Cayley E. Velazquez

Associations between energy drink consumption and alcohol use behaviors among college students

BACKGROUND To explore associations between energy drink consumption and alcohol use among college students. METHODS Participants included 585 students (m age=18.7; 47.0% White, 21% Hispanic, 25% Asian, 7% other race/ethnicity; 56.0% female). Energy drink behaviors included past month and past week consumption. Alcohol use behaviors included past month and past two week consumption, as well as heavy drinking and quantity of alcohol consumed. Consumption of energy drinks mixed with alcohol was also measured. Linear and logistic regression analyses between energy drink consumption and alcohol use were run controlling for gender, age, and race/ethnicity. RESULTS For each one unit increase in past month (i.e., additional day used) energy drink use, the likelihood of past month alcohol use increased by 80%, heavy drinking by 80% and past month energy drinks mixed with alcohol use by 90%. Similar results were found for past week energy drink use. A positive relationship between energy drink use and quantity of alcohol consumed during a single episode of drinking was also found (p<0.001). Significant gender interactions between energy drink consumption and alcohol use as well as quantity of alcohol consumed were found, with relationships stronger among males than females. There were no significant interactions by race/ethnicity. CONCLUSIONS Energy drinks are readily available to students and pose potential health risks. Students who report greater energy drink consumption also consume more alcohol, are more likely to mix energy drinks and alcohol, and experience heavy episodes of drinking, which is problematic given the potential negative consequences of these drinks.

Differential prevalence of alcohol use among 2-year and 4-year college students

PURPOSE To determine whether alcohol use behaviors and alcohol-related consequences differed among students attending two-year versus four-year colleges. METHODS 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 students. RESULTS 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. CONCLUSIONS 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.

Attention to Food and Beverage Advertisements as Measured by Eye-Tracking Technology and the Food Preferences and Choices of Youth

The purpose of this study was to examine how objective measures of attention to food/beverage advertising were associated with the unhealthy food/beverage preferences and choices of children and adolescents. A self-report survey and eye-tracking session were completed by 102 youth (mean age=11.6 years; 56.4% were white; 43.1% were female) between April and November 2010. Participants viewed 40 food/beverage advertisements on a computer and their eye movements were recorded. Objective attention measures included total viewing time, fixation length (time spent viewing characters/logos, unhealthy food/beverage items), and fixation count (number of times an individual stops to examine characters/logos, unhealthy food/beverage items). Food/beverage preferences and choices were measured by self-report. The preferences index summed responses to 12 questions measuring snack food and sugar-sweetened beverage preferences and the choices index summed responses to eight questions measuring consumption of snack foods and sugar-sweetened beverages. Regression models examined whether attention to food/beverage advertising was associated with food preferences and choices, controlling for sex, age, and body mass index z score. The length of time and number of times participants looked at unhealthy food and beverage items within advertisements were each significantly associated with unhealthy food/beverage preferences of youth (P<0.05). Associations were no longer significant after controlling for demographic characteristics. Attention to advertising was not significantly associated with food/beverage choices. Research with larger samples is needed to more fully understand the role of attention. Future research should also examine the association between attention to advertising and purchase requests, given the important role of parents in the decision-making process surrounding food choice.

Are adolescents' perceptions of dietary practices associated with their dietary behaviors?

Despite interventions designed to change behavior, many adolescents continue to consume unhealthy foods. Dietary patterns are important for disease prevention, making it necessary to understand the reasons for these poor choices. This cross-sectional study explored the relationship between perception of dietary practices and dietary behaviors among adolescents. Participants (n=15,283; mean age=15 years; 50.7% female) completed the 2004-2005 Texas School Physical Activity and Nutrition survey. Perception of dietary practices included fat content of foods usually eaten and healthiness of usual eating habits. Dietary behavior was measured by self-report of foods eaten the day before survey administration. Composite scores of unhealthy and healthy eating were created. Regression analyses examined whether perception of dietary practices was consistent with actual dietary behavior, controlling for sex, grade, and race/ethnicity, and accounting for the complex sampling design. Higher perceived fat content was associated with increased consumption of unhealthy foods, while higher perceived healthiness of eating was associated with increased consumption of healthy foods. For perceived fat content, the difference in the Healthy Eating Index between extreme categories was 26% (P<0.001), while the difference in the Unhealthy Eating Index between extreme categories was 81% (P<0.001). For perceived healthiness, the difference in the Healthy Eating Index between extreme categories was 23% (P<0.001), while the difference for the Unhealthy Eating Index was 44% (P<0.001). Self-perceptions of dietary practices were significantly associated with dietary behaviors, indicating awareness about the relative nutrient content of foods consumed. Interventions that move beyond dietary knowledge and create changes in the social and physical environment are needed.

Weight misperception and health risk behaviors among early adolescents

OBJECTIVES To examine associations between weight misperception and youth health risk and protective factors. METHODS Three thousand ten US seventh-graders (72.1% white, mean age: 12.7 years) self-reported height, weight, risk, and protective factors. Analyses were conducted to determine cross-sectional and longitudinal associations between weight overestimation and health risk and protective factors. RESULTS 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. CONCLUSIONS Weight overestimation and risk factors appear to co-occur, suggesting a constellation of risk that warrants further research.

Sustainability and public health nutrition at school: assessing the integration of healthy and environmentally sustainable food initiatives in Vancouver schools

OBJECTIVE To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools. DESIGN The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food. SETTING Vancouver, Canada. SUBJECTS A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education. RESULTS Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus. CONCLUSIONS More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

Who Uses Snus? A Study of Texas Adolescents

INTRODUCTION Snus, a smokeless tobacco product, was introduced in the United States in 2006. Because it is available in a variety of flavors and is relatively easy to conceal, snus might be particularly attractive to adolescents. Yet, no studies have examined snus use in U.S. adolescents. This brief report examined (a) differences between adolescent snus users and non-snus users on a variety of demographic, behavioral, and intrapersonal factors and (b) prevalence of snus use among current users of various other tobacco products versus nontobacco users. METHODS Participants were 8,472 6th- to 12th-grade students who voluntarily completed the 87-item Texas Youth Tobacco Survey during class time. RESULTS Overall, 7.1% of students reported ever trying snus; of these, 77% were male, 68% were in high school, and 46% were White. Mixed-effects regression models indicated that the prevalence of cigarette, chew, cigar, and alcohol use was higher among snus users than among non-snus users. Compared with non-snus users, snus users performed more poorly in school and perceived snus, cigarettes, chew, and cigars to be less dangerous. Finally, current users of cigarettes, chew, and cigars had a higher prevalence of snus use than did their peers who did not use the respective products. CONCLUSIONS Among U.S. adolescents, snus use may be part of a constellation of health compromising behaviors. Additional research is needed to determine who is using snus and identify the determinants and consequences of snus use, all of which can inform interventions and policies aimed at decreasing tobacco use among youth.

Food and beverage promotions in Vancouver schools: A study of the prevalence and characteristics of in-school advertising, messaging, and signage

The purpose of this study was to provide a descriptive profile of food-related advertising, messaging, and signage in Vancouver schools and to examine differences in the prevalence and characteristics of promotions between elementary and secondary schools. All food-related promotions were photographed in 23 diverse Vancouver public schools between November 2012 and April 2013. Key attributes, including the location, size, and main purpose of each promotion, as well as the type of food and/or beverage advertised and compliance with provincial school nutrition guidelines, were coded. Descriptive statistics assessed the prevalence and characteristics of promotions. Cross-tabulations examined whether the promotional landscape differed between elementary and secondary schools. All secondary and 80% of elementary schools contained food or beverage promotions (median = 17, range = 0–57 promotions per school). Of the 493 promotions documented, approximately 25% depicted “choose least” or “not recommended” items, prohibited for sale by provincial school nutrition guidelines. Nearly 1/3 of promotions advertised commercial items (e.g., brand name beverages such as Pepsi), in violation of the Board of Educations advertising policies and only 13% conveyed nutrition education messages. Close to half of all promotions were created by students for class projects, many of which marketed minimally nutritious items. In Vancouver schools, food-related promotions are common and are more prevalent in secondary than elementary schools. Students are regularly exposed to messaging for nutritionally poor items that are not in compliance with provincial school nutrition guidelines and which violate school board advertising policies. Stronger oversight of food-related promotional materials is needed to ensure that schools provide health promoting food environments.

A Multi-Method Study to Understand How Youth Perceive and Evaluate Food and Beverage Advertisements

As a formal practice, advertising has been in existence for over 100 years, most often with the purpose of creating consumer excitement for, and the voluntary purchase of, company products and goods (Grier & Kumanyika, 2010). While advertising is meant to drive consumption, the purchase of certain products, especially among specific groups, may be problematic. Recent literature suggests that there may be a link between food and beverage advertising and the prevalence of childhood obesity among youth in the USA (IOM, 2006). Because of the dramatic increase in the prevalence of obesity over the past 30 years (Ogden, Carrol, Curtin, Lamb, & Flegal, 2010), investigating factors that may contribute to weight gain among children and adolescents is essential. While overweight and obesity is influenced by many factors, food and beverage advertising, and its resulting influence on the dietary preferences and choices of youth, is thought to be a key factor (Story & French, 2004; IOM, 2006). The amount and type of advertising that is directed toward youth has grown considerably in recent years, with marketers using an increasing number of techniques and outlets to promote their products. Greater media use among youth (Rideout, Foehr, & Roberts, 2010), in combination with advertising that extends to a variety of media channels, has resulted in increased exposure to unhealthy food and beverage products.

Food and Beverage Marketing in Schools: A Review of the Evidence

Despite growing interest from government agencies, non-governmental organizations and school boards in restricting or regulating unhealthy food and beverage marketing to children, limited research has examined the emerging knowledge base regarding school-based food and beverage marketing in high-income countries. This review examined current approaches for measuring school food and beverage marketing practices, and evidence regarding the extent of exposure and hypothesized associations with children’s diet-related outcomes. Five databases (MEDLINE, Web of Science, CINAHL, Embase, and PsycINFO) and six grey literature sources were searched for papers that explicitly examined school-based food and beverage marketing policies or practices. Twenty-seven papers, across four high-income countries including Canada (n = 2), Ireland (n = 1), Poland (n = 1) and United States (n = 23) were identified and reviewed. Results showed that three main methodological approaches have been used: direct observation, self-report surveys, and in-person/telephone interviews, but few studies reported on the validity or reliability of measures. Findings suggest that students in the U.S. are commonly exposed to a broad array of food and beverage marketing approaches including direct and indirect advertising, although the extent of exposure varies widely across studies. More pervasive marketing exposure was found among secondary or high schools compared with elementary/middle schools and among schools with lower compared with higher socio-economic status. Three of five studies examining diet-related outcomes found that exposure to school-based food and beverage marketing was associated with food purchasing or consumption, particularly for minimally nutritious items. There remains a need for a core set of standard and universal measures that are sufficiently rigorous and comprehensive to assess the totality of school food and beverage marketing practices that can be used to compare exposure between study contexts and over time. Future research should examine the validity of school food and beverage marketing assessments and the impacts of exposure (and emerging policies that reduce exposure) on children’s purchasing and diet-related knowledge, attitudes and behaviors in school settings.