Andrew E. Springer

Reductions in Child Obesity Among Disadvantaged School Children With Community Involvement: The Travis County CATCH Trial

The objective of this study was to compare the impact of two intervention approaches on the prevalence of child overweight and obesity: (i) Coordinated Approach To Child Health BasicPlus (CATCH BP), in which schools were provided evidence‐based coordinated school health program training, materials, and facilitator support visits, and (ii) CATCH BP and Community (BPC), in which BP schools received additional promotion of community partnerships with the aim of integrating community members and organizations into schools, local decision making and action, and best practices workshops. Schools (n = 97) in four central Texas districts were recruited to participate in the 4‐year project. Of the low‐income schools (n = 58), 15 schools were selected to receive the BPC intervention and matched with 15 schools in the BP condition. A serial cross‐sectional design was used, in which 4th grade student BMI, physical activity, and diet were assessed in the 30 schools in spring 2007 and 2008. Measurements in spring 2007 included 1,107 students, with 53% female; 61% Hispanic, and 14% African American; and mean age of 9.9 years. Adjusted prevalence of overweight/obesity (≥85th percentile) was 42.0 and 47.4% in spring 2007 for the BP and BPC students, respectively. From spring 2007 to spring 2008, the percent of students classified as overweight/obese decreased by 1.3 percentage points (P = 0.33) in BP schools, compared to a decrease of 8.3 percentage points (P < 0.005) in students from BPC schools; the difference between conditions was significant (P = 0.05). CATCH BPC students also reported more positive trends in related behaviors. Implementation of a community‐enhanced school program can be effective in reducing the prevalence of child overweight in low‐income student populations.

Prevalence of overweight misperception and weight control behaviors among normal weight adolescents in the United States

Weight perceptions and weight control behaviors have been documented with underweight and overweight adolescents, yet limited information is available on normal weight adolescents. This study investigates the prevalence of overweight misperceptions and weight control behaviors among normal weight adolescents in the U.S. by sociodemographic and geographic characteristics. We examined data from the 2003 Youth Risk Behavior Survey (YRBS). A total of 9,714 normal weight U.S. high school students were included in this study. Outcome measures included self-reported height and weight measurements, overweight misperceptions, and weight control behaviors. Weighted prevalence estimates and odds ratios were computed. There were 16.2% of normal weight students who perceived themselves as overweight. Females (25.3%) were more likely to perceive themselves as overweight than males (6.7%) (p < 0.05). Misperceptions of overweight were highest among white (18.3%) and Hispanic students (15.2%) and lowest among black students (5.8%). Females (16.8%) outnumbered males (6.8%) in practicing at least one unhealthy weight control behavior (use of diet pills, laxatives, and fasting) in the past 30 days. The percentage of students who practiced at least one weight control behavior was similar by ethnicity. There were no significant differences in overweight misperception and weight control behaviors by grade level, geographic region, or metropolitan status. A significant portion of normal weight adolescents misperceive themselves as overweight and are engaging in unhealthy weight control behaviors. These data suggest that obesity prevention programs should address weight misperceptions and the harmful effects of unhealthy weight control methods even among normal weight adolescents.

Senate Bill 42: Implementation and Impact on Physical Activity in Middle Schools

PURPOSE In 2005, the Texas State Legislature passed Senate Bill 42 (SB42), which required public middle school students (grades 6-8) to participate in 30 minutes of daily structured physical activity. The purpose of this study was to assess awareness of and adherence to SB42 in Texas middle schools, and to assess the impact of SB42 on the frequency and quality of structured physical activity. METHODS Key informant (school principals, physical education [PE] instructors, nurses, or designated personnel) telephone interviews on the implementation of SB42 were conducted from a statewide representative sample of public middle schools (n=112). Direct observation, key informant, and student report of physical activity in PE classes at 17 Texas-Mexico border middle schools assessed the frequency and quality of structured physical activity. RESULTS State level (94% +/- 4.5%) and border district (94% +/- 13.5%) key informants reported a high level of overall awareness of SB42. Postimplementation of SB42 border districts reported a minimum of 4 days per week of PE instruction and more than 58 minutes per PE class, exceeding the 30-minute minimum of structured physical activity per day or 135 minutes per week as required by SB42 (range: 58.2-61.4 minutes). A significant increase in the number of days of PE class was observed in the border sample between 2004 and 2005 and 2006 and 2008, with eighth grade students reporting an average of 2.0 days and 3.7 days of PE per week, respectively (p < .001). Additionally, border districts met the Healthy People 2010 objective of 50% time in moderate-to-vigorous physical activity (mean 54.9% +/- 5.1%) during PE class. CONCLUSIONS Implementation of SB42 appears to have impacted the frequency of school PE in Texas and the prevalence of child self-reported physical activity behaviors along the Texas-Mexico border. General awareness of and adherence to SB42 was high in both statewide and among the border districts. Our mixed findings on adherence to specific components of the legislation suggest the need for further investigation of the factors that both facilitate and inhibit local leadership around school policy and the mechanisms to ensure the school policy is being implemented.

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador

BackgroundAdolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains–aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors–among public secondary school students in central El Salvador.MethodsWe employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Preventions Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12–20 years participated in the study.ResultsHealth risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).ConclusionA high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.

A Descriptive Study of Beverage Consumption among an Ethnically Diverse Sample of Public School Students in Texas

Objective: The purpose of this study was to examine prevalence rates of 5 types of beverage consumption by sociodemographic factors among 4th-, 8th-, and 11th-grade public school students in Texas. Methods: This study is based on secondary analyses of cross-sectional data from the 2004–2005 School Physical Activity and Nutrition study, a comprehensive surveillance study of energy balance–related behaviors and behavioral antecedents in a state-representative sample of 4th-, 8th-, and 11th-grade public school students in Texas (N  =  23,190). Previous-day beverage consumption prevalence estimates were calculated for 5 types of beverages (i.e., fruit-flavored drinks, regular sodas, diet sodas, milk, and 100% fruit juice) by grade level, gender, ethnicity, school-level socioeconomic status, and metropolitan status. Logistic regression estimates of consumption prevalence were obtained for important sociodemographic indicators, including sex, grade, and ethnicity. Adjusted Wald tests were used to derive significance tests for sex differences in consumption, as sex emerged as a key determinant of consumption prevalence and varied systematically by type of beverage. Results: The most commonly consumed beverage by all participants was milk. However, more than 50% of students also reported regular soda and fruit-flavored drink consumption during the previous day. Milk and fruit juice consumption showed a steady decline with grade level, while consumption of regular soda increased with grade level. By 11th grade, the prevalence of any beverage consumption, including milk and juice, was significantly greater among boys. Ethnic differences in sugar-sweetened beverage consumption were most prevalent in 8th and 11th grades, with the highest estimated prevalence of sugar-sweetened beverages (i.e., fruit-flavored drink and regular soda) consumption among African Americans. Differences in beverage consumption by school-level socioeconomic status and metropolitan status were small. Conclusions: These findings indicate that a large proportion of public elementary students in Texas are consuming sugar-sweetened beverages and that consumption of sugar-sweetened beverages varies by a range of sociodemographic factors. Given the important link between sugar-sweetened beverages and obesity in children, these findings can be used to tailor obesity prevention efforts to specific subpopulations for the promotion of healthier beverage consumption.

Prevalence of Physical Activity and Sedentary Behaviors in US High School Students by Metropolitan Status and Geographic Region

BACKGROUND Geographic differences in the prevalence of physical activity (PA) have been found among adults in the US; similar studies have not been conducted among adolescents. METHODS Using nationally representative cross-sectional data from the CDCs 2003 Youth Risk Behavior Survey, we estimated the prevalence of PA and sedentary behaviors by metropolitan status and geographic region. RESULTS The prevalence of PA was lowest and prevalence of sedentary behavior highest for urban students. Students from the South reported the lowest prevalence of PA and the highest prevalence of TV watching, while students from the West generally reported the highest PA prevalence and lowest sedentary behavior prevalence. Prevalence differences ranged from < 1.0% to > 15%, with most differences falling between 5% and 10%. CONCLUSIONS Findings mirror regional variations previously observed in adult PA. We need to understand factors that contribute to lower PA in youth living in the South and in urban settings.

School-level economic disadvantage and obesity in middle school children in central Texas, USA: a cross-sectional study

BackgroundAlthough children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students.MethodsMultilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender.ResultsStudents attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (ORAdj =3.4, 95% CI: 1.1-11.4), Hispanic (ORAdj=1.8, 95% CI 1.1-3.0) and White (ORAdj=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While no obesity differences across school ED categories were found for Hispanic Spanish-speaking students, Hispanic English-speaking students (HES) attending high ED schools were 2.4 times more likely to be obese as HES students at low ED schools (p=.003).ConclusionFindings support the need to prioritize economically disadvantaged schools for obesity prevention efforts and support further exploration of school SES context in shaping children’s physical activity and dietary behaviors.

Promoting Energy-Balance Behaviors Among Ethnically Diverse Adolescents: Overview and Baseline Findings of the Central Texas CATCH Middle School Project

The Central Texas Coordinated Approach To Child Health (CATCH) Middle School Project is a 3.5-year school-based project aimed at promoting physical activity (PA), healthy eating, and obesity prevention among public middle school students in Texas. This article describes the CATCH intervention model and presents baseline findings from spring 2009. CATCH comprises six core components: CATCH Team, CATCH PE, CATCH Classroom, CATCH Eat Smart Cafeteria, CATCH Family, and CATCH Social Marketing. A group randomized serial cross-sectional design is being employed to test the effect of three program support conditions (n = 10 schools each) on energy-balance behaviors: Basic (training and curriculum only), Basic Plus (training and curriculum plus CATCH facilitator support), and Basic Plus Social Marketing (all inputs plus social marketing component). The study sample is composed of a cross-sectional sample of eighth-grade students (primary outcome evaluation sample) and sixth- and seventh-grade students (PE process evaluation sample) who are selected and measured each year. At baseline, 37.9% of eight-grade students (n = 2,841; 13.9 years) were overweight/obese and 19.2% were obese. Eighth-grade students reported, on average, consuming sugar-sweetened beverages more than two times on the previous day and fruits and vegetables roughly three times on the previous day; only two of five school districts surpassed the recommended 50% cut-point for class time spent in moderate-and-vigorous PA as measured in classes of sixth- and seventh-grade students. Additional behavioral findings are reported. Body mass index and behaviors were comparable across conditions. Baseline findings underscore the need to promote student energy-balance behaviors.

Applying an Expanded Social Determinant Approach to the Concept of Adherence to Treatment: The Case of Colombian Women Living With HIV/AIDS

BACKGROUND The purpose of this study was to explore and analyze social determinants that influence adherence among Colombian women living with HIV/AIDS in poverty conditions. METHODS A qualitative, descriptive-interpretative study was developed. Forty-seven women participated in five focus group discussions. Also, in-depth interviews with six women were conducted. FINDINGS Results showed that women with lower adherence sell their antiretroviral medication to satisfy economic needs, and prioritize the care of their HIV-positive children over their own adherence needs. In contrast, women with higher adherence were found to participate in social support groups offered by nongovernmental organizations. CONCLUSION These findings underscore the need to understand the social determinants that facilitate and/or hinder adherence among women in poverty-associated conditions. Results indicate the need to facilitate access to treatment on a timely and continual basis; provide economic resources, including support to meet basic needs as well as subsidies for transportation to health care centers; and explore mechanism for supporting the care of their offspring.

The Relationship Between Perceived Exposure to Promotional Smoking Messages and Smoking Status among High School Students

Data on self-reported perceived exposure to pro-smoking messages were collected from 1,608 high school students surveyed through the ASPIRE (A Smoking Prevention Interactive Experience) Program in Houston, Texas, in 2003. Results indicated that high school smoking quitters had approximately twice the odds of perceived exposure to pro-smoking messages as nonsmokers through billboard advertisements (Adjusted Odds Ratio [AOR] = 2.04, 95% CI: 1.09, 3.81), newspapers & magazines (AOR: 1.97, 95% CI: 1.09, 3.56), and movies (AOR: 1.94, 95% CI: 1.03, 3.65). Smoking experimenters marginally perceived more exposure to pro-smoking radio messages (AOR = 1.31, 95% CI: 1.04, 1.67) and billboard advertisements (AOR = 1.28, 95% CI: 1.02, 1.61) compared to nonsmokers. Lastly, current smokers were 1.82 times as likely to report exposure to pro-smoking poster advertisements as nonsmokers (95% CI: 1.19, 2.79, p < or = .05). These findings suggest that experimenters and quitters may pay more attention to smoking advertisements than nonsmokers and current smokers.