Allison W. Watts

Associations between the school food environment, student consumption and body mass index of Canadian adolescents

BackgroundIncreasing attention has been paid to the school food environment as a strategy to reduce childhood obesity. The purpose of this study was to examine associations between the school food environment, students’ dietary intake, and obesity in British Columbia (BC), Canada.MethodsIn 2007/08, principal responses about the school environment (N = 174) were linked to grades 7-12 students (N = 11,385) from corresponding schools, who participated in the BC Adolescent Health Survey. Hierarchical mixed-effect regression analyses examined the association between the school food environment and student’s intake of sugar-sweetened beverages (SSBs), food consumption, and body mass index. Analyses controlled for school setting, neighborhood education level and student’s age and sex.ResultsSchool availability of SSBs was positively associated with moderate (Odds Ratio (OR) = 1.15, 95% Confidence Interval (CI) = 1.02-1.30) and high (OR = 1.43, 95% CI = 1.13-1.80) SSB intake as were less healthful school nutrition guidelines for moderate SSB consumers only (OR = 0.65, 95% CI = 0.48-0.88). Availability of SSBs at school and its consumption were positively associated with student obesity (OR = 1.50, 95% CI = 1.12-2.01 and OR = 1.66, 95% CI = 1.19-2.34, respectively) but not with overweight. In contrast, consumption of less healthful food was positively associated with overweight (OR = 1.03, 95% CI = 1.01-1.06).ConclusionsThe results of this study provide further evidence to support the important role of schools in shaping adolescents’ dietary habits. Availability and consumption of SSBs, but not less healthful foods, at school were associated with higher adolescent obesity highlighting that other environments also contribute to adolescent obesity.

Adolescent Snacking Behaviors Are Associated with Dietary Intake and Weight Status

BACKGROUND Most adolescents consume ≥1 snack/d; exploring the relevance of snacking patterns for overall diet and weight status is important to guide dietary counseling and public health strategies for obesity prevention. OBJECTIVE This study examined intake of common energy-dense snack foods, total number of snacks consumed, frequency of consuming snacks prepared away from home, and frequency of snacking while watching television in adolescents and how these behaviors may be linked to diet and weight status. Relations were examined with attention to potential confounders that may help explain the mixed findings of previous research. METHODS Survey measures of snacking behavior, a food-frequency questionnaire, and anthropometric measurements were completed by 2793 adolescents (53.2% girls, mean age = 14.4 y) in Minneapolis-St. Paul school classrooms in 2009-2010. Linear regression was used to examine associations with adjustment for sociodemographic characteristics and other potential confounding factors, such as meal skipping, underreporting energy intake, dieting to lose weight, and physical activity. RESULTS Adolescents reported consuming a mean of 2.2 energy-dense snack food servings/d and 4.3 snacks/d and purchasing snacks prepared away from home on 3.2 occasions/wk. More than two-thirds of adolescents reported that they sometimes, usually, or always consumed a snack while watching television. The measures of snacking were directly associated (P < 0.01) with higher energy, lower fruit/vegetable, higher sugar-sweetened beverage, and more frequent fast-food intakes in all models except for one: energy-dense snack food servings were not related to sugar-sweetened beverage intake. A direct relation between daily servings of energy-dense snack foods and body mass index (BMI) z score was found; however, the snacking behaviors were inversely related to BMI z score (P < 0.01). CONCLUSIONS The observed cross-sectional associations suggest that snack consumption is a risk factor for poor diet, but unless energy-dense foods are consumed, snacking does not consistently contribute to overweight in US adolescents.

Stimulating Innovations in the Measurement of Parenting Constructs

Parents can play a crucial role in the development of childrens behaviors associated with dietary habits, physical activity, and sedentary lifestyles. Many parenting practices and/or styles measures have been developed; however, there is little agreement as to how the influence of parenting should be measured. More importantly, our ability to relate parenting practices and/or styles to childrens behaviors depends on its accurate assessment. While there is a need to standardize our assessment to further advance knowledge in this area, this article will discuss areas that may stimulate advances in the measurement of parenting constructs. Because self-report measures are important for the assessment of parenting, this article discusses whether solutions to improve self-report measures may lie in: (1) Improving the questions asked; (2) improving the methods used to correct for social desirability or measurement errors; (3) changing our measurement paradigm to assess implicit parenting behaviors; (4) changing how self-report is collected by taking advantage of ecological momentary assessment methods; (5) using better psychometric methods to validate parenting measures or alternatively using advances in psychometric methods, such as item banking and computerized adaptive testing, to solve common administration issues (i.e., response burden and comparability of results across studies); and (6) employing novel technologies to collect data such as portable technologies, gaming, and virtual reality simulation. This article will briefly discuss the potential of technologies to measure parenting constructs.

Socioeconomic differences in overweight and weight-related behaviors across adolescence and young adulthood: 10-year longitudinal findings from Project EAT.

Reducing socioeconomic disparities in weight-related health is a public health priority. The purpose of this paper was to examine 10-year longitudinal patterns in overweight and weight-related behaviors from adolescence to young adulthood as a function of family-level socioeconomic status (SES) and educational attainment. Project EAT (Eating and Activity in Teens and Young Adults) followed a diverse sample of 2287 adolescents from 1999 to 2009. Mixed-effects regression tested longitudinal trends in overweight, fast food, breakfast skipping, physical inactivity, and screen use by family-level SES. The influence of subsequent educational attainment in young adulthood was examined. Results revealed that the prevalence of overweight increased significantly from adolescence to young adulthood with the greatest change seen in those from low SES (mean change=30.7%, 95% CI=25.6%-35.9%) as compared to high SES families (mean change=21.7%, 95% CI=18.2%-25.1%). Behavioral changes from adolescence to young adulthood also differed by SES background; the prevalence of frequent fast food intake (≥3times/week) increased most dramatically in those from low SES (mean change=6%, 95% CI=0.5%-11%) as compared to high SES families (mean change=-1.2%, 95% CI=-5.2%-2.9%). Overall trends suggest that a higher educational attainment mitigates the negative impacts of a low SES background. These findings suggest that continued effort is needed to ensure that public health strategies addressing obesity and related behaviors reach adolescents and young adults from low SES backgrounds and do not contribute to widening socioeconomic gaps in weight-related health.

Does Body Satisfaction Help or Harm Overweight Teens? A 10-Year Longitudinal Study of the Relationship Between Body Satisfaction and Body Mass Index

PURPOSE This study examines the relationship between body satisfaction of overweight adolescents and 10-year changes in body mass index (BMI). METHODS Participants who were overweight as adolescents (n = 496) were drawn from Project Eating and Activity in Teens and Young Adults (Project EAT), a 10-year longitudinal study. RESULTS Among overweight girls, a significant difference in 10-year BMI change across baseline body satisfaction quartiles was observed. Overweight girls with the lowest body satisfaction at baseline had a nearly three unit greater increase in BMI at follow-up, compared with overweight girls in the high body satisfaction quartile; this difference has important clinical significance. Among overweight boys, no significant associations between body satisfaction quartile and change in BMI were not observed. CONCLUSION Overall, findings indicate that among overweight adolescents, a high level of body satisfaction during adolescence was not harmful, and in fact may be beneficial for girls, in terms of long-term weight management. These findings refute the commonly held notion that overweight young people should be dissatisfied with their bodies to motivate positive change.

Millennials at work: workplace environments of young adults and associations with weight-related health

Background The purpose of this study was to describe the workplace environments of young adults and examine associations with diet, physical activity (PA) and body mass index (BMI). Methods Cross-sectional data were collected (2008–2009) from 1538 employed young adult participants in Project EAT (Eating and Activity among Teens and Young Adults), a diverse population-based sample. Survey measures assessed height, weight, diet, moderate-to-vigorous PA, transportation-related PA and perceptions of the workplace food and PA environments (eg, soda availability, coworker support). Healthful characteristics were summed to reflect overall workplace healthfulness. Modified Poisson regression analyses conducted in 2015 identified associations between workplace food and PA environments and diet, PA and BMI. Results The healthfulness of workplace environments was suboptimal. Greater exposure to healthful workplace characteristics was related to more young adults engaged in favourable diet and PA behaviours and a lower prevalence obesity. For example, adjusted rates of obesity were 24% and 17% among those reporting low (≤1 characteristic) versus high (≥3 characteristics) exposure to healthful food environments, respectively (p<0.05). Workplace characteristics independently associated with weight-related outcomes included soda availability, proximity to a fast food outlet, living close to work and perceived ease of eating a healthy diet or being active at work. Conclusions A more healthful workplace environment overall, including physical attributes and perceived social norms, may contribute to more favourable weight-related behaviours and lower prevalence of obesity among young adults. Employer-initiated and community-initiated policies may represent one way to create healthier workplace environments for young adults.

Do students' perceptions of school smoking policies influence where students smoke?: Canada's Youth Smoking Survey.

ObjectiveThe objective of this study was to explore students’ perceptions of school policy characteristics that influence the location of smoking while at school.MethodsData were collected from a nationally representative sample of Canadian youth in grades 7–12 as part of the 2006–2007 Youth Smoking Survey. We used multilevel logistic regression to examine how students’ perceptions of school policies predicted smoking behavior on and off school grounds in 11,881 students who had ever smoked. Separate analyses were conducted for grades 7–9 and 10–12.ResultsIn both grades 7–9 and 10–12, perceiving clear rules about smoking decreased the likelihood that a student would smoke on school grounds, while perceiving that a high percentage of peers smoke, that there are school rules about smoking, that students obey the rules, and that students can be fined for smoking increased the likelihood that a student would smoke off school grounds.ConclusionsClearly perceived rules about smoking encourage students not to smoke on school grounds; however, perceptions of rules, along with strong enforcement, may displace behavior off of school grounds. Non-smoking policies should be part of a comprehensive approach, that supports cessation.

Experiences of overweight/obese adolescents in navigating their home food environment

OBJECTIVE To explore perceived factors that impede or facilitate healthful eating within the home environment among overweight/obese adolescents. DESIGN In the present qualitative photovoice study, participants were instructed to take photographs of things that made it easier or harder to make healthful food choices at home. Digital photographs were reviewed and semi-structured interviews were conducted to promote discussion of the photographs. Data were analysed using constant comparative analysis. SETTING Vancouver, Canada, in 2012-2013. SUBJECTS Twenty-two overweight/obese adolescents who completed a family-based lifestyle modification intervention. RESULTS The mean age of participants was 14 (sd 1.9) years, 77% were female and their mean BMI Z-score was 2.4 (sd 0.6). Adolescents talked about six aspects of the home environment that influenced their eating habits (in order of frequency): home cooking, availability and accessibility of foods/beverages, parenting practices, family modelling, celebrations and screen use/studying. In general, homes with availability of less healthful foods, where family members also liked to eat less healthful foods and where healthier foods were less abundant or inaccessible were described as barriers to healthful eating. Special occasions and time spent studying or in front of the screen were also conducive to less healthful food choices. Home cooked meals supported adolescents in making healthier food choices, while specific parenting strategies such as encouragement and restriction were helpful for some adolescents. CONCLUSIONS Adolescents struggled to make healthful choices in their home environment, but highlighted parenting strategies that were supportive. Targeting the home food environment is important to enable healthier food choices among overweight/obese adolescents.

Parent–Child Associations in Selected Food Group and Nutrient Intakes among Overweight and Obese Adolescents

Few studies have compared parent-child dietary intake among adolescents who are overweight or obese. The purpose of our study was to determine the relationship between parent-teen intake of selected dietary components among this sample. Baseline data from 165 parent and adolescent (aged 11 to 16 years) pairs who presented for a lifestyle behavior modification intervention were collected between 2010 and 2012. Parent and adolescent dietary intake (servings of fruits and vegetables [F/V]; grams of sugar; and percent energy from total fat, saturated fat, dessert/treats, sugar-sweetened beverages, and snacks) was assessed using web-based 24-hour dietary recalls. Multivariable linear and negative binomial regression models identified associations between parent and child dietary intake adjusting for relevant covariates. A large proportion of adolescents and parents did not meet dietary recommendations for F/V, total fat, and saturated fat. Parent-adolescent intake of F/V, total fat, saturated fat, sugar, sugar-sweetened beverages, and snacks were positively associated (r=0.19 to 0.37). No relationship was observed for dessert/treats. In multivariate models, significant interaction effects suggest that the parent-child association in diet was weaker for fat intake among parents with higher educational attainment (b=-.31; P<0.05) and for snacking among adolescent boys (b=-.30; P<.05). Parent intake of several dietary components important for good health, and related to obesity, was associated with adolescent intake. Helping parents improve their diet may promote improvements in their adolescents diet and is a potential target for interventions designed to increase healthy eating among adolescents.

School and Community Predictors of Smoking: A Longitudinal Study of Canadian High Schools

OBJECTIVES We identified the most effective mix of school-based policies, programs, and regional environments associated with low school smoking rates in a cohort of Canadian high schools over time. METHODS We collected a comprehensive set of student, school, and community data from a national cohort of 51 high schools in 2004 and 2007. Hierarchical linear modeling was used to predict school and community characteristics associated with school smoking prevalence. RESULTS Between 2004 and 2007, smoking prevalence decreased from 13.3% to 10.7% in cohort schools. Predictors of lower school smoking prevalence included both school characteristics related to prevention programming and community characteristics, including higher cigarette prices, a greater proportion of immigrants, higher education levels, and lower median household income. CONCLUSIONS Effective approaches to reduce adolescent smoking will require interventions that focus on multiple factors. In particular, prevention programming and high pricing for cigarettes sold near schools may contribute to lower school smoking rates, and these factors are amenable to change. A sustained focus on smoking prevention is needed to maintain low levels of adolescent smoking.