on the initiation of a monitoring program and the resulting dataset of high-precision GHG measurements at the Amazon Tall Tower Observatory (ATTO), located in the central Amazon region of Brazil. In September 2021, we installed an automated flask sampler designed and built by the Integrated Carbon Observation System (ICOS) to collect air samples in 3 L flasks at a height of 324 m above ground level (ma.g.l.). Samples are collected weekly, during a one-hour integration time between 13:00 and 14:00 h LT (17:00–18:00 UTC). The flasks are shipped to Jena, Germany, for analyses of CO2, CO, CH4, N2O, H2, SF6, δ13C−CO2, Δ14C−CO2, δ18O−CO2, δ13C−CH4, δ2H−CH4, O2/N2, and Ar/N2 at the laboratories of the Max Planck Institute for Biogeochemistry (MPI-BGC). Measurements from this monitoring program provide reference information for this site and act as an additional independent quality control for other measurements in the region. The record of SF6 and simulations based on a regional atmospheric transport model suggest that the footprint of the measurements is predominantly from the southeasterly and northeasterly directions. The time series of the different gas species measured in this monitoring program are being made publicly available through the ATTO data portal (https://doi.org/10.17871/ATTO.574.13.2365, Sierra et al., 2025).