This review summarizes the evidence on the number and intensity of steps associated with health benefits. For older adults, 6000-8000 daily steps is associated with substantial cardiovascular disease (CVD) and mortality benefits and taking more than 8000 daily steps appears to be associated with additional benefit. For younger adults, taking 8000-10,000 daily steps is associated with substantial mortality benefit.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

The 2020–2025 Dietary Guidelines for Americans (DGA) recommends less than 10% of total daily calories come from added sugars. However, many adults overconsume added sugars putting them at risk for poor health outcomes. We examined characteristics of high added sugars consumers among US adults (≥20 years) and described their top 10 sources of added sugars intake using National Health and Nutrition Examination Survey 2015–2018 data (n = 9647). We defined high consumers as consuming >15% of daily calories from added sugars (1.5 times higher than the DGA). We used the National Cancer Institute method to estimate usual intake of energy and percent of calories from added sugars. Top 10 sources were identified based on their percentage contribution to total added sugars intake on a given day. T-tests were used to examine differences by age, sex, race/ethnicity, education, income, marital status, and weight status. Overall, mean usual total energy intake and added sugars intake was 2068 kcal/day and 264 kcal/day, respectively, and 30% of adults were classified as high consumers. The prevalence of high added sugars consumers was significantly higher among 20–30-year-olds (29%), 31–50-year-olds (33%), and 51–70-year-olds (29%) than those aged ≥70 years (22%); non-Hispanic Black (39%) and non-Hispanic White (31%) adults than Hispanics (26%); adults with <high school (37%), high school/GED (38%), or some college (34%) than adults with college or higher (15%); adults living in lower-income households (39% for federal poverty income ratio < 130% and 35% for 130%–<350%) than high-income households (21%). The prevalence of high consumers did not differ by sex or weight status. Top sources of added sugars were sweetened beverages (42%), tea (12%), sweet bakery products (11%), and jams/syrups/sugars (7%). Our findings can inform intervention efforts to decrease added sugars intake to support health.

INTRODUCTION:Policies and practices at the local level can help reduce chronic disease risk by providing environments that facilitate healthy decision-making about diet.METHODS:We used data from the 2014 and 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living to examine prevalence among US municipalities of policies to support access to healthier food in supermarkets, convenience stores, and farmers markets, as well as policies to support breastfeeding among government employees. Chi-square tests were conducted to compare prevalence estimates from 2021 to 2014 overall and according to municipal characteristics.RESULTS:In 2021, 29% of municipalities had at least 1 policy to encourage full-service grocery stores to open stores, which was not significantly different from 31% in 2014. Prevalence of having at least 1 policy to help corner stores sell healthier foods declined significantly from 13% in 2014 to 9% in 2021. Prevalence of policies providing all local government employees who were breastfeeding breaktime and space to pump breast milk increased significantly from 25% in 2014 to 52% in 2021. The percentage of municipalities that provided 8 or more weeks of paid maternity leave for employees increased significantly from 16% in 2014 to 19% in 2021.CONCLUSION:Prevalence of supports for supermarkets, convenience stores, and farmers markets generally did not increase among US municipalities from 2014 to 2021, while some supports for breastfeeding among municipal employees increased during this time. Opportunities exist to improve municipal-level policies that support healthy eating and breastfeeding among community residents and employees.

Introduction: Communities with high diabetes burden may benefit from local policies that facilitate healthy eating and breastfeeding. Methods: Data from the 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS HEAL; n=1,927 municipalities) were linked to 2019 county level small area estimates of adult diabetes prevalence (the most recent available) from the Centers for Disease Control and Prevention. We estimated the percentage of US municipalities reporting policies to support healthier food access in supermarkets, convenience stores, and farmers markets and policies to support breastfeeding for municipal employees. Chi-Square tests were used to determine if the presence of policies differed by community diabetes burden. Results: Among municipalities with the highest diabetes burden (≥10.1%), 33.8% had a policy for supermarkets, 9.3% had a policy for convenience stores, and 62.9% had a policy for farmers markets and the percent of municipalities reporting these policies did not differ significantly by diabetes burden. The percentage of municipalities that provided breastfeeding employees time and space to pump breast milk differed by diabetes burden (p=0.006) and ranged from 47.7% among those with the highest diabetes burden to 69.3% among municipalities with the lowest burden (≤6.5%). Among municipalities with the highest diabetes burden, 38.2% provided any paid maternity leave, and 19.9% provided ≥8 weeks of maternity leave. Frequency of maternity leave policies did not differ significantly by diabetes burden. Conclusion: Among US municipalities healthy food retail policies did not differ by diabetes burden. Less than half of municipalities with the greatest burden reported policies to support breastfeeding for municipal employees. Opportunities exist to improve support for healthy eating and breastfeeding among communities with high burden of diabetes. Disclosure S.J.Onufrak: None. D.Galuska: None. S.L.Pierce: None. C.A.Macgowan: None. L.Moore: None.

Introduction: Many Americans exceed the dietary recommendations for added sugars. Healthy People 2030 set a population target mean of 11.5% calories from added sugars for persons aged >2 years. This paper describes the reductions needed in population groups with varying added sug-ars intake to meet this target using four different public health approaches.Methods: Data from the 2015-2018 National Health and Nutrition Examination Survey (n=15,038) and the National Cancer Institute method were used to estimate the usual percentage calories from added sugars. Four approaches investigated lowering intake among (1) the general U.S. population, (2) people exceeding the 2020-2025 Dietary Guidelines for Americans recommen-dation for added sugars (>10% calories/day), (3) high consumers of added sugars (>15% calories/ day), or (4) people exceeding the Dietary Guidelines for Americans recommendation for added sugars with two different reductions on the basis of added sugars intake. Added sugars intake was examined before and after reduction by sociodemographic characteristics.Results: To meet the Healthy People 2030 target using the 4 approaches, added sugars intake needs to decrease by an average of (1) 13.7 calories/day for the general population; (2) 22.0 calories/day for people exceeding the Dietary Guidelines for Americans recommendation; (3) 56.6 calories/day for high consumers; or (4) 13.9 and 32.3 calories/day for people consuming 10 to <15% and >15% calories from added sugars, respectively. Differences in added sugars intake were observed before and after reduction by race/ethnicity, age, and income.Conclusions: The Healthy People 2030 added sugars target is achievable with modest reductions in added sugars intake, ranging from 14 to 57 calories/day depending on the approach.

INTRODUCTION:The 2014 Community-Based Survey of Supports for Healthy Eating and Active Living documented the prevalence of US municipal policy and community design supports for physical activity. The survey was repeated in 2021. Our study examined change in the prevalence of supports from 2014 to 2021, overall and by municipality characteristic.METHODS:Municipalities were sampled independently each survey year. We calculated prevalence in 2014 and 2021 and the prevalence ratio (PR) for 15 supports covering zoning codes, park policies and budgets, design standards, Complete Streets policies, and shared use agreements. We used a Bonferroni-corrected Breslow-Day test to test for interaction by municipality characteristic.RESULTS:In 2014 (2,009 municipalities) compared with 2021 (1,882 municipalities), prevalence increased for several zoning codes: block sizes of walkable distances (PR = 1.46), minimum sidewalk width (PR = 1.19), pedestrian amenities along streets (PR = 1.15), continuous sidewalk coverage (PR = 1.14), and building orientation to pedestrian scale (PR = 1.08). Prevalence also increased for design standards requiring dedicated bicycle infrastructure for roadway expansion projects or street retrofits (PR = 1.19). Prevalence declined for shared use agreements (PR = 0.87). The prevalence gap widened between the most and least populous municipalities for Complete Streets policies (from a gap of 33.6 percentage points [PP] in 2014 to 54.0 PP in 2021) and for zoning codes requiring block sizes that were walkable distances (from 11.8 PP to 41.4 PP).CONCLUSION:To continue progress, more communities could consider adopting physical activity-friendly policies and design features.

The National Collaborative on Childhood Obesity Research (NCCOR), a public–private partnership of 4 leading childhood obesity research funders—the Centers for Disease Control and Prevention, NIH, Robert Wood Johnson Foundation, and U.S. Department of Agriculture—was formed in 2008 with a goal of accelerating progress to reduce childhood obesity by improving measurement and increasing access to childhood obesity data.1 NCCOR has a shared ownership model. Each organization contributes funding, which supports projects as well as coordination by a nonprofit human development organization, FHI 360.

Background: High consumption of added sugars is related to adverse health consequences. Objective: The objective of this study was to examine characteristics of US youth who report high intakes of added sugars, as well as the eating occasions and top sources of added sugars that contributed to intakes among consumers with high added sugars intake. Design and participants/setting: We conducted a cross-sectional study using 2015–2018 NHANES data among 5280 US youths (2–19 years). Main outcome measures: Outcome measure was usual percent of calories from added sugars using 2 days of dietary recall based on the National Cancer Institute method. High consumers were defined as consuming greater than 15% of total daily calorie intake from added sugars (1.5 times higher than the 2020–2025 Dietary Guidelines for Americans recommendation of <10% of total daily calorie intake). Explanatory measures were selected sociodemographics (e.g., age, sex, race/ethnicity). Eating occasions were breakfast, lunch, dinner, and snack. Statistical analyses performed: We used t-tests to compare mean differences between sociodemographic groups. Results: Overall, 34% of US youths were classified as high consumers of added sugars. The prevalence of high consumers of added sugars significantly varied by some sociodemographics (i.e., age, race/ethnicity, and head of household’s education level). The prevalence of high added sugars consumers was significantly greater among 12–19-year-olds (41%) and 6–11-year-olds (37%) compared to 2–5-year-olds (19%), non-Hispanic Black (42%) and non-Hispanic White (42%) persons compared to Hispanic persons (19%), and those with a head of household’s education level of high school/some college (40%) compared to households with college degree or higher (29%). The prevalence of high consumers did not differ by sex, income, or weight status. Of eating occasions, the amount of added sugars youths consumed was highest during snack occasions among high consumers. Top five sources of added sugars among high consumers on a given day were sweetened beverages, sweet bakery products, candy, other desserts, and ready-to-eat cereals. Conclusion: One in three US youths consumed more than 15% of total calories from added sugars. High added sugars intake was more prevalent among certain subgroups such as 12–19-year-olds and non-Hispanic Black or non-Hispanic White youth. Our findings can provide information for intervention efforts to decrease added sugars intake to promote child health.

Background: Taking fewer than the widely promoted “10 000 steps per day” has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose–response relationship between steps per day and CVD can help inform clinical and public health guidelines. Methods: Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance–weighted random effects models. Results: The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults. Conclusions: For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician–patient communication and population health to reduce the risk of CVD.

Context: Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown. Objective: To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative. Design: A cross-sectional survey administered from May through September 2014. Setting: Nationally representative sample of US municipalities with populations of 1000 or more people. Participants: Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018). Main Outcome Measures: The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them. Results: Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative. Conclusions: Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.

Welcome to this supplement issue of Health Promotion Practice (HPP), “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field” (https://journals.sagepub.com/ toc/hppa/23/1_suppl), which is entirely devoted to practice-based wisdom from the field of nutrition, physical activity, and obesity programs. The specific aims of this supplement are to advance public health research and practice by showcasing innovative community-centered interventions, implementation, adaptations, and evaluations employed by the Centers for Disease Control and Prevention (CDC), Division of Nutrition, Physical Activity, and Obesity (DNPAO) (www.cdc.gov/nccdphpd/dnpao/index.html) cooperative agreement recipients: State Physical Activity and Nutrition Program (SPAN, DP18-1807) (www.cdc.gov/nccdphp/dnpao/state-local-programs/ span-1807/index.html), Racial and Ethnic Approaches to Community Health (REACH, DP18-1813) (www.cdc. gov/nccdphp/dnpao/state-local-programs/reach/index. htm), and the High Obesity Programs (HOP, DP18-1809) (www.cdc.gov/nccdphp/dnpao/state-local-programs/ hop-1809/high-obesity-program-1809.html).

This cohort study uses National Health and Nutrition Examination Survey data to estimate the number of deaths that could be prevented through increased physical activity among US adults.

Introduction: The goal of 10,000 steps/day is widely promoted. There is limited evidence, however, of the number of steps/day associated with risk of developing cardiovascular disease (CVD). Hypothesis: We hypothesize a dose-response association between higher device-measured steps/day with lower CVD incidence. Methods: The Steps for Health Collaborative conducted a meta-analysis of seven prospective studies with device-measured steps/day and followed participants for CVD events. Participants without CVD at baseline were included. CVD was defined as coronary heart disease, stroke, and/or heart failure. Data were analyzed at the study level. Study-specific associations of quartiles of steps/day with incident CVD was assessed using Cox proportional hazards regression models and summarized using random effects meta-analysis. Models were adjusted for age, race/ethnicity, sex, body mass index, device wear time, and study-specific indicators for education or income, smoking, alcohol intake, blood pressure, dysglycemia, and hyperlipidemia. Study heterogeneity was assessed using I2 statistic. Results: The meta-analysis included 16,906 adults (mean age 62 years; 51% women), with median follow-up of 6.3 years (limits 2.9-10.7 years) and 1370 (8.1%) CVD events. Medians of study-specific steps/day were 1,951 (first quartile, Q1), 3,823 (second quartile, Q2), 5,685 (third quartile, Q3), and 9,487 (fourth quartile, Q4). Compared with Q1, summary hazard ratios for CVD were 0.83 (Q2, 95% confidence interval 0.72-0.95), 0.68 (Q3, 0.58-0.80), and 0.60 (Q4, 0.47-0.78) (Figure). There was low to moderate heterogeneity; I2 values were 0% for Q2, 2% for Q3, and 37% for Q4. Conclusions: Higher steps/day were associated with progressively lower risk of CVD. Monitoring and promoting steps/day can be a simple, easy to interpret metric used for clinician-patient communication and population health to reduce the risk of CVD.

Park planning documents may be valuable tools in order to promote policies and direct resources toward parks. However, the prevalence of such planning documents and policies specific to parks across municipal characteristics is not well known. This study compares the presence of parks and recreation plans and policies that address park safety and maintenance by municipality characteristics. Nationally representative data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living were analyzed (n=2005, response rate: 45%). About 7 out of 10 U.S. municipalities with a population of at least 1,000 reported having a parks and recreation plan. Prevalence of specific park or outdoor recreation policies was 78% for lighting, 85% for patrols by police and security, and 87% for maintenance of green space and equipment. The prevalence of a parks and recreation plan and of specific park or outdoor recreation policies were significantly lower in the smaller communities examined in this study. Most communities with at least 1,000 residents have park planning documents and policies, and opportunities may exist for practitioners to leverage the planning process to better engage residents. Future studies could investigate the role and importance of using planning documents, policies, or budget provisions to address park access and quality in less populous municipalities.

According to the 2020-2025 Dietary Guidelines for Americans, persons should consume fruits and vegetables as part of a healthy eating pattern to reduce their risk for diet-related chronic diseases, such as cardiovascular disease, type 2 diabetes, some cancers, and obesity.* A healthy diet is important for healthy growth in adolescence, especially because adolescent health behaviors might continue into adulthood (1). The U.S. Department of Agriculture (USDA) recommends minimum daily intake of 1.5 cups of fruit and 2.5 cups of vegetables for females aged 14-18 years and 2 cups of fruit and 3 cups of vegetables for males aged 14-18 years.† Despite the benefits of fruit and vegetable consumption, few adolescents consume these recommended amounts (2-4). In 2013, only 8.5% of high school students met the recommendation for fruit consumption, and only 2.1% met the recommendation for vegetable consumption (2). To update the 2013 data, CDC analyzed data from the 2017 national and state Youth Risk Behavior Surveys (YRBSs) to describe the percentage of students who met intake recommendations, overall and by sex, school grade, and race/ethnicity. The median frequencies of fruit and vegetable consumption nationally were 0.9 and 1.1 times per day, respectively. Nationally, 7.1% of students met USDA intake recommendations for fruits (95% confidence interval [CI] = 4.0-10.3) and 2.0% for vegetables (upper 95% confidence limit = 7.9) using previously established scoring algorithms. State-specific estimates of the percentage of students meeting fruit intake recommendations ranged from 4.0% (Connecticut) to 9.3% (Louisiana), and the percentage meeting vegetable intake recommendations ranged from 0.6% (Kansas) to 3.7% (New Mexico). Additional efforts to expand the reach of existing school and community programs or to identify new effective strategies, such as social media approaches, might help address barriers and improve adolescent fruit and vegetable consumption.

PURPOSE: The simplicity of steps/day as a metric makes it appealing for physical activity promotion in clinical and population settings. Summarizing the association of steps and health can advance health promotion guidelines. The Steps for Health Collaborative is compiling data from cohort studies for meta-analysis with device-measured steps and prospective health outcomes. To harmonize data, it is important to examine how step estimates may differ by device and demographic characteristics. Our objective was to describe daily steps in the participating cohort studies by age, sex and step-counting device. METHODS: Steps/day were summarized from 11 cohorts in 6 countries. We report the cohort-specific steps/day measured from pedometers (2 studies; waist worn) or accelerometers (9 studies; 8 waist, 1 thigh worn). Medians and interquartile ranges (IQRs) of steps/day were calculated for each study for the total sample and by sex. RESULTS: Median steps ranged from 4398 to 9418 steps/day (Figure). Cohorts with older participants (age ≥ 60 years) generally had lower median steps/day compared to younger aged cohorts. Cohorts of comparable ages, using the same device, had similar estimates of median steps/day for totals and by sex. Similar steps/day for total samples were observed for CARDIA (9146 [IQR: 7307-11162]) and NHANES (8055 [IQR: 5489-10681]) using the ActiGraph 7164, HCHS/SOL (7318 [IQR: 4985-10525]) and FHS (7312 [IQR: 5362-9901]) using the Actical, and WHS (5094 [IQR:3609-6927]) and BRHS (4398 [IQR:2842-6316]) using the ActiGraph GT3X. CONCLUSIONS: Daily steps were consistently reported in studies using similar devices and in men and women. Many of the cohorts are predominantly white, limiting generalizability. Across all studies, there was about 5000 steps/day range in medians, which may be influenced by device, country, and age. Further understanding these study-level variables across prospective cohorts will benefit meta-analyses of steps and health.

Objective The purpose of this study was to investigate the association of sodium intake with obesity in US children and adolescents. Methods Cross-sectional data were analyzed for 9,026 children and adolescents in the National Health and Nutrition Examination Survey (NHANES) 2009-2016. Usual sodium intake was estimated from 24-hour dietary recalls using a measurement error model. Logistic regression was used to assess the association of sodium intake with overweight/obesity, obesity, and central obesity (waist to height ratio [WtHR] >= 0.5; waist circumferences (WC) >= age- and sex-specific 90th percentile). Results Mean (SE) sodium intake was 3,010 (9) and 3,404 (20) mg/d for children and adolescents, respectively. The adjusted odds ratio (AOR) comparing Q4 versus Q1 (87.5th vs. 12.5th percentile of sodium intake) among children was 1.98 (95% CI: 1.19-3.28) for overweight/obesity, 2.20 (1.30-3.73) for obesity, 2.10 (1.12-3.95) for WC >= 90th percentile, and 1.68 (0.95-2.97) for WtHR >= 0.5, adjusting for demographics, energy, and sugar-sweetened beverage intake. Among adolescents, AOR was 1.81 (0.98-3.37) for overweight/obesity, 1.71 (0.82-3.56) for obesity, 1.62 (0.71-3.66) for WC >= 90th percentile, and 1.73 (0.85-3.50) for WtHR >= 0.5. Conclusions Sodium intake was positively associated with overweight/obesity, obesity, and central obesity among US children independent of energy and SSB intake, but the association did not reach significance among adolescents.