Young adolescent alcohol users drink at higher rates than their peers throughout adolescence and appear to be less amenable to intervention. This study compares those who reported alcohol use in the past year to those who reported no use in a multiethnic, urban sample of sixth graders in 61 schools in Chicago in 2002 (N = 4,150). Demographic, behavioral, intrapersonal, and socioenvironmental factors were identified based on behavioral theories and potential mediators of the Project Northland Chicago intervention. Single and multiple regression models were created for users and nonusers to determine associations between these factors and alcohol use behavior and intentions. The multiple regression models explained 35% and 56% of the variance in alcohol use behavior and intentions between students for nonusers and users, respectively. Results suggest that primary prevention programs for alcohol use should occur prior to sixth grade, particularly for the substantial group at high risk for early use.
alcohol use; adolescents; nonusers
To investigate which points of the middle-school drinking distribution are the most influential in the social contagion of drinking across the middle-school years, in order to identify potential social multipliers.
We measured drinking intentions and behaviors by gender, school, and grade among urban middle-school students who participated in Project Northland Chicago in a longitudinal cohort design.
Individual drinking behaviors were consistently influenced by extreme (80th percentile) drinking intentions and behaviors. This effect was mediated through normal or average levels of drinking, over time.
Interventions can target extreme drinkers as the influential persons in middle-school grades.
social norms; drinking; middle school; gender; mediation
Despite the known deficits in sleep that occur during adolescence and the high prevalence of substance use behaviors among this group, relatively little research has explored how sleep and substance use may be causally related. The purpose of this study was to explore the longitudinal bi-directional relationships between sleep duration, sleep patterns and youth substance use behaviors. Participants included 704 mostly white (86.4 %) youth, 51 % female, with a baseline mean age of 14.7 years. Self-reported substance use behaviors included past month alcohol, cigarette, and marijuana use. Sleep measures included sleep duration on weekends and weekdays, total sleep, weekend oversleep, and weekend sleep delay. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between sleep and substance use adjusting for socio-demographic characteristics, pubertal status, body mass index z-score, and depressive symptoms. Cigarette use and weekend sleep were bi-directionally related as were marijuana use and total sleep. No other bidirectional associations were identified. However, alcohol use predicted shorter weekend oversleep and marijuana use predicted increased weekend sleep and weekend oversleep. Sleep patterns and duration also predicted adolescents’ cigarette, alcohol, and marijuana use. Sleep, both patterns and duration, and substance use among youth are intertwined. Future research is needed to explore these bidirectional relationships, as well as other important contextual factors that may moderate these associations.
Substance use; Sleep; Adolescents; Youth; Cross-lagged models
To determine the relationship between parent time demands and presence and enforcement of family rules and parent/child dyad weight status.
Dyads of one child/parent per family (n=681dyads), Twin Cities, Minnesota, 2007–2008 had measured height/weight and a survey of demographics, time demands and family rules-related questions. Parent/child dyads were classified into four healthy weight/overweight categories. Multivariate linear associations were analyzed with SAS, testing for interaction by work status and family composition (p<0.10).
In adjusted models, lack of family rules and difficulty with rule enforcement were statistically lower in dyads in which the parent/child was healthy weight compared to dyads in which the parent/child was both overweight (Difference in family rules scores=0.49, p=0.03; difference in rule enforcement scores=1.09, p=<0.01). Of parents who worked full-time, healthy weight dyads reported lower time demands than other dyads (Difference in time demands scores=1.44, p=0.01).
Family experiences of time demands and use of family rules are related to the weight status of parents and children within families.
adult; child; weight status; time demands; family rules
To investigate whether smoking prevalence in grade-level networks influences individual smoking, suggesting that peers are important social multipliers in teen smoking.
We measured gender-specific, grade-level recent and life-time smoking among urban middle-school students who participated in Project Northland Chicago in a longitudinal cohort design.
Within schools, grade-level recent smoking had comparable effects on girls’ and boys’ individual-level smoking. Grade-level lifetime smoking had a greater effect on girls’ smoking.
Interventions can target middle school classes and schools broadly, without making the identification of friendship networks a concern.
social norms; smoking; middle school; gender
Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed.
Body composition; Adolescents; Substance use; Obesity
The purpose of this study was to describe the extent to which vending offerings in 106 schools in the St. Paul-Minneapolis, Minnesota metropolitan area met criteria for types of beverages, fat and calories based on selected criteria offered by the Institute of Medicine.
Schools where youth participants were attending for the 2006-2007 school year were identified and invited to participate in the study (n=143); 81% of schools (n=116) agreed to participate.
Of the 116 schools, 106 had vending machines. Across schools with vending machines (n=106), 5085 food and 8442 beverage items were offered. Overall, only 18% of beverage items met criteria for calories and type of beverage; significantly more items in public schools met the criteria as compared to private schools (19% vs. 12%; p<0.01). This difference was also significant for high schools as compared to middle schools (18% vs. 22%; p<0.01). For food items, 41% met calorie criteria, 45% met fat criteria, and 22% met both fat and calorie criteria. Significantly more food items met both criteria in public than private schools (22% vs. 18%; p=0.01), while high schools (22%) and middle schools (21%) were similar. A very small proportion of foods (<5%) would have met the full criteria suggested by the Institute of Medicine for competitive foods..
Overall, foods and beverages offered in vending machines continue to be high in fat and calories. Public schools are doing a slightly better job of providing healthy foods as compared to private schools.
To assess the relationship between adolescent perception of time to walk to neighborhood food retail outlets and purchasing of sugar sweetened beverages (SSB), fast and convenience food items and test for differences by urban versus suburban environment.
Cross-sectional observational study.
Twin Cities Metropolitan Area, Minnesota.
Adolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted using SAS.
There were 634 adolescents, approximately half male, predominately white, with a middle-class background. Greater perceived time to food outlets were associated with less frequent purchasing of SSB, convenience store foods and fast food items. Multivariate models showed that a perceived shorter walking time (i.e. 1–5 versus 31+ minutes) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10–minute walk (B=0.05, p=0.02).
A reduction in consumption of SSB and other energy dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.
To determine whether alcohol use behaviors and alcohol-related consequences differed among students attending two-year versus four-year colleges.
Participants (N=13,700) from 7 two-year and 11 four-year colleges completed the 2010 College Student Health Survey. Alcohol use behaviors included past year alcohol use, past month alcohol use, and binge drinking over the past two weeks. Alcohol-related factors included average calculated blood alcohol level and average number of alcohol-related consequences. Cross-sectional mixed-effects regression analyses were conducted to determine if the prevalence of alcohol-related behaviors and consequences differed among two-year and four-year colleges.
Students attending four-year colleges, particularly males, were more likely to report past year alcohol use, past month alcohol use, and binge drinking, as well as a higher average blood alcohol content and a greater number of alcohol-related consequences than their two-year counterparts (p<0.05). Among female students there were fewer differences between two-year and four-year college students. Many differences remained after adjusting for socio-demographic factors (e.g., age, race/ethnicity), however, with the addition of living situation as a covariate, several of the differences among males were no longer significant.
Significant differences in alcohol-related behaviors and consequences exist among students attending two-year versus four-year colleges. While the prevalence of alcohol-related behaviors and consequences was lower among two-year college students, they are not a population to be over-looked. The prevalence of alcohol use remains high among both two-year and four-year college students, making it important for researchers to design appropriate interventions for all students regardless of the type of institution being attended.
Alcohol use; emerging adulthood; college youth
To examine associations between weight misperception and youth health risk and protective factors.
Three thousand ten US seventh-graders (72.1% white, mean age: 12.7 years) self-reported height, weight, risk, and projective factors. Analyses were conducted to determine cross-sectional and longitudinal associations between weight overestimation and health risk and protective factors.
Risk and protective factors had significant cross-sectional associations with weight overestimation. However, only depressive symptoms and reduced optimism predicted weight overestimation in eighth grade. Weight overestimation did not predict engagement in risky behaviors.
Weight overestimation and risk factors appear to co-occur, suggesting a constellation of risk that warrants further research.
weight perception; risk and protective factors; substance use; depression
The objective of this study was to determine whether obesity prevalence and weight-related behaviors (e.g., diet, physical activity) differ among students enrolled in two-year community/technical colleges and those attending four-year colleges/universities. This information could inform the development of intervention strategies. Through an existing surveillance system of Minnesota post-secondary education institutions, survey data were collected from 16,539 students from 27 campuses (14 two-year college campuses, 13 four-year college/university campuses; 2007-2008), including self-reported physical activity, media use, dietary patterns, weight control behaviors, height and weight. Unadjusted analyses indicated that students enrolled in two-year colleges, particularly females, had a higher prevalence of overweight/obesity, lower levels of physical activity, more television viewing, higher intakes of soda, fast food, and diet pills compared to students attending four-year colleges (p<0.05). Females attending four-year colleges were more likely to engage in certain unhealthy weight control behaviors (taking diet pills, binge eating, self-induced vomiting) compared to females attending two-year institutions. Among male students there were fewer differences between two-year and four-year colleges. Controlling for sociodemographic factors (e.g., race/ethnicity, age), most disparities in prevalence estimates remained, though many were attenuated. Overall, few young adults engage in weight-related behaviors consistent with national recommendations. Two-year college students may represent a particularly at-risk group. Disparities between two- and four-year college students exist beyond the sociodemographic differences in these populations. Effective weight-related interventions are needed for young adults, particularly females attending two-year colleges and all males attending post-secondary institutions.
The purpose of this study was to explore how behavioral, intra-personal and socio-environmental factors were associated with the likelihood of having at least one older friend.
Participants included 3709 ethnically-diverse 8th grade students in the Project Northland Chicago intervention trial. Socio-demographic characteristics included gender, family composition, language spoken at home, race/ethnicity, and age. Behavioral factors included cigarette, alcohol, and marijuana use, depressed feelings, willingness to wear alcohol-branded merchandise, and violent and delinquent behavior. Intrapersonal factors included low refusal self efficacy and outcome expectations and expectancies. Socio-environmental factors included alcohol offers and access, normative estimates and expectations, and peer alcohol use. Having an older friend was defined as having at least one friend aged 16 or older (students’ mean age=14.2). Logistic mixed-effects regression models were used and controlled for gender, race/ethnicity, treatment status, and age.
Females and older eighth graders were significantly more likely to have at least one older friend. Students who scored higher on all of the behavioral, intra-personal and socio-environmental risk factors were significantly more likely to have at least one older friend. Significant gender interactions were found for several of the relationships.
Overall this study found multiple risk-related factors are associated with having older friends in eighth grade. Particularly important factors appear to be cigarette, marijuana and alcohol use, having friends who use alcohol, having increased alcohol offers, and being willing to wear or use alcohol-branded merchandise.
Peers; Friends; Risk Behaviors; Risk Factors; Adolescence
To assess the correlates of parental classification of adolescent weight status.
Measured adolescent weight status was compared to parent self-report perception data (n=374 dyads) using multivariate analyses with interactions to identify characteristics associated with inaccurate parent classification of adolescent weight status.
Adolescent weight status was underestimated by 31% of parents. College-educated parents were more likely to underestimate the weight of their male adolescents (OR=1.95) and overweight adolescents (OR=4.0). Non-college-educated parents were 8.92 times as likely to misclassify overweight adolescents, regardless of the sex of the child.
Parental perception may play a role in supporting adolescent’s healthy weight-related behaviors.
parent perceptions; adolescent weight; overweight; underestimate; weight discordance
Research to date in young children and adults shows a strong, inverse relationship between sleep duration and risk for overweight and obesity. Fewer studies examining this relationship have been conducted in adolescents. The purpose of the article is to describe the relationship between sleep and weight in a population of adolescents, controlling for demographics, energy intake, energy expenditure, and depression. This is a cross-sectional study of 723 adolescents participating in population-based studies of the etiologic factors related to obesity. We examined the relationship between three weight-related dependent variables obtained through a clinical assessment and three sleep variables obtained through self-report. Average caloric intake from dietary recalls, average activity counts based on accelerometers, and depression were included as covariates and the analysis was stratified by gender and grade level. Our results show that the relationship between sleep duration and BMI is evident in middle-school boys (β = −0.32, s.e. = 0.06: P < 0.001) and girls (β = −0.18, s.e. = 0.08: P = 0.02) but largely absent in high-school students. Differences in sleep patterns have little association with weight in males, but in high-school girls, waking up late on weekends as compared to weekdays is associated with lower body fat (β = −0.80, s.e. = 0.40: P = 0.05) and a healthy weight status (β = −0.28, s.e. = 0.14: P = 0.05). This study adds to the evidence that, particularly for middle-school boys and girls, inadequate sleep is a risk factor for early adolescent obesity. Future research needs to examine the relationship longitudinally and to study potential mediators of the relationship.
To examine neighbourhood food environments, adolescent nutrition and weight status.
Cross-sectional, observational study.
Minneapolis/St. Paul metropolitan region, Minnesota, USA.
A total of 349 adolescents were recruited to the study. Participants completed 24 h dietary recalls and had their weight and height measured. They also reported demographic information and other diet-related behaviours. Geographic Information Systems were used to examine the availability and proximity of food outlets, particularly those captured within the 800, 1600 and/or 3000m network buffers around participants' homes and schools.
Adjusting for gender, age and socio-economic status, adolescents' sugar-sweetened beverage intake was associated with residential proximity to restaurants (including fast food), convenience stores, grocery stores and other retail facilities within the 800 and/or 1600m residential buffers (P ≤ 0.01). BMI Z-score and percentage body fat were positively associated with the presence of a convenience store within a 1600m buffer. Other individual-level factors, such as energy, fruit and vegetable intake, as well as convenience store and fast food purchasing, were not significantly associated with features of the residential neighbourhood food environment in adjusted models. In addition, school neighbourhood environments yielded few associations with adolescent outcomes.
Many factors are likely to have an important role in influencing adolescent dietary intake and weight status. Interventions aimed at increasing neighbourhood access to healthy foods, as well as other approaches, are needed.
Adolescent; Food environment; Obesity
Growth curve models examined changes in adolescent self-reported parent-child communication conditional on family meal frequency over a 3.5 year period among a population of racially-diverse, low-income adolescents from an urban environment (n = 4750). Results indicated that although both family dinner frequency and adolescent perceptions of parent-child communication scores were characterized by negative linear growth over time (both p < .0001), family dinner frequency was positively associated with adolescent perceptions of parent-child communication scores over time (p < .0001). Study findings suggest that families with teenagers may enhance parent-child communication and ultimately promote healthy adolescent development by making family dinner a priority. Additionally, the communication benefits of family dinner at the beginning of 6th grade may be protective through 8th grade.
adolescents; family dinner; family meals; parent-child communication; race/ethnicity; urban
To explore how weekday and weekend sleep patterns are related to adolescent substance use, depressive symptoms, and school truancy.
Self-report surveys of 242 youth (93.4% white, mean age 16.4 years).
Longer weekday sleep duration was inversely associated with depressive symptoms, past month alcohol use, and drunkenness. Later weekend bedtime and wake-times, compared to those of weekdays, were associated with increased substance use and truancy.
Weekday sleep duration appears to be protective for substance use, depression and school truancy for teenagers. However, inconsistent sleep patterns between weekdays and weekends were associated with a range of markers for adolescent risk.
adolescents; sleep; risk behaviors; depressive symptoms
The purpose of this research is to evaluate 2 methods of assessing foods available on school à la carte lines for schools’ ability to assess the proportion of foods that are healthful options.
This observational study used data collected at 38 middle schools, October 2006–May 2007. An inventory method was used to collect detailed information of items available on each school’s à la carte line, followed by a simplified checklist form. Using the detailed inventory method, the proportion of items meeting the Institute of Medicine’s (IOM) nutrition standards for foods available at each school was calculated. From the checklists, we calculated the proportion of categories representing more healthful foods. Schools were independently ranked according to the percentage of items meeting the IOM criteria, (inventory data) and the percentage of food categories considered “healthy” (checklist data). Wilcoxon rank sum test was used to compare school rankings.
The inventory and checklist approaches showed a good level of agreement when both methods were independently used to rank the level of healthy foods available on à la carte (Wilcoxon rank sum = 32.5, p = .62).
For purposes of ranking schools along a continuum of “healthfulness of foods on à la carte lines,” especially when resources are limited, a checklist approach appears to be satisfactory. This method may also be useful to school stakeholders needing an inexpensive à la carte assessment tool.
à la carte; competitive foods; school environment; assessment methods
The purpose of this study was to determine if parents’ and children’s reports of parenting practices were correlated, if the reports were differentially associated with alcohol use, and which report had the strongest association with alcohol use.
Cross-sectional and longitudinal.
Public schools, Chicago, Illinois.
Participants included 1373 ethnically-diverse students and parents involved in an alcohol use prevention intervention. Surveys were conducted in sixth grade and eighth grade. Mixed-effects regression analyses were used to model relationships cross-sectionally and longitudinally.
Parents’ and children’s perceptions of parenting practices, while significantly correlated, were not strongly associated. Analyses within each parenting domain found parents’ report of parental monitoring and children’s reports of alcohol-specific communication, general communication, and relationship satisfaction were associated with alcohol use behaviors and intentions. After adjusting for all other parenting practices, parents’ report of parental monitoring and children’s report of alcohol-specific communication were most strongly related to alcohol use behaviors and intentions both cross-sectionally and longitudinally.
When comparing results across studies, it is important to identify whose report was used, parent or child, as the results may differ based on reporter. Studies with limited resources may consider using parents’ reports about parental monitoring and using children’s reports for alcohol-specific communication, general communication, and relationship satisfaction.
Parenting; parent-child relationships; alcohol use; early adolescence
To determine if weight status affects the relationship between weight-related beliefs and consumption of sugar-sweetened beverages (SSB) and fast and convenience store food purchases (FCFP).
Twin Cities Metropolitan area, Minnesota, USA.
Body composition and psychosocial survey were obtained for 345 adolescents. General Linear Models tested adjusted (age and sex) associations between weight-related beliefs and consumption of SSB and FCFP. Significant associations were tested for moderation by weight status.
SSB was positively related to perceptions that people worry too much about their weight (β = 0.103, p = 0.016), with no moderation present. FCFP were positively associated to perceived barriers to maintaining a healthy weight (β = 0.042, p = 0.004) with a subsequent significant interaction by weight status. Stratified models showed a significant association between perceived barriers to a healthy weight and FCFP for overweight adolescents (β = 0.345, p = 0.022).
Addressing perceived barriers to a healthy diet may lead to important risk reduction.
adolescence; fast food; perceived barriers; sugar-sweetened beverage; weight status
Few studies have examined the context of a wide range of risk behaviors among emerging adults (ages 18–25 years), approximately half of whom in the USA enroll in post-secondary educational institutions. The objective of this research was to examine behavioral patterning in weight behaviors (diet and physical activity), substance use, sexual behavior, stress, and sleep among undergraduate students. Health survey data were collected among undergraduates attending a large, public US university (n=2,026). Latent class analysis was used to identify homogeneous, mutually exclusive “classes” (patterns) of ten leading risk behaviors. Resulting classes differed for males and females. Female classes were defined as: (1) poor lifestyle (diet, physical activity, sleep), yet low-risk behaviors (e.g., smoking, binge drinking, sexual risk, drunk driving; 40.0% of females), (2) high risk (high substance use, intoxicated sex, drunk driving, poor diet, inadequate sleep) (24.3%), (3) moderate lifestyle, few risk behaviors (20.4%), (4) “health conscious” (favorable diet/physical activity with some unhealthy weight control; 15.4%). Male classes were: (1) poor lifestyle, low risk (with notably high stress, insufficient sleep, 9.2% of males), (2) high risk (33.6% of males, similar to class 2 in females), (3) moderate lifestyle, low risk (51.0%), and (4) “classic jocks” (high physical activity, binge drinking, 6.2%). To our knowledge, this is among the first research to examine complex lifestyle patterning among college youth, particularly with emphasis on the role of weight-related behaviors. These findings have important implications for targeting much needed health promotion strategies among emerging adults and college youth.
Emerging adulthood; Latent class analysis; Diet; Physical activity
The purpose of this study was to explore how exposure to alcohol outlets (around home and school) influenced alcohol use among 242 high-school students (mean age 16.4, 48.8% male, 93.4% White). Results found no relationship between alcohol outlet exposure, using a measure of both distance to and density around students’ homes and schools, and alcohol use. This study suggests that outlet exposure may not influence alcohol use among mostly White, middle- class, and suburban youth. However, the lack of association may also reflect the lower level of alcohol outlets present in low-density residential environments as well as differences in accessibility.
alcohol outlet density; adolescent alcohol use; alcohol outlet exposure
The objectives of this study were to determine: (1) if the number of outdoor alcohol advertisements around schools varied by ethnicity of students in the school, and (2) how the content of alcohol advertising around schools varied by the ethnicity of students in the school.
All outdoor alcohol advertisements within 1500 feet of 63 Chicago schools were documented and coded for content and theme. On average, the ethnic make-up of schools was 54.9% African American, 24.4% Hispanic, and 16.2% White; 79.7% of students were low SES. To compare the mean number and type of ads by ethnicity of the school, schools were coded by ethnicity (i.e. 20% or more Hispanic students compared with less than 20% Hispanic students).
Youth attending schools with 20% or more Hispanic students were exposed to 6.5 times more alcohol advertising than students attending schools with less than 20% Hispanic students. Schools with 20% or more Hispanic students were also surrounded by more beer advertising and alcohol advertisements on bars and liquor stores.
Alcohol advertising is more prevalent around schools with 20% or more Hispanic students. Policies should be considered to reduce the amount of alcohol advertising around schools.
Alcohol advertising; Hispanic youth; Adolescents
Despite the need for effective obesity prevention strategies, little research is currently available to assess adolescents’ knowledge around basic concepts of energy intake, expenditure and balance. Using data from 349 adolescent-caregiver pairs (recruited from Minneapolis/St. Paul metro region, MN, 2006-2007), cross-sectional linear regression was used to assess adolescent and parental knowledge related to energy intake and expenditure as a predictor of adolescent weight-related behaviors and outcomes. Findings indicated that knowledge related to energy intake and expenditure was highly variable, with a substantial proportion of participants (particularly adolescents) lacking knowledge on a range of concepts. Adolescent knowledge was positively associated with moderate physical activity and negatively associated with television viewing (P< 0.05), but it was not associated with sweetened beverage consumption, fast food intake, weight status, and/or body composition. While overall parental knowledge was a significant predictor of adolescent knowledge (p<0.01), parent-child agreement on individual items was poor. As adolescents age, low literacy in this area may set the stage for poor decision-making related to energy balance and healthy weight maintenance. However, in that knowledge was not a significant predictor of various weight-related outcomes, these and other findings suggest that purely education-based health promotion strategies are insufficient to initiate long-term healthy behavior change. Educational strategies may be effective when combined with those also targeting familial, social, and environmental influences. The examination of interactive effects between individual-level and environmental influences on health behavior is an important area for future obesity-related research.
adolescence; nutrition; obesity; health knowledge