External Factors Influencing the Implementation of Policy, System, and Environmental Change Strategies Within Cooperative Extension.

. Multilevel approaches are important to promote the adoption of healthier practices at the individual and community levels. Cooperative Extension pairs policy, systems, and environmental (PSE) change approaches with direct education programs focused on individual and community health.

The intergenerational metabolic-cardiovascular life course: maternal body mass index (BMI), offspring BMI, and blood pressure of adolescents born extremely preterm.

Background: The aim of this study was to evaluate associations between pre-pregnancy maternal obesity and adolescent blood pressures (BPs) among children born extremely preterm.

Methods: This longitudinal observational cohort study included participants in the multicenter Extremely Low Gestational Age Newborn (ELGAN) study, born before 28 weeks of gestation, recruited at birth between 2002 and 2004, and followed prospectively through late adolescence. Between 2015 and 2022, three oscillometric BPs were obtained from participants (mean age 17.

The role of preterm birth in stress-induced sodium excretion in young adults.

Background: Early-life programming due to prematurity and very low birth weight (VLBW, <1500 g) is believed to contribute to development of hypertension, but the mechanisms remain unclear. Experimental data suggest that altered pressure natriuresis (increased renal perfusion pressure promoting sodium excretion) may be a contributing mechanism. We hypothesize that young adults born preterm will have a blunted pressure natriuresis response to mental stress compared with those born term.

Duration of Simultaneous Exposure to High-Risk and Lower-Risk Nephrotoxic Antimicrobials in the Neonatal Intensive Care Unit (NICU) and Future Adolescent Kidney Health.

Objective: To determine whether greater duration of simultaneous exposure to antimicrobials with high nephrotoxicity risk combined with lower-risk antimicrobials (simultaneous exposure) in the neonatal intensive care unit (NICU) is associated with worse later kidney health in adolescents born preterm with very low birth weight (VLBW).

Study Design: Prospective cohort study of participants born preterm with VLBW (<1500 g) as singletons between January 1, 1992, and June 30, 1996. We defined simultaneous exposure as a high-risk antimicrobial, such as vancomycin, administered with a lower-risk antimicrobial on the same date in the NICU.

Sexually dimorphic methylation patterns characterize the placenta and blood from extremely preterm newborns.

Background: Health outcomes among children born prematurely are known to be sexually dimorphic, with male infants often more affected, yet the mechanism behind this observation is not clear. CpG methylation levels in the placenta and blood also differ by sex and are associated with adverse health outcomes. We contrasted CpG methylation levels in the placenta and neonatal blood (n = 358) from the Extremely Low Gestational Age Newborn (ELGAN) cohort based on the EPIC array, which assays over 850,000 CpG sites across the epigenome.

Association of antenatal corticosteroids with kidney function in adolescents born preterm with very low birth weight.

Objective: Investigate if antenatal corticosteroids (ANCS) are associated with worse kidney function in adolescence and if greater adiposity magnifies this association.

Study Design: Prospective cohort of 162 14-year-olds born preterm with very low birth weight (<1500 g). Outcomes were estimated glomerular filtration rate (eGFR) and first-morning urine albumin-to-creatinine ratio (UACR).

U.S. Cooperative Extension's response to substance misuse: A scoping review.

Background: The U.S. has experienced exponential growth in overdose fatalities over the past four decades and more than 22 million people are currently living with a substance use disorder (SUD).

Cooperative Extension professionals' knowledge and attitudes toward the opioid epidemic: Implications for capacity development and outreach.

Introduction: Worsening of the opioid epidemic amplifies calls for involvement of the nationwide Cooperative Extension System (Extension) in addressing this crisis. Understanding knowledge and attitudes among Extension professionals who directly interact with communities is critical given identified needs for increased capacity and substantial federal investments supporting Extension's opioid response. This study explored opioid knowledge and attitudes among Extension professionals in one state to identify attitudes and perceptions that may influence community-level efforts.

Growth During Infancy After Extremely Preterm Birth: Associations with Later Neurodevelopmental and Health Outcomes.

Objective: To evaluate associations between changes in weight, length, and weight/length ratio during infancy and outcomes later in life among individuals born extremely preterm.

Study Design: Among participants in the Extremely Low Gestational Age Newborn (ELGAN) study, we measured weight and length at discharge from the neonatal intensive care unit (NICU) and at age 2 years and evaluated neurocognitive, psychiatric, and health outcomes at age 10 years and 15 years. Using multivariable logistic regression, we estimated associations between gains in weight, length, and weight/length ratio z-scores between discharge and 2 years and outcomes at 10 and 15 years.

Exploring Extension Agent Capacity and Readiness to Adopt Policy, Systems and Environmental Change Approaches.

Introduction: Enhanced Extension outreach strategies combine traditional direct education programs with public health approaches like policy, systems, and environmental (PSE) change. However, the Cooperative Extension system and county-based Family and Consumer Sciences (FCS) Extension agents have historically prioritized direct education programming and diffusion of enhanced outreach strategies has varied. Extension personnel may lack capacity and readiness for successful PSE change implementation.

Psychiatric Outcomes, Functioning, and Participation in Extremely Low Gestational Age Newborns at Age 15 Years.

Objective: To evaluate the prevalence, co-occurrence, sex differences, and functional correlates of DSM-5 psychiatric disorders in 15-year-old adolescents born extremely preterm.

Method: The Extremely Low Gestational Age Newborns (ELGAN) Study is a longitudinal study of children born <28 weeks gestation. At age 15, 670 adolescents completed the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), the Youth Self-Report, a disability scale of participation in social roles, and cognitive testing.

Extension Educators and Volunteer Leaders: Evaluation of Fitness Outcomes Among Participants in Community Strength Training Classes.

Volunteer-led strength training classes can expand access, improve exercise adherence, and enhance intervention sustainability for older adults. This study compared participant functional fitness outcomes between volunteer-led and Extension educator-led StrongWomen strength training groups in community settings. Change scores for participants ( = 317) were calculated for six Senior Fitness Test (SFT) measures.

Using Yoga to Reduce Anxiety in Children: Exploring School-Based Yoga Among Rural Third- and Fourth-Grade Students.

Introduction: Anxiety is becoming more common in children and can negatively affect social and academic performance. The purpose of this study was to explore the impact of 10 min of yoga on anxiety in third- and fourth-graders over 8 weeks.

Method: Participants completed 10 min of yoga daily during the school week.

Lower urinary α-Klotho is associated with lower angiotensin-(1-7) and higher blood pressure in young adults born preterm with very low birthweight.

Early-life factors including preterm birth and VLBW increase the risk of hypertension, but the mechanisms remain poorly understood. Reductions in the anti-aging protein α-klotho are associated with hypertension, possibly due to angiotensin (Ang) II activation, but the mechanisms are incompletely understood and clinical evidence is lacking. The association of α-klotho with the alternative Ang-(1-7) pathway, which counteracts Ang II to lower BP, is undescribed.

Association of circulating uric acid and angiotensin-(1-7) in relation to higher blood pressure in adolescents and the influence of preterm birth.

Elevated serum uric acid increases the risk of hypertension, and individuals born preterm have higher blood pressure (BP) and uric acid, but the mechanisms remain unclear. Preclinical studies demonstrate uric acid increases BP via increased renin-angiotensin system (RAS) expression, especially angiotensin (Ang) II, but the association of uric acid with Ang-(1-7) is unknown. Ang-(1-7), an alternative RAS product, counteracts Ang II by stimulating sodium excretion, vasodilation, and nitric oxide, thus contributing to lower BP.

Treatment for hypotension in the first 24 postnatal hours and the risk of hearing loss among extremely low birth weight infants.

Objective: To evaluate whether treated hypotension in the first 24 postnatal hours is associated with hearing loss in extremely low birth weight (ELBW) infants.

Study Design: In a cohort of 735 ELBW infants, we identified 25 with sensorineural hearing loss (SNHL) at 12-24 months adjusted age. For each case, we selected three controls with normal hearing.

Evaluation of a Policy, Systems, and Environmental-Focused Faith-Based Health Promotion Program.

Objective: This study assessed the impact and lessons learned from implementing policy, systems, and environmental (PSE) changes through Faithful Families Thriving Communities (Faithful Families), a faith-based health promotion program, in 3 southern states.

Methods: Faithful Families classes and PSE changes were implemented through a coordinated effort between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program-Education (SNAP-Ed). Changes were measured using a faith community assessment, site reports, and annual reporting.

Influence of race on the effect of premature birth on salivary cortisol response to stress in adolescents.

Background: Adolescents born preterm have altered hypothalamic-pituitary-adrenal axis function with a blunted cortisol stress response, however, the influences of intrauterine growth restriction and race are unclear.

Methods: We measured salivary cortisol before and 20 min after a maximal-exercise stress test and calculated the cortisol stress response. We used linear regression to compare cortisol stress responses between preterm and term groups, adjusting for birth weight z-score and maternal hypertension, and examined effect modification by race and sex.

Antenatal Steroid Exposure, Aerobic Fitness, and Physical Activity in Adolescents Born Preterm with Very Low Birth Weight.

Objective: To determine whether antenatal corticosteroid exposure is associated with aerobic fitness or physical activity participation in adolescents born preterm with very low birth weight (VLBW).

Study Design: Observational cohort study of 14-year-old adolescents (n = 173) born with VLBW between 1992 and 1996 at a regional perinatal center with 91 exposed to antenatal corticosteroids. Aerobic fitness was determined from peak oxygen uptake (V˙Opeak) obtained via maximal exercise testing on a cycle ergometer.

Development and Implementation of the Health Literacy Program in Rural Counties.

Background: Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care.

Evaluating the Effectiveness of the How to Talk to Your Doctor HANDbook Program.

Background: Millions of Americans have low health literacy, potentially leading to a number of issues including medication errors, hospital admissions, unnecessary emergency department visits, skipped screenings and shots, and misinterpretation of treatment plans. People with low health literacy have less knowledge of illness management, less ability to share in decision-making, and poorer self-reported health status. Addressing health literacy is necessary to improve health care quality, reduce costs, and reduce disparities.

Fetal programming and the angiotensin-(1-7) axis: a review of the experimental and clinical data.

Hypertension is the primary risk factor for cardiovascular disease that constitutes a serious worldwide health concern and a significant healthcare burden. As the majority of hypertension has an unknown etiology, considerable research efforts in both experimental models and human cohorts has focused on the premise that alterations in the fetal and perinatal environment are key factors in the development of hypertension in children and adults. The exact mechanisms of how fetal programming events increase the risk of hypertension and cardiovascular disease are not fully elaborated; however, the focus on alterations in the biochemical components and functional aspects of the renin-angiotensin (Ang) system (RAS) has predominated, particularly activation of the Ang-converting enzyme (ACE)-Ang II-Ang type 1 receptor (ATR) axis.