Chrisa Arcan

Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT

OBJECTIVE To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes. DESIGN Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts. SUBJECTS/SETTING The sample included 509 pairs of parents/guardians and adolescents. RESULTS Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02). CONCLUSIONS The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.

Are There Nutritional and Other Benefits Associated with Family Meals Among At-Risk Youth?

PURPOSE The literature suggests positive associations between family dinner frequency and dietary practices and psychosocial well-being, and inverse associations between family dinner frequency and overweight status among general adolescent populations. The present study aims to examine these associations among a population of adolescents at-risk of academic failure. METHODS A racially diverse sample of adolescents (n = 145, 52% male, 61% nonwhite) from six alternative high schools (AHS) completed surveys and had their heights and weights measured by trained research staff. Mixed-model logistic regression analyses assessed associations between family dinner frequency and overweight status, healthy and unhealthy weight management, and food insecurity, whereas mixed linear models assessed associations with breakfast consumption, fruit and vegetable consumption, high-fat food intake, fast food intake, substance use, and depressive symptoms. Analyses adjusted for race/ethnicity, age, gender, socioeconomic status, and the random effect of school. RESULTS Family dinner frequency was positively associated with breakfast consumption and fruit intake (p < .01 and p < .05, respectively), and inversely associated with depressive symptoms (p < .05). Adolescents who reported never eating family dinner were significantly more likely to be overweight (odds ratio [OR] = 2.8, confidence interval [CI] = 1.1-6.9) and food insecure (OR = 6.0, CI = 2.2-16.4) than adolescents who reported five to seven family meals per week. CONCLUSIONS In this at-risk sample of youth, some, but not all of the benefits of family meals found in other studies were apparent. Intervention programs to increase the availability and affordability of healthful foods and promote family meals for families of AHS students may be beneficial.

Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first‐grade American Indian children. Bright Start was a group‐randomized, school‐based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI‐Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of −11.4% (P = 0.033). The intervention significantly reduced parent‐reported mean child intakes of sugar‐sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.

Sociodemographic Differences in Selected Eating Practices among Alternative High School Students

BACKGROUND Students attending alternative high schools are an at-risk group of youth for poor health behaviors and obesity. However, little is known about their dietary practices. OBJECTIVE To examine associations between sex, race/ethnicity, and socioeconomic status and selected dietary practices, including consumption of sugar-sweetened beverages, high-fat foods, and fruits and vegetables and fast-food restaurant use, among students attending alternative high schools. DESIGN Population-based, cross-sectional study. SUBJECTS/SETTING A convenience sample of adolescents (n=145; 52% men; 63% aged <18 years; and 39% white, 32% African American, and 29% other/multiracial) attending six alternative high schools in the St Paul/Minneapolis, MN, metropolitan area completed a survey. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention trial. STATISTICAL ANALYSES PERFORMED Descriptive statistics were used to describe dietary practices. Mixed model multivariate analyses were used to assess differences in dietary practices by sex, race/ethnicity, and socioeconomic status. RESULTS Regular soda was consumed at least five to six times per week by more than half of students. One half of students reported eating or drinking something from a fast-food restaurant at least three to four times a week. African-American students had the highest consumption of sugar-sweetened beverages (P=0.025), high-fat foods (P=0.002), and highest frequency of fast-food restaurant use (P<0.025). Mean fruit/vegetable intake was 3.6 servings/day; there were no sociodemographic differences in fruit/vegetable consumption. Higher socioeconomic status was associated with a higher consumption of regular soda (P=0.027). CONCLUSIONS Racial/ethnic and sex differences in the consumption of regular soda, high-fat foods, and fast-food restaurant use among alternative high school students underscores the importance of implementing health promotion programs in alternative high schools.

Objectively measured physical activity in urban alternative high school students.

INTRODUCTION Alternative high school (AHS) students are an underserved population of youth at greater risk for poor health behaviors and outcomes. Little is known about their physical activity patterns. PURPOSE : The purpose of this study was to describe 1) physical activity levels of students attending alternative high schools (AHS) in St. Paul/Minneapolis, MN, and 2) compliance with wearing a physical activity accelerometer. METHODS Sixty-five students (59% male, 65% <18 yr old, 51% African American, 17% Caucasian, 32% mixed and other) wore an accelerometer during all waking hours for 7 d as part of the baseline assessment for a school-based physical activity and dietary behavior intervention. Accelerometer data were reduced to summary variables using a custom software program. Compliance with wearing the accelerometer was assessed by the number of days with >or=10 h of data. Accelerometer counts per minute and minutes spent in moderate-to-vigorous physical activity (MVPA) were calculated. RESULTS Students averaged 323 +/- 143.0 counts min(-1) and 51 +/- 25.5 min d(-1) of MVPA. Minutes of MVPA d(-1) were greater on weekdays compared with the weekend (52 +/- 27.3 vs 43 +/- 39.7 min d(-1), respectively; P = 0.05). However, students wore the accelerometer less on the weekends (weekdays = 17.2 +/- 3.0, weekend = 14.9 +/- 6.8 h d(-1)). Expressing minutes of MVPA as a percentage of the number of minutes of available data, students spent approximately 5% of their time in MVPA on weekdays and weekends. Forty-five percent of students had 7 d of data, 51% had 4-6 d, and 5% had fewer than 4 d. On average, students wore the accelerometer for 17 +/- 3.2 h d(-1) (range = 12.0-23.8 h d(-1)). CONCLUSION Compliance was high (95% of students provided at least 4 d of data), and physical activity was relatively low representing a vulnerable population in need of further study and intervention.

Associations of home food availability, dietary intake, screen time and physical activity with BMI in young American-Indian children

OBJECTIVE To evaluate associations between home environmental factors and BMI of young American-Indian children. DESIGN Cross-sectional and prospective study. SETTING School-based obesity prevention trial (Bright Start) on a Northern Plains Indian reservation in South Dakota. Mixed model multivariable analysis was used to examine associations between child BMI categories (normal, overweight and obese) and home food availability, childrens dietary intake and physical activity. Analyses were adjusted for age, gender, socio-economic status, parent BMI and school; prospective analyses also adjusted for study condition and baseline predictor and outcome variables. SUBJECTS Kindergarten children (n = 424, 51 % male; mean age = 5.8 years, 30 % overweight/obese) and parents/caregivers (89 % female; 86 % overweight/obese) had their height and weight measured and parents/caregivers completed surveys on home environmental factors (baseline and 2 years later). RESULTS Higher fast-food intake and parent-perceived barriers to physical activity were marginally associated with higher probabilities of a child being overweight and obese. Vegetable availability was marginally associated with lower probabilities of being overweight and obese. The associations between home environmental factors and child weight status at follow-up were not significant. CONCLUSIONS Findings indicate that selected aspects of the home environment are associated with weight status of American-Indian children. Obesity interventions with this population should consider helping parents to engage and model healthful behaviours and to increase availability of healthful foods at home.

Alternative High School Students: Prevalence and Correlates of Overweight.

OBJECTIVE To determine prevalence and correlates of overweight among adolescents attending alternative high schools (AHS). METHODS AHS students (n=145) from 6 schools completed surveys and anthropometric measures. Cross-sectional associations were assessed using mixed model multivariate logistic regression. RESULTS Among students, 42% were overweight, with female, low-income and racial/ethnic minorities disproportionately affected. The odds of being overweight were significantly associated with self-described health status, social support, family meals, intentions to eat healthy at school, and use of healthy weight management strategies. CONCLUSIONS Overweight was prevalent among AHS students and requires further study. Correlates provide targets for future research.

Substance use and dietary practices among students attending alternative high schools: results from a pilot study

BackgroundSubstance use and poor dietary practices are prevalent among adolescents. The purpose of this study was to examine frequency of substance use and associations between cigarette, alcohol and marijuana use and selected dietary practices, such as sugar-sweetened beverages, high-fat foods, fruits and vegetables, and frequency of fast food restaurant use among alternative high school students. Associations between multi-substance use and the same dietary practices were also examined.MethodsA convenience sample of adolescents (n = 145; 61% minority, 52% male) attending six alternative high schools in the St Paul/Minneapolis metropolitan area completed baseline surveys. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention pilot trial. Mixed model multivariate analyses procedures were used to assess associations of interest.ResultsDaily cigarette smoking was reported by 36% of students. Cigarette smoking was positively associated with consumption of regular soda (p = 0.019), high-fat foods (p = 0.037), and fast food restaurant use (p = 0.002). Alcohol (p = 0.005) and marijuana use (p = 0.035) were positively associated with high-fat food intake. With increasing numbers of substances, a positive trend was observed in high-fat food intake (p = 0.0003). There were no significant associations between substance use and fruit and vegetable intake.ConclusionsAlternative high school students who use individual substances as well as multiple substances may be at high risk of unhealthful dietary practices. Comprehensive health interventions in alternative high schools have the potential of reducing health-compromising behaviors that are prevalent among this group of students. This study adds to the limited research examining substance use and diet among at-risk youth.Trial registration numberClinicalTrials.gov: NCT01315743

Dietary and weight-related behaviors and body mass index among Hispanic, Hmong, Somali, and white adolescents.

BACKGROUND The population of the United States is becoming increasingly ethnically and racially diverse, much of it due to immigration patterns. However, little is known about dietary intake and weight-related concerns and behaviors of youth from some ethnic-minority groups, especially Hispanic, Hmong, and Somali adolescents. OBJECTIVE Our aim was to describe dietary intake and weight-related concerns and behaviors among Hispanic, Hmong, and Somali adolescents and compare them with white adolescents. DESIGN We performed a cross-sectional analysis of data from Eating and Activity in Teens 2010, a population-based study in the Minneapolis/St Paul metropolitan area. PARTICIPANTS/SETTING Current analysis includes 1,672 adolescents (Hispanic: n=562 [33.6%]; Hmong: n=477 [28.5%]; Somali: n=113 [6.8%]; white: n=520 [31.1%]; mean age=15.0 years). Adolescents completed classroom surveys and had their height/weight measured during the 2009-2010 academic year. STATISTICAL ANALYSIS Multivariable regression models, adjusted for socioeconomic status, age, and school as a random effect were used to examine racial/ethnic differences for each outcome variable for boys and girls. RESULTS There were numerous differences in the behaviors of Hispanic, Hmong, and Somali adolescents as compared with whites. Hispanic and Somali youth consumed fruit and fast food more frequently. Hmong adolescents consumed sugar-sweetened beverages less frequently, and Somali boys consumed energy and sport drinks more frequently than whites. Compared with white boys, overweight/obesity was higher among Hispanic and Hmong. A higher percentage of Hmong and Somali adolescents engaged in unhealthy weight control behaviors. Body satisfaction was lower for all Hmong adolescents compared with whites. CONCLUSIONS There were varying areas of concern in dietary intake, weight, and weight-related concerns and behaviors among adolescents in all ethnic groups. Future nutrition and physical activity interventions that include adolescents from these ethnic and cultural groups can benefit from, for example, modifying intervention strategies to the specific priority behaviors within the target population.

Summer effects on body mass index (BMI) gain and growth patterns of American Indian children from kindergarten to first grade: a prospective study

BackgroundOverweight and obesity are highly prevalent among American Indian children, especially those living on reservations. There is little scientific evidence about the effects of summer vacation on obesity development in children. The purpose of this study was to investigate the effects of summer vacation between kindergarten and first grade on growth in height, weight, and body mass index (BMI) for a sample of American Indian children.MethodsChildren had their height and weight measured in four rounds of data collection (yielded three intervals: kindergarten, summer vacation, and first grade) as part of a school-based obesity prevention trial (Bright Start) in a Northern Plains Indian Reservation. Demographic variables were collected at baseline from parent surveys. Growth velocities (Z-score units/year) for BMI, weight, and height were estimated and compared for each interval using generalized linear mixed models.ResultsThe children were taller and heavier than median of same age counterparts. Height Z-scores were positively associated with increasing weight status category. The mean weight velocity during summer was significantly less than during the school year. More rapid growth velocity in height during summer than during school year was observed. Obese children gained less adjusted-BMI in the first grade after gaining more than their counterparts during the previous two intervals. No statistically significant interval effects were found for height and BMI velocities.ConclusionsThere was no indication of a significant summer effect on childrens BMI. Rather than seasonal or school-related patterns, the predominant pattern indicated by weight-Z and BMI-Z velocities might be related to age or maturation.Trial registrationBright Start: Obesity Prevention in American Indian Children Clinical Trial Govt ID# NCT00123032