Alice F. Yan

Weight Perception and Weight Control Practice in a Multiethnic Sample of US Adolescents

Objectives: Obesity is disproportionately prevalent among many racial/ethnic minority groups. The main objectives of this study are (1) to examine the extent of body weight misperception for a representative sample of US adolescents; (2) to explore the gender and racial/ethnic differences associated with an adolescents’ weight goals and weight loss attempts and; (3) to examine the influence of an array of sociodemographic factors (eg socioeconomic status) on body weight misperception in adolescents. Methods: A sample of 2,195 adolescents (aged 10 to 18 years) enrolled in the National Health and Nutrition Examination Survey (2005–2006) was examined. Adolescents’ weight and height were measured by lab exams. Perception of weight status, weight goals, and weight loss attempts were obtained by questionnaire. Participants’ self-perceptions of their current weight status were compared to classification of their body mass index (BMI) in order to determine concordance. We used multinomial logistic regression models to assess the predictive effects of various sociodemographic factors on weight misperception. Results: Twenty-five percent of girls and 33.2% of boys misperceived their weight status by medical standards. Significant sex and racial/ethnic differences existed in weight perception, attempts to lose weight, and weight goals. Multivariate analysis revealed that age, gender, marital status of parent/guardian were independently associated with the misperception of weight status, controlling for body mass index. Conclusions: Differences in weight perception, weight goals, and weight loss attempts among ethnic and racial groups call for targeted obesity control efforts.

A comparison of drivers with high versus low perceived risk of being caught and arrested for driving under the influence of alcohol

Objectives: To examine the beliefs, behaviors, and knowledge of drivers concerning drunk driving and to compare those with greater or lesser perceptions of risk of being caught driving while impaired. Methods: A random-digit-dial telephone survey was conducted of 850 licensed drivers throughout Maryland who reported their driving behaviors, crash history, beliefs about various alcohol countermeasures, and their knowledge of state alcohol laws. Results: Most drivers (72%) did not feel that it was very likely that they would be stopped by the police if they drove after having too much to drink (low-risk perceivers). High-risk perceivers (28%) felt that it was very likely that they would be stopped and most (70%) felt that it was very likely that they would be arrested and convicted. Less than half (45%) of the low-risk perceivers felt that they would be arrested and convicted if they drove impaired. High-risk perceivers were significantly more likely to be non-white, less likely to drive 10 mph above the speed limit, but were more likely have five or more tickets in their lifetime and believed that sobriety checkpoints are effective. They were also more aware of laws regarding mandatory use of ignition interlocks for repeat driving under the influence (DUI) offenders and the zero tolerance law for under-21-year-old drivers. Conclusion: There is a need to elevate the perceived risk of being caught when driving while alcohol impaired. Despite several years of prevention programs, a substantial portion of Maryland drivers do not feel it very likely that they would be stopped by the police if they were to drive after drinking too much. Drivers who perceive these risks are more accepting of enforcement and treatment countermeasures and are more likely to report safer driving behaviors.

A comparison of web-based and telephone surveys for assessing traffic safety concerns, beliefs, and behaviors

INTRODUCTION The purpose of this investigation was to compare the results of a web-based and a telephone interview survey measuring driver concerns about a variety of traffic safety issues, their beliefs, and specific driving behaviors. METHOD State-wide, annual random digit-dial telephone surveys and web-based surveys were conducted in Maryland. A total of 1,700 drivers were surveyed by telephone and 6,806 took a web survey. RESULTS Telephone respondents were more likely to be female and older. Web respondents were more likely to be white and not Latino/Hispanic. After controlling for demographic differences, telephone survey respondents were more likely to be concerned about traffic safety. They were more likely to believe that sobriety checkpoints reduce drunk driving (OR=2.18, 95% CI 1.94, 2.45), they would be ticketed for not wearing a seat belt (OR=1.26, 95% CI 1.12, 1.43), and they would be stopped by the police if they drove after drinking too much (OR=1.17, 95% CI 1.03, 1.32). They were less likely to report a variety of risky behaviors including using a cell phone while driving (OR=.54, 95% CI .48, .61) and driving 10+ mph over the speed limit (OR=.81, 95% CI .72, .91), but were more likely to report having been ticketed for a moving violation in the last month (OR=2.22, 95% CI 1.70, 2.90). Suggestions are offered for overcoming potential sources of sampling bias. IMPACT ON INDUSTRY Web-based surveys produce substantially different results than random-digit-dial telephone surveys, when used for public assessments of traffic safety concerns and behaviors.

A social ecological assessment of physical activity among urban adolescents

OBJECTIVES To examine the physical, social and temporal contexts of physical activity, as well as sex variations of the associations among 314 urban adolescents. METHODS Three-day physical activity recall measured contextual information of physical activities. Logistic regressions and generalized estimating equation models examined associations among physical activity types and contexts, and sex differences. RESULTS Active transportation was the most common physical activity. Home/neighborhood and school were the most common physical activity locations. School was the main location for organized physical activity. Boys spent more time on recreational physical activity, regardless of the social context, compared to girls. The average physical activity level was significantly lower for girls than for boys after school. CONCLUSIONS Physical activity promotion interventions need to target physical activity environments and social contexts in a sex-specific manner.

Hurried driver dispositions: their relationship to risky traffic behaviors

OBJECTIVE To examine the relationship of driver dispositions with traffic safety behaviors and beliefs. METHODS A random digit-dial telephone survey was conducted of 796 licensed drivers. RESULTS Binary and multivariate logistic regression analyses compared hurried and nonhurried drivers and found that hurried drivers were more likely to admit to a variety of risky behaviors. They were also less likely to believe they would be ticketed for speeding and to report wearing their seat belt than were nonhurried drivers. CONCLUSIONS More research is needed into identifying the underlying motivational factors of hurried drivers and what countermeasures will be most effective for them.

The Relationship between Impaired Driving Crashes and Beliefs about Impaired Driving: Do Residents in High Crash Rate Counties Have Greater Concerns about Impaired Driving?

Objectives: The purpose of this investigation was to examine the relationship between impaired driving crashes and public beliefs and concerns about impaired driving across each of Marylands twenty-four counties (including Baltimore City). It was hypothesized that residents of counties that experience higher impaired driving crashes would express more concerns about impaired driving and perceive more risks about driving impaired than residents of counties that have lower rates of impaired driving. Methods: Data for alcohol impaired driving crashes were obtained for the years 2004–2006. These data were compared to public opinion data that was obtained annually by random-digit-dial telephone surveys from 2004 to 2007. Results: Concerns about drunk driving as well as perceptions of the likelihood of being stopped by the police if one were to drive after having too much to drink were related to counties with higher serious impaired driving crash rates, as were perceptions that the police and the legal system were too lenient. Perceptions about the likelihood of being stopped by the police were higher in those counties with more impaired driving enforcement activity. Conclusion: Perceptions of concern appear to be shaped more by crash exposure than enforcement activity. Campaigns that address impaired driving prevention should substantially increase enforcement, strengthen the adjudication process of impaired drivers, and emphasize the potential seriousness of drinking-driving crashes in their promotional activities.

Methods and protocol of a mixed method quasi-experiment to evaluate the effects of a structural economic and food security intervention on HIV vulnerability in rural Malawi: The SAGE4Health Study

BackgroundPoverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people’s economic status and food security translate into changes in HIV vulnerability.MethodsIn this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18- and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants.DiscussionIn addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.

Structural Model Analysis of HIV Risk Behaviors among Sexually Active Minority Adolescents

UNLABELLED Contents of this article are solely the responsibility of the authors and do not necessarily reflect the opinions, official policy or position of the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration or Centers for Mental Health Services and Substance Abuse Prevention. OBJECTIVE To evaluate an HIV risk profile in sexually active black and Hispanic adolescents using a structural equation model (SEM). METHOD Grantees from 15 states and Washington, DC, were selected to participate in the study. Black and Hispanic adolescents (N = 2,371) who completed the baseline instrument were required to have experienced vaginal, oral or anal sex in order to be included in this study. Total minority youths who self-reported as black but not Hispanic were n = 1,455 and for Hispanic n = 916. RESULTS The hypothesized model fit moderately well (CFI = 0.940, TLI = 0.928, RMSEA = 0.039). The key significant direct effect was found (P < 0.05) for higher alcohol, tobacco and other drug use related to nonuse of condoms, more sex partners and use of substances before sex. CONCLUSION Current findings underscore the need to incorporate culturally sensitive strategies in developing programs for minority youth. However, given that minority group members often report greater experiences of discrimination than whites, future research in this area should also include an examination of the role of other stressors such as racial disparities and their potential cumulative impact on minority youth and their risks for alcohol, tobacco and other drug use and HIV.

Obesity, body image, and its impact on children's eating and exercise behaviors in China: A nationwide longitudinal study

Body image seems to mediate the association between obesity and health behaviors as well as weight control attempts. We examined the distribution of childrens body image by demographic characteristics and their subsequent associations with eating, exercise, and weight change. Child body image and health behaviors from the China Health National Survey 2000-2011 were assessed at baseline and in follow-up for 6- to 17-year-old children during 2000-2011 using mixed models. There was a large discrepancy between childrens actual weight status (overweight: 16.9%) vs. self-rated body image (fat: 2.4% in 2011). Less than 1% of children desired a fat body; girls were more likely to want to be thin (52.5% vs. 40.9%) than boys. About 11% of children needed to lose weight in order to be at their desired baseline. During follow-up, those needing weight loss to be as desired were more likely to attempt dieting to change their weight (OR, 95% CI=1.9, 1.1-3.5 in boys; 1.7, 1.1-2.5 in girls) and less likely to feel they had enough physical activity (OR, 95% CI=0.5, 0.4-0.7 in boys; 0.6, 0.5-0.9 in girls), although their weight gain had been significantly higher than those having consistent self and desired body images (β [SE]=0.4 [0.1] in boys; 0.2 [0.1] in girls, all p<0.05). However, no significant difference was shown in subsequent health behaviors among overweight children by body image discrepancy. The discrepancy in self vs. desired body image motivated children to change their obesity-related health behaviors among non-overweight children in China.

Mismatch in Children’s Weight Assessment, Ideal Body Image, and Rapidly Increased Obesity Prevalence in China: A 10-Year, Nationwide, Longitudinal Study: Body Image Change and Obesity Epidemic

This study examined secular trends in children’s weight‐status assessment, measured weight status, and ideal body image and their associations with subsequent changes in BMI, and it explored the differences between sociodemographic groups in China.