Cheryl L. Perry

Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors.

OBJECTIVES A major assumption underlying youth health promotion has been that physiological risk factors track from childhood into adulthood. However, few studies have systematically examined how behaviors change during adolescence. This paper describes longitudinal tracking of adolescent health behaviors in two Minnesota Heart Health Program communities. METHODS Beginning in sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline n = 2376). Self-reported data included smoking behavior, physical activity, and food preferences. RESULTS A progressive increase in the change to weekly smoking status was observed across the smoking status categories. As students began to experiment with smoking, they were more likely to either begin to be or remain regular smokers. Tracking of physical activity and food choice variables was also apparent. In nearly all the follow-up periods, the students identified at baseline as measuring high remained high, and those measuring low remained low. CONCLUSIONS These results indicate that there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behavior. The early consolidation of health behaviors implies that interventions should begin prior to sixth grade, before behavioral patterns are resistant to change. The smoking results suggest that students are experiencing difficulty quitting smoking; thus, youth smoking cessation interventions are warranted.

Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors

OBJECTIVES: This study aimed to assess the prevalence of perceived weight-teasing and associations with unhealthy weight-control behaviors and binge eating in a population-based sample of youth. Particular focus was placed on overweight youth, who may be most vulnerable to weight-teasing.METHODS: The study population included 4746 adolescents from St Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of Project EAT, a population-based study of eating patterns and weight concerns among teens.RESULTS: There were statistically significant associations between perceived weight-teasing and weight status; both overweight and underweight youth reported higher levels of teasing than average weight youth. Very overweight youth (body mass index (BMI) ≥95th percentile) were most likely to be teased about their weight; 63% of very overweight girls, and 58% of very overweight boys reported being teased by their peers, while weight-teasing by family members was reported by 47% of these girls and 34% of these boys. Youth who were teased about their weight, particularly overweight girls, reported that it bothered them. Perceived weight-teasing was significantly associated with disordered eating behaviors among overweight and non-overweight girls and boys. For example, among overweight youth, 29% of girls and 18% of boys who experienced frequent weight-teasing reported binge-eating as compared to 16% of girls and 7% of boys who were not teased.CONCLUSIONS: Many adolescents, in particular those who are overweight, report being teased about their weight and being bothered by the teasing. Weight-teasing is associated with disordered eating behaviors that may place overweight youth at increased risk for weight gain. Educational interventions and policies are needed to curtail weight-related mistreatment among youth.

Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group.

OBJECTIVE To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease. DESIGN A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994). PARTICIPANTS A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas. INTERVENTION Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education. MAIN OUTCOME MEASURES At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures. RESULTS In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed. CONCLUSION The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

OBJECTIVES Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

Correlates of fruit and vegetable intake among adolescents: Findings from Project EAT

BACKGROUND This study aims to identify correlates of fruits and vegetables from within the domains of personal factors (taste preferences, health/nutrition attitudes, weight/body concerns, and self-efficacy), behavioral factors (meal frequency, fast food intake, and weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). This study further aims to identify correlates of home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between availability and taste preferences. METHODS The population included 3957 adolescents from 31 public middle and high schools in Minnesota. Structural equation modeling was used for model testing. RESULTS The strongest correlates of fruit/vegetable intake were home availability of fruits/vegetables and taste preferences of fruits/vegetables. The final model explained 13% of the variance in fruit/vegetable intake, 45% of the variance in home availability, and 28% of the variance in taste preferences. Correlates of home availability included social support for healthy eating, family meal patterns, family food security, and socio-economic status. Correlates of taste preferences included health/nutrition attitudes and home availability of fruits/vegetables. A test of interaction effects indicated that when home availability of fruits/vegetables was low, intake patterns did not differ, regardless of taste preferences. In contrast, even when taste preferences for fruits/vegetables were low, if fruits/vegetables were available, intake increased. CONCLUSIONS Interventions to increase fruit/vegetable intake in adolescents need to target socio-environmental factors such as greater availability of fruits/vegetables.

Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys Findings from Project EAT

OBJECTIVE To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls. METHODS The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating). RESULTS In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys. CONCLUSIONS Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.

Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota.

OBJECTIVES A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. METHODS The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. RESULTS The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. CONCLUSIONS Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.

Communitywide smoking prevention : Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study

OBJECTIVES The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP), a populationwide research and demonstration project designed to reduce cardiovascular disease in three educated communities from 1980 to 1993. This paper describes an intensive, school-based behavioral intervention on cigarette smoking, comparing long-term outcomes in one of the intervention communities with those in a matched reference community. METHODS Beginning in sixth grade (1983), seven annual waves of cohort and cross-sectional behavioral measurements were taken from one MHHP intervention community and its matched pair. All students in each community were eligible to participate (baseline n = 2401). Self-reported data collected at each period described prevalence and intensity of cigarette smoking. RESULTS There were no differences at baseline for either weekly smoking prevalence or intensity of smoking. Throughout the follow-up period, however, smoking rates as determined by these measures were significantly lower in the intervention community: 14.6% of students were weekly smokers at the end of high school compared with 24.1% in the reference community. CONCLUSIONS These results suggest that multiple intervention components such as behavioral education in schools, booster programs to sustain training, and complementary communitywide strategies may all be needed for lasting reductions in adolescent tobacco use.

Pilot study of smoking, alcohol and drug abuse prevention.

A longitudinal pilot study gathered data on the onset and prevention of smoking, alcohol, and drug abuse among 526 students from two junior-high-schools in California. Over two school years, students who were trained to resist social pressures toward tobacco, alcohol, and drug use began smoking at less than one-half the rate of those who did not receive special training. Frequent alcohol and marijuana use was also less prevalent among the students who received such training.

Personality and behavioral vulnerabilities associated with risk status for eating disorders in adolescent girls.

This article presents first-year cross-sectional findings from a study of the development of eating disorders. Adolescent female (N = 937) 7th through 10th graders completed measures that included information on personality, self-concept, eating patterns, and attitudes. A risk status score was calculated on the basis of comprehensive information regarding DSM-III-R eating disorders criteria and other weight and attitudinal data. All personality measures showed significant differences according to risk, based on subject classification into high, moderate, and mild risk status and comparison groups. Early puberty was not associated with increased risk. The strongest predictor variables for risk were body dissatisfaction, negative emotionality, and lack of interoceptive awareness. The possible diathesis of personality including temperamental factors in the later development of an eating disorder is discussed.