Janet L. Collins

Physical activity, food choice, and weight management goals and practices among U.S. college students

INTRODUCTION Physical activity and a healthy diet have been recommended to help reverse the increasing prevalence of overweight among adolescents and adults in the United States. METHODS Data is from the 1995 National College Health Risk Behavior Survey. A representative sample of US undergraduate college students (n = 4609) were analyzed to examine associations of physical activity and food choice with weight management goals and practices. RESULTS Based on self-reported height and weight, 35% of students were overweight or obese (body mass index > or = 25.0). Nearly half (46%) of all students reported they were trying to lose weight. Female students were less likely than male students to be overweight, but more likely to be trying to lose weight. Among female and male students, using logistic regression to control for demographics, trying to lose weight was associated with participation in vigorous physical activity and strengthening exercises, and consumption of < or = 2 servings/ day of high-fat foods. Female and male students who reported using exercise to lose weight or to keep from gaining weight were more likely than those who did not to participate in vigorous, strengthening, and moderate physical activity, and were more likely to eat > or = 5 servings/day of fruits and vegetables and < or = 2 servings/day of high-fat foods. Among students who were trying to lose weight, only 54% of females and 41% of males used both exercise and diet for weight control. CONCLUSION Colleges should implement programs to increase student awareness of healthy weight management methods and the importance of physical activity combined with a healthy diet.

Co-occurrence of health-risk behaviors among adolescents in the United States.

PURPOSE Although it is common for adolescents to experiment with several health-risk behaviors before reaching adulthood, little is known about the co-occurrence of these behaviors. The purposes of this study were to determine the co-occurrence of specific health-risk behaviors among a nationally representative sample of adolescents, and to examine whether the distribution of multiple risk behaviors varies by age, sex, and school enrollment status. METHODS This study analyzed survey data from a United States national probability sample (n = 10,645) of youth aged 12-21 years. Survey items measuring current seat belt use, weapon carrying, tobacco, alcohol, and other drug use, and sexual behavior were included in the analysis. RESULTS The majority of adolescents aged 12-17 years did not engage in multiple health-risk behaviors. However, the prevalence of multiple risk behaviors increased dramatically with age. While only 1 in 12 adolescents aged 12-13 years engaged in two or more of these behaviors, one-third of those aged 14-17 years and half of the college-aged youth (18-21 years) did so. Male respondents and out-of-school youth aged 14-17 years were more likely to engage in multiple health-risk behaviors than were other respondents. CONCLUSIONS These results suggest that the likelihood that adolescents engage in multiple health-risk behaviors is related to age and that many adolescents engage in these behaviors serially rather than at the same time.

Safer choices: reducing teen pregnancy, HIV, and STDs.

Objectives. This study evaluated the long-term effectiveness of Safer Choices, a theory-based, multi-component educational program designed to reduce sexual risk behaviors and increase protective behaviors in preventing HIV, other STDs, and pregnancy among high school students. Methods. The study used a randomized controlled trial involving 20 high schools in California and Texas. A cohort of 3869 ninth-grade students was tracked for 31 months from fall semester 1993 (baseline) to spring semester 1996 (31-month follow-up). Data were collected using self-report surveys administered by trained data collectors. Response rate at 31-month follow-up was 79%. Results. Safer Choices had its greatest effect on measures involving condom use. The program reduced the frequency of intercourse without a condom during the three months prior to the survey, reduced the number of sexual partners with whom students had intercourse without a condom, and increased use of condoms and other protection against pregnancy at last intercourse. Safer Choices also improved 7 of 13 psychosocial variables, many related to condom use, but did not have a significant effect upon rates of sexual initiation. Conclusions. The Safer Choices program was effective in reducing important risk behaviors for HIV, other STDs, and pregnancy and in enhancing most psychosocial determinants of such behavior.

Sexual behavior among U.S. high school students, 1990-1995

CONTEXT High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.

The use of condoms with other contraceptive methods among young men and women.

In a nationally representative sample of sexually experienced youths aged 14-22, 37% of young women and 52% of young men said the condom was the primary method used to prevent pregnancy at last intercourse; an additional 8% and 7%, respectively, said they used a condom at last intercourse; much of this represents dual use [corrected]. Condom use at last intercourse was reported by 25% of young men whose partner was using the pill. Significant independent predictors of condom use with the pill among men included younger age, black race, engaging in fewer nonsexual risk behaviors and having received instruction about HIV in school. Among young women, 21% of those relying on the pill reported also using a condom at last intercourse. For women, independent predictors of dual use included younger age, black race, older age at first sex, fewer nonsexual risk behaviors, having no partners in the previous three months and having talked to parents or other adult relatives about HIV.

Weapon-carrying, physical fighting, and fight-related injury among U.S. adolescents

INTRODUCTION Access to firearms and other weapons has been cited as an important factor contributing to the rise in violence-related injury among adolescents in the United States. METHODS Data from the Youth Risk Behavior Survey supplement to the 1992 National Health Interview Survey were analyzed to examine relationships among weapon-carrying, physical fighting, and fight-related injury among U.S. adolescents aged 12-21 years (N = 10,269). Adjusted odds ratios (OR) were used to describe the association of weapon-carrying during the past 30 days with physical fighting and fight-related injury during the past 12 months. RESULTS Weapon-carrying (15%) and physical fighting (39%) were common among adolescents. One out of 30 (3.3%) adolescents reported receiving medical care for fight-related injuries. Controlling for demographic characteristics, youth who carried weapons were more likely than those who did not to have been in a physical fight (OR = 3.3). The association between weapon-carrying and physical fighting was stronger among females (OR = 5.0) than among males (OR = 2.9), but did not vary significantly by age, race/ethnicity, or place of residence (urban, suburban, rural). Controlling for frequency of physical fighting and demographics, adolescents who carried a handgun (OR = 2.6) or other weapon (OR = 1.6) were more likely than those who did not carry a weapon to have had medical care for fight-related injuries. CONCLUSIONS Among adolescents, weapon-carrying is associated with increased involvement in physical fighting and a greater likelihood of injury among those who do fight. Efforts to reduce fight-related injuries among youth should stress avoidance of weapon-carrying.

An assessment of the effect of data collection setting on the prevalence of health risk behaviors among adolescents

PURPOSE To examine the effect of data collection setting on the prevalence of priority health risk behaviors among adolescents. METHODS Analyses were conducted using data from two national probability surveys of adolescents, the 1993 national school-based Youth Risk Behavior Survey (YRBS) and the 1992 household-based National Health Interview Survey (NHIS/YRBS). Forty-two items were worded identically on both surveys. RESULTS Thirty-nine of the 42 identically worded items (93%) showed that the YRBS produced estimates indicating higher risk than the NHIS. Twenty-four of these comparisons yielded statistically significant differences. The prevalence estimates affected most were those for behaviors that are either illegal or socially stigmatized. CONCLUSIONS School-based surveys produce higher prevalence estimates for adolescent health risk behaviors than do household-based surveys. Each has advantages and disadvantages, and both can play a role in assessing these behaviors.

Age of initiating selected health-risk behaviors among high school students in the United States.

PURPOSE To estimate and compare the age of initiation of alcohol use, cigarette smoking, sexual intercourse, and marijuana use among female and male students in U.S. high schools. METHODS Using data from the 1991 and 1993 national school-based Youth Risk Behavior Surveys, life-table analysis was used to create hypothetical cohorts to estimate age of initiation of selected health-risk behaviors. The sample size was 12,272 in 1991 and 16,296 in 1993, with an overall response rate of 68% in 1991 and 70% in 1993. RESULTS Male students initiate each of these behaviors earlier than female students, but the pace of initiation for females accelerates so that by age 15 years the cumulative proportion of male and female students who have initiated these behaviors is similar. For both female and male students, the youngest cohort appears to initiate use of alcohol and sexual intercourse at earlier ages than older cohorts. Similarly, the younger cohorts of female students appear to initiate smoking cigarettes and using marijuana at earlier ages than older cohorts. CONCLUSIONS Many high school students are initiating alcohol use, cigarette smoking, sexual intercourse, and marijuana use at early ages. These data suggest a need for intensive intervention programs by middle/junior high school to motivate and prepare students to avoid these behaviors. Clinicians should begin screening and counseling for risk behaviors in early adolescence.

Health impact assessment: a step toward health in all policies.

FOR THE PAST 4 DECADES, THE ENVIRONMENTAL IMpact statement (EIS) process has been used to assess the environmental effects of major projects and policies that involve federal funds, such as designing highways, altering waterways, extracting resources on federal lands, and setting Corporate Average Fuel Economy standards. Created under the National Environmental Policy Act of 1969, EISs do not determine policy but rather ensure that stakeholders have full information about unintended environmental impacts before reaching a decision. By evaluating alternative proposals and their relative risks and benefits, an EIS helps decision makers choose options that promote favorable outcomes and mitigate adverse environmental consequences. A natural extension of this work is the use of health impact assessment (HIA) to examine the effects that a policy, program, or project may have on the health of a population. An HIA is defined as “a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, programme or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.” Most health professionals are probably more familiar with EISs and their intent and usage than with HIAs. Yet there has been a movement to adopt HIAs in public policy settings and legislation and in a recently emerging health policy literature that describes and advocates for this process. HIAs offer great potential for promoting health by encouraging decisions that protect and enhance health and health equity. There is increasing recognition that many contemporary health issues are profoundly influenced by factors outside the traditional realm of health and health care. Factors such as literacy, poverty, employment, and racism contribute to disparities in life expectancy as well as to health-related quality of life. Concerns about how to address these factors have led to a focus on “health in all policies,” in which policies in social sectors such as transportation, housing, employment, and agriculture ideally would contribute to health and health equity. An HIA offers a vehicle to make these health effects explicit. Unfortunately, the evaluation of health effects in policy making has been slow to take hold. The United States lags behind many European nations, Canada, and other countries in the use of HIAs. This situation is somewhat surprising, given that US environmental policy explicitly requires the examination of health effects as part of the National Environmental Policy Act. Although most EISs in the United States incorporate little about health effects, experience in California and Alaska has demonstrated that a wide range of health effects can be successfully integrated into the EIS process. Beyond increasing attention to health outcomes within EISs, the potential applications of HIAs are clearly evident. For example, although air pollution and injury prevention are often considered in major transportation projects, the influence of road design on physical activity and obesity is not. An HIA that recommends the addition of pedestrian and bicycle facilities (“complete streets”) to a transportation plan would contribute to a built environment that promotes the public’s health. The agriculture sector seeks to maximize productivity, meet consumer demand, and sustain livelihoods. From a health perspective, agricultural policy determines food quantity, quality, and prices that directly affect consumption patterns and therefore affect health. HIAs could be used to examine the health effects of proposed agricultural policies, such as ones that enhance production of energy-dense, nutrient-poor foods that contribute to the increasing obesity epidemic. HIAs of proposed zoning plans, which would contribute to decreased density of fast-food and liquor stores or increased density of restaurants and full-service grocery stores, especially in low-income areas, could result in changes that better promote health. In education, a timely HIA might have reduced the inadvertent effects of the No Child Left Behind legislation on physical education programs and health curricula by pro-

Domains of Core Competency, Standards, and Quality Assurance for Building Global Capacity in Health Promotion: The Galway Consensus Conference Statement

This paper reports the outcome of the Galway Consensus Conference, an effort undertaken as a first step toward international collaboration on credentialing in health promotion and health education. Twenty-nine leading authorities in health promotion, health education, and public health convened a 2-day meeting in Galway, Ireland, during which the available evidence on credentialing in health promotion was reviewed and discussed. Conference participants reached agreement on core values and principles, a common definition, and eight domains of core competency required to engage in effective health promotion practice. The domains of competency are catalyzing change, leadership, assessment, planning, implementation, evaluation, advocacy, and partnerships. The long-term aim of this work is to stimulate a global dialogue that will lead to the development and widespread adoption of standards and quality assurance systems in all countries to strengthen capacity in health promotion, a critical element in achieving goals for the improvement of global population health.