Elizabeth G. Klein

Examining the relationships between family meal practices, family stressors, and the weight of youth in the family

BackgroundResearch is limited on how the social environment of the home is related to childhood obesity.PurposeThe purpose of this research was to examine the relationships between positive family meal practices, family stressors, and the weight of youth and to examine parental weight status as a moderator of these relationships.MethodsThe study enrolled 368 parent/child dyads from a Minnesota sample. We used mediation analysis to examine the associationsResultsFamilies represented by an overweight parent reported fewer positive family meal practices (p < 0.001), higher levels of depression (p = 0.01), and fewer family rules (p = 0.02) as compared to families represented by a healthy weight parent. For overweight parents, positive family meal practices mediated the relationship between some family stressors and child weight.ConclusionsThis research suggests that the home environment may affect the weight of children in the family, and the effect is more pronounced in families with at least one overweight parent.

Tobacco advertising and sales practices in licensed retail outlets after the Food and Drug Administration regulations.

To assess retailer compliance with Food and Drug Administration (FDA) regulations on tobacco sales and advertising practices, including point-of-sale advertisements, in two distinct Columbus, Ohio neighborhood groups by income. Data were gathered from a random sample of 129 licensed tobacco retailers, which included data on both exterior and interior advertisements as well as sales practices. Descriptive analyses compared retail outlets by high and low income neighborhood locations. Compliance with FDA regulations was high in the random sample of urban tobacco retail outlets. None of the retail outlets sold loose cigarettes or offered free items with purchase. Less than 10% of the outlets surveyed offered self-service access to cigarettes or smokeless tobacco products. From all surveyed retail outlets 95% had cigarette, 57% had smokeless, and 57% had cigar advertisements at the point-of-sale. There were no significant differences in compliance by income, but the mean number of advertisements on the building and self-service access to cigars was significantly different by neighborhood income. There was a high degree of compliance with the new FDA regulation on tobacco marketing and sales practices in urban retail tobacco outlets in Columbus, Ohio. Tobacco advertising and marketing remain highly prevalent in retail outlets, with some significant differences between high and low income neighborhoods.

Smoking Initiation During Young Adulthood: A Longitudinal Study of a Population-Based Cohort

PURPOSE To examine the extent to which young adults initiate smoking between the ages of 18 and 21 years; to characterize the frequency and quantity of use among initiators; and to examine predictors of initiation. METHODS Participants included youth who were part of the Minnesota Adolescent Community Cohort Study and had not smoked a whole cigarette before age of 18 (n = 2,034). Initiation in the present study was defined as having smoked a whole cigarette or more between the ages of 18 and 21. Predictors of initiation were measured at age 18 and included sociodemographic characteristics, social influences, and attitudes and beliefs about smoking. RESULTS Twenty-five percent (n = 510) of participants initiated smoking between the ages of 18 and 21 years. Among those who initiated, the majority (64%) reported smoking during the past 30 days, and approximately one-quarter (24%) reported smoking 100 cigarettes or more. Predictors of young adult initiation included being male, living in a metropolitan area, having friends who smoke, and the belief that smoking can calm someone down when they are angry or nervous. CONCLUSIONS This study indicates that smoking initiation during young adulthood is not uncommon. These results highlight the need for tobacco prevention programs that target young adults.

Minnesota Tobacco-Free Park Policies: Attitudes of the General Public and Park Officials

A growing number of cities and counties in Minnesota have adopted policies or ordinances that restrict tobacco in outdoor locations. Current policies banning or limiting tobacco use on park and recreation grounds exist in at least 70 communities around Minnesota. However, little is known about the support for such policies. The goal of this project was to learn more about the level of support for tobacco-free park policies in Minnesota. A mail survey was sent to 2,400 randomly selected adult Minnesota residents, and a phone survey was administered to 257 park and recreation directors. Of the 2,400 surveys mailed, 1,501 (68%) were returned. Among the general public, 70% favored tobacco-free park policies. Reasons cited for supporting such policies include to reduce litter (71%), to reduce youth opportunities to smoke (65%), to avoid second-hand smoke (64%), and to establish positive role models for youth (63%). Park and recreation directors also support such policies (75%). Recreation directors in cities without a policy expressed a high level of concern over enforcement issues (91%), but few problems were reported (26%) in communities with a tobacco-free park policy. Broad support for tobacco-free park policies exists among the public at large and among park and recreation directors who work in tobacco-free parks. Fears of policy difficulties among park and recreation directors who work in parks without a tobacco-free policy are much greater than actual problems experienced in Minnesota tobacco-free park areas.

An Evaluation of Mother-Centered Anticipatory Guidance to Reduce Obesogenic Infant Feeding Behaviors

OBJECTIVE: To evaluate the effect of 2 anticipatory guidance styles (maternal focused [MOMS] and infant focused [Ounce of Prevention]) directed at mothers of infants aged newborn to 6 months on their infant feeding behaviors at 1 year compared with routine advice as outlined in Bright Futures (BF). METHODS: This is a cluster randomized trial. A total of 292 mother/infant dyads were enrolled at their first well-child visit to 3 urban pediatric clinics in Columbus, Ohio. Intervention-specific brief advice and 1-page handouts were given at each well visit. In addition to infant weights and lengths, surveys about eating habits and infant feeding practices were completed at baseline and 12 months. RESULTS: Baseline data revealed a group with high rates of maternal overweight (62%) and obesogenic habits. At 12 months, the maternal-focused group gave their infants less juice (8.97 oz vs 14.37 oz, P < .05), and more daily servings of fruit (1.40 vs 0.94, P < .05) and vegetables (1.41 vs 1.03, P < .05) compared with BF mothers. Ounce of Prevention mothers also gave less juice (9.3 oz, P < .05) and more fruit servings (1.26 P < .05) than BF. CONCLUSIONS: Brief specific interventions added to well-child care may affect obesogenic infant feeding behaviors of mothers and deserves further study as an inexpensive approach to preventing childhood obesity.

The relationship between local clean indoor air policies and smoking behaviours in Minnesota youth

Background: While clean indoor air (CIA) policies are intended to reduce exposure to second-hand smoke in the workplace, restrictions in public workplaces have the potential to discourage youth smoking. There is growing evidence from cross-sectional and ecological studies, but limited evidence from longitudinal studies that this is so. Objective: To evaluate the association between local CIA policies and smoking behaviours among Minnesota youth over time. Design, setting and subjects: A cohort of 4233 Minnesota youths, ages 11 to 16 at baseline, was interviewed via telephone for 6 years (2000–2006). Individual, family and community level variables were collected from participants every 6 months. A generalised estimating equation (GEE) logistic regression was used to assess the relationship between CIA policies and past-month smoking in youth over time. The analysis was controlled for potential confounders at individual and community levels. Results: There was not significant association between CIA policies and youth smoking behaviours in the multivariate analyses. At the individual level, parental smoking significantly increased the odds of smoking nearly 40% and close friend smoking increased the odds of past-month smoking by nearly 100% for each close friend. Banning smoking in the home was significantly associated with a 12% reduction in the odds of past-month smoking. Conclusion: After accounting for other community and individual level factors known to be associated with youth smoking, there was no significant association between CIA policies and past-month smoking for youth over time.

Social ecological predictors of the transition to overweight in youth: results from the Teens Eating for Energy and Nutrition at Schools (TEENS) study.

OBJECTIVE To explore the social ecological predictors of the transition to overweight in youth, as shown in results from the Teens Eating for Energy and Nutrition at Schools study. DESIGN Longitudinal data from a school-based intervention trial. PARTICIPANTS Adolescents who were involved in the Teens Eating for Energy and Nutrition at Schools intervention study who reported a healthful weight at baseline in 1998 (n=1,728). MAIN OUTCOME MEASURE Transition to overweight status (body mass index > or =85th percentile) at follow-up in eighth grade. STATISTICAL ANALYSIS Generalized linear mixed model regression. RESULTS Factors in the social, environmental, individual, and behavioral domains had significant unadjusted relationships with a transition to overweight status. In the multivariate analysis, adolescents who perceived themselves to be overweight at baseline were 2.3 times more likely to be overweight at follow-up compared to those with a normal weight self-perception. Compared to nondieters, current dieters were 2.6 times more likely to be overweight at follow-up, and boys were nearly three times more likely to transition to overweight status at follow-up compared with girls. CONCLUSIONS Individual factors, primarily related to a self-perception of being overweight, were the strongest predictors of transitioning to overweight as adolescents progressed from seventh through eighth grade. A better understanding of the relationship between weight concern and transition to overweight is needed.

Multilevel Predictors of Smoking Initiation among Adolescents: Findings from the Minnesota Adolescent Community Cohort (MACC) Study

OBJECTIVE To understand how factors at multiple levels of influence impact adolescent smoking initiation. METHOD Data from the Minnesota Adolescent Community Cohort, a population-based cohort, were analyzed. Adolescents were recruited from randomly selected geopolitical units (GPUs) in Minnesota at ages 12 to 13 (n=1953), and were surveyed every six months (2000-2006) until 18. The association between baseline social factors and smoking initiation was analyzed using logistic regression. Linear regression was used to analyze predictors and age of initiation among smokers (n=603). RESULTS Higher proportion of 15-16 year-olds who smoke at the area-level (GPU) was associated with younger initiation (15.47 vs 15.87, p<.05). Higher proportion of the population employed and higher median household income were associated with older initiation (15.90 vs. 15.56 p<.05). Parent education, living with parents or siblings who smoke, living in homes that allow smoking, and having friends who smoke at baseline were associated with smoking initiation or younger initiation (p<.05). Participants whose parents had less than a high school education were 1.6 times more likely than those with college educated parents to have smoked at least a whole cigarette (CI=1.06, 2.26). CONCLUSION Factors at multiple levels of influence effect adolescent smoking initiation. Smoking by older age peers and lower SES predicts earlier smoking.

Sexual Assault Reporting Procedures at Ohio Colleges

Abstract Objective: To assess how Ohio colleges conform to recommendations that address barriers to reporting sexual assault. Participants: A study sample of Ohio 4-year colleges (N = 105). Methods: College Web sites were examined between March and November 2011 for their availability of sexual assault policies using 8 measures. Results: Of the colleges in the sample, 66% had an online sexual assault policy. Less than 1% of colleges included definitions for applicable sexual offenses in the Ohio Revised Code. All colleges with a policy included on-campus personnel to whom a victim could report. Approximately 25% and 31% of colleges included confidential or 24/7 reporting options, respectively. Conclusions: Many colleges are failing to offer basic reporting options to victims of sexual assault. Having a clearly labeled sexual assault policy on a campus Web site that includes 24/7 reporting options and defines acts of sexual assault can aid victims in the reporting process.

Promoting Active Transportation as a Partnership between Urban Planning and Public Health: the Columbus Healthy Places Program

Active transportation has been considered as one method to address the American obesity epidemic. To address obesity prevention through builtenvironment change, the local public health department in Columbus, Ohio, established the Columbus Healthy Places (CHP) program to formally promote active transportation in numerous aspects of community design for the city. In this article, we present a case study of the CHP program and discuss the review of city development rezoning applications as a successful strategy to link public health to urban planning. Prior to the CHP review, 7% of development applications in Columbus included active transportation components; in 2009, 64% of development applications adopted active transportation components specifically recommended by the CHP review. Active transportation recommendations generally included adding bike racks, widening or adding sidewalks, and providing sidewalk connectivity. Recommendations and lessons learned from CHP are provided.