Keith M. Drake

Influence of Sports, Physical Education, and Active Commuting to School on Adolescent Weight Status

OBJECTIVE: To compare the associations between weight status and different forms of physical activity among adolescents. METHODS: We conducted telephone surveys with 1718 New Hampshire and Vermont high school students and their parents as part of a longitudinal study of adolescent health. We surveyed adolescents about their team sports participation, other extracurricular physical activity, active commuting, physical education, recreational activity for fun, screen time, diet quality, and demographics. Overweight/obesity (BMI for age ≥ 85th percentile) and obesity (BMI for age ≥ 95 percentile) were based on self-reported height and weight. RESULTS: Overall, 29.0% (n = 498) of the sample was overweight/obese and 13.0% (n = 223) were obese. After adjustments, sports team participation was inversely related to overweight/obesity (relative risk [RR] = 0.73 [95% confidence interval (CI): 0.61, 0.87] for >2 sports teams versus 0) and obesity (RR = 0.61 [95% CI: 0.45, 0.81] for >2 sports teams versus 0). Additionally, active commuting to school was inversely related to obesity (RR = 0.67 [95% CI: 0.45, 0.99] for >3.5 days per week versus 0). Attributable risk estimates suggest obesity prevalence would decrease by 26.1% (95% CI: 9.4%, 42.8%) if all adolescents played on 2 sports teams per year and by 22.1% (95% CI: 0.1%, 43.3%) if all adolescents walked/biked to school at least 4 days per week. CONCLUSIONS: Team sport participation had the strongest and most consistent inverse association with weight status. Active commuting to school may reduce the risk of obesity, but not necessarily overweight, and should be studied further. Obesity prevention programs should consider strategies to increase team sport participation among all students.

Built Environment Predictors of Active Travel to School Among Rural Adolescents

BACKGROUND Most studies of active travel to school (ATS) have been conducted in urban or suburban areas and focused on young children. Little is known about ATS among rural adolescents. PURPOSE To describe adolescent ATS in two predominantly rural states and determine if school neighborhood built environment characteristics (BECs) predict ATS after adjusting for school and individual characteristics. METHODS Sixteen BECs were assessed through census data and onsite observations of 45 school neighborhoods in 2007. ATS and individual characteristics were assessed through telephone surveys with 1552 adolescents and their parents between 2007 and 2008. Active travelers were defined as those who walked/cycled to/from school ≥1 day/week. Hierarchic linear modeling was used for analysis, conducted in 2009. RESULTS Slightly less than half (n=735) of the sample lived within 3 miles of school, of whom 388 (52.8%) were active travelers. ATS frequency varied by season, ranging from a mean of 1.7 (SD=2.0) days/week in the winter to 3.7 (SD=1.6) in the spring. Adolescents who attended schools in highly dense residential neighborhoods with sidewalks were most likely to be active travelers. ATS frequency was greater in school neighborhoods with high residential and intersection densities, on-street parking, food outlets, and taller and continuous buildings with small setbacks. CONCLUSIONS The BECs that support safe travel may be necessary to allow for ATS, whereas ATS frequency among adolescents may be influenced by a wider variety of design characteristics. Additional strategies to promote ATS and physical activity are needed in rural areas because of long commuting distances for many students.

Fast-Food Environments and Family Fast-Food Intake in Nonmetropolitan Areas

BACKGROUND Little is known about the influence of in-town fast-food availability on family-level fast-food intake in nonmetropolitan areas. PURPOSE The purpose of the current study was to determine whether the presence of chain fast-food outlets was associated with fast-food intake among adolescents and parents, and to assess whether this relationship was moderated by family access to motor vehicles. METHODS Telephone surveys were conducted with 1547 adolescent-parent dyads in 32 New Hampshire and Vermont communities between 2007 and 2008. Fast-food intake in the past week was measured through self-report. In-town fast-food outlets were located and enumerated using an onsite audit. Family motor vehicle access was categorized based on the number of vehicles per licensed drivers in the household. Poisson regression was used to determine unadjusted and adjusted risk ratios (RRs). Analyses were conducted in 2011. RESULTS About half (52.1%) of adolescents and 34.7% of parents consumed fast food at least once in the past week. Adolescents and parents who lived in towns with five or more fast-food outlets were about 30% more likely to eat fast food compared to those in towns with no fast-food outlets, even after adjusting for individual, family, and town characteristics (RR=1.29, 95% CI= 1.10, 1.51; RR=1.32, 95% CI=1.07, 1.62, respectively). Interaction models demonstrated that the influence of in-town fast-food outlets on fast-food intake was strongest among families with low motor vehicle access. CONCLUSIONS In nonmetropolitan areas, household transportation should be considered as an important moderator of the relationship between in-town fast-food outlets and family intake.

Perceived intrinsic barriers to physical activity among rural mothers.

BACKGROUND The purpose of this study was to identify and determine the influence of perceived intrinsic barriers to physical activity among mothers living in rural areas. METHODS Mothers were identified through a study of child-parent dyads in the predominantly rural states of New Hampshire and Vermont. Using a telephone interview, we asked mothers (n = 1691) about their level of physical activity and assessed eight potential barriers to physical activity. Data were analyzed using chi-square tests, t tests, and analysis of variance (ANOVA) comparisons for groups within each variable. We used multiple regression analysis to assess associations between perceived barriers to physical activity and self-reported levels of physical activity. RESULTS Each barrier was inversely associated with physical activity. Multivariate models that included terms for all potential barriers and covariates identified three barriers associated with lower levels of physical activity: lack of self-discipline, lack of time, and lack of interest. CONCLUSIONS Rural mothers are less likely to be physically active if they identify lack of self-discipline, time, or interest as barriers, suggesting that they have difficulty prioritizing exercise for themselves. Interventions aimed at increasing physical activity for mothers should specifically consider these barriers. One possible solution may be to support infrastructure that facilitates active living as the default option, to remove the issue of having to purposefully engage in physical activity as a separate aspect of a mothers life.

Two-method measurement for adolescent obesity epidemiology: reducing the bias in self-report of height and weight.

BACKGROUND Despite validation studies demonstrating substantial bias, epidemiologic studies typically use self-reported height and weight as primary measures of body mass index because of feasibility and resource limitations. PURPOSE To demonstrate a method for calculating accurate and precise estimates that use body mass index when objectively measuring height and weight in a full sample is not feasible. METHODS As part of a longitudinal study of adolescent health, 1,840 adolescents (ages 12-18) self-reported their height and weight during telephone surveys. Height and weight was measured for 407 of these adolescents. Sex-specific, age-adjusted obesity status was calculated from self-reported and from measured height and weight. Prevalence and predictors of obesity were estimated using self-reported data, measured data, and multiple imputation (of measured data). RESULTS Among adolescents with self-reported and measured data, the obesity prevalence was lower when using self-report compared with actual measurements (p < .001). The obesity prevalence from multiple imputation (20%) was much closer to estimates based solely on measured data (20%) compared with estimates based solely on self-reported data (12%), indicating improved accuracy. In multivariate models, estimates of predictors of obesity were more accurate and approximately as precise (similar confidence intervals) as estimates based solely on self-reported data. CONCLUSIONS The two-method measurement design offers researchers a technique to reduce the bias typically inherent in self-reported height and weight without needing to collect measurements on the full sample. This technique enhances the ability to detect real, statistically significant differences, while minimizing the need for additional resources.

Child-targeted fast-food television advertising exposure is linked with fast-food intake among pre-school children

OBJECTIVE To determine whether exposure to child-targeted fast-food (FF) television (TV) advertising is associated with childrens FF intake in a non-experimental setting. DESIGN Cross-sectional survey conducted April-December 2013. Parents reported their pre-school childs TV viewing time, channels watched and past-week FF consumption. Responses were combined with a list of FF commercials (ads) aired on childrens TV channels during the same period to calculate childrens exposure to child-targeted TV ads for the following chain FF restaurants: McDonalds, Subway and Wendys (MSW). SETTING Paediatric and Women, Infants, and Children (WIC) clinics in New Hampshire, USA. SUBJECTS Parents (n 548) with a child of pre-school age. RESULTS Childrens mean age was 4·4 years; 43·2 % ate MSW in the past week. Among the 40·8 % exposed to MSW ads, 23·3 % had low, 34·2 % moderate and 42·5 % high exposure. McDonalds accounted for over 70 % of childrens MSW ad exposure and consumption. Childrens MSW consumption was significantly associated with their ad exposure, but not overall TV viewing time. After adjusting for demographics, socio-economic status and other screen time, moderate MSW ad exposure was associated with a 31 % (95 % CI 1·12, 1·53) increase and high MSW ad exposure with a 26 % (95 % CI 1·13, 1·41) increase in the likelihood of consuming MSW in the past week. Further adjustment for parent FF consumption did not change the findings substantially. CONCLUSIONS Exposure to child-targeted FF TV advertising is positively associated with FF consumption among children of pre-school age, highlighting the vulnerability of young children to persuasive advertising and supporting recommendations to limit child-directed FF marketing.

Do “Reverse Payment” Settlements Constitute an Anticompetitive Pay-for-Delay?

Abstract Brand and generic drug manufacturers frequently settle patent litigation on terms that include a payment to the generic manufacturer. The Federal Trade Commission contends that these agreements extend the brand’s market exclusivity and amount to anticompetitive market division. Involved parties defend the settlements as normal business agreements that reduce business risk. The anticompetitive hypothesis implies brand stock prices should rise with settlement announcements. We classify 68 brand-generic settlements into those with and without indication of a “reverse payment,” and conduct an event study of the settlement announcement’s influence on the brand’s stock price. For settlements with indication of a reverse payment, brand stock prices rise on average 6% at the announcement. A control group of brand-generic settlements without indication of a reverse payment had no significant effect. Our results support the hypothesis that settlements with a reverse payment increase the expected profits of the brand manufacturer and are anticompetitive.

An Entertainment-Based Approach to Promote Fruits and Vegetables to Young Children.

Public health efforts to promote fruit and vegetable intake (FVI) among young children must compete with pervasive child-targeted food marketing for nutrient-poor products. Such marketing often features cartoon brand characters (eg, General Mills Trix cereal rabbit) or crosspromotional tie-ins that link food products with popular media characters (eg, Nickelodeon’s SpongeBob Squarepants on packages of Cheez-It snack crackers). Brand characters and cross-promotional tie-ins are commonly used advertising techniques designed to appeal to children emotionally by creating positive associations between the character and advertised product. The Institute of Medicine recommends the use of successful advertising strategies to promote healthy diets to children; this is referred to as countermarketing. Several experimental studies have demonstrated that children’s preferences and consumption patterns are influenced by and can be improved through branding healthy foods with entertainment characters.

Graphic warning labels and the demand for cigarettes

Background In 2010, the US Food and Drug Administration (FDA) proposed requiring tobacco companies to add graphic warning labels (GWLs) to cigarette packs. GWLs are large prominently placed warnings that use both text and photographic images to depict health risks of smoking. The companies challenged FDAs authority on First Amendment grounds; the courts accepted that FDA could compel companies to add GWLs, but argued that FDA had not established that GWLs would significantly reduce smoking. Objective This paper adds new evidence on the question of whether GWLs would have reduced cigarette demand, by examining whether tobacco companies’ share prices fell unusually after news indicating a higher likelihood of having GWLs, and rose on the opposite news. Such findings would be expected if investors viewed GWLs as likely to reduce cigarette demand. Methods An event-study approach is used to determine whether the stock prices of US tobacco companies rose or fell unusually after news events in the period when GWLs were proposed, finalised, challenged and withdrawn. Findings Tobacco companies’ stock prices indeed realised significant abnormal returns after GWL news, consistent with expected negative effects on cigarette demand. Our estimates suggest investors expected GWLs to reduce the number of smokers by an extra 2.4–6.9 million in the 10 years after the rule took effect. Conclusions These findings support the view that the GWLs proposed by FDA would have curbed cigarette consumption in the USA in an appreciable way.

Student scientists learn about energy balance through science museum-academic partnership.

The concept of energy balance (i.e., calories consumed versus expended) is essential to understanding contributors to and prevention of childhood obesity. Prevailing ecological models of childhood obesity emphasize risk and protective factors within multiple environments, including family, school, and community.1,2 However, most school-based obesity prevention curricula focus predominantly on individual behavior change and rarely connect energy balance concepts to children’s daily environments.3–5 With few exceptions,6 the ecological framework of childhood obesity has yet to widely permeate elementary and middle school curricula. The current study ties the ecological framework with social cognitive theories (SCT) of individual behavior change.7 SCT is well-suited to examining obesity prevention in school because of its ability to account for multiple social learning influences in children’s environment that impact individual behavior. Personal agency represents a key component of SCT, in which individuals are empowered to exercise control over their daily environments to support behavior change.8 Helping students to identify energy balance influences in their local environments is a novel approach to support personal9 and ecological6 obesity prevention efforts among children. Middle school represents an ideal time to introduce such an approach, due to early adolescents’ increased autonomy and decision-making over their own health-related behaviors.10,11