Kian Farbakhsh

Project Northland High School Interventions: Community Action to Reduce Adolescent Alcohol Use

Project Northland is a randomized community trial initially implemented in 24 school districts and communities in northeastern Minnesota, with goals of delaying onset and reducing adolescent alcohol use using community-wide, multiyear, multiple interventions. The study targets the Class of 1998 from the 6th to 12th grades (1991-1998). The early adolescent phase of Project Northland has been completed, and reductions in the prevalence of alcohol use at the end of 8th grade were achieved. Phase II of Project Northland, targeting 11th- and 12th-grade students, uses five major strategies: (1) direct action community organizing methods to encourage citizens to reduce underage access to alcohol, (2) youth development involving high school students in youth action teams, (3) print media to support community organizing and youth action initiatives and communicate healthy norms about underage drinking (e.g., providing alcohol to minors is unacceptable), (4) parent education and involvement, and (5) a classroom-based curriculum for 11th-grade students. This article describes the background, design, implementation, and process measures of the intervention strategies for Phase II of Project Northland.

Away-from-Home Family Dinner Sources and Associations with Weight Status, Body Composition, and Related Biomarkers of Chronic Disease among Adolescents and Their Parents

Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietetics practitioners. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and takeout foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006-2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly vs none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z score, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, triglycerides, fasting glucose, insulin, and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency, and demographic characteristics. The odds of overweight/obesity were considerably greater when families reported at least one away-from-home dinner purchase in the past week (odds ratio=1.2 to 2.6). Mean percent body fat, metabolic risk cluster z scores, and insulin levels were significantly greater with weekly purchases of family dinner from fast-food restaurants (P<0.05). Mean percent body fat, metabolic risk cluster z scores, and high-density lipoprotein levels were significantly higher for families who purchased weekly family dinner from takeout sources (P<0.05). Although frequent family dinners may be beneficial for adolescents, the source of dinners is likely as important in maintaining a healthy weight. Interventions should focus on encouragement of healthful family meals.

The relationship between sleep and weight in a sample of adolescents.

Research to date in young children and adults shows a strong, inverse relationship between sleep duration and risk for overweight and obesity. Fewer studies examining this relationship have been conducted in adolescents. The purpose of the article is to describe the relationship between sleep and weight in a population of adolescents, controlling for demographics, energy intake, energy expenditure, and depression. This is a cross‐sectional study of 723 adolescents participating in population‐based studies of the etiologic factors related to obesity. We examined the relationship between three weight‐related dependent variables obtained through a clinical assessment and three sleep variables obtained through self‐report. Average caloric intake from dietary recalls, average activity counts based on accelerometers, and depression were included as covariates and the analysis was stratified by gender and grade level. Our results show that the relationship between sleep duration and BMI is evident in middle‐school boys (β = −0.32, s.e. = 0.06: P < 0.001) and girls (β = −0.18, s.e. = 0.08: P = 0.02) but largely absent in high‐school students. Differences in sleep patterns have little association with weight in males, but in high‐school girls, waking up late on weekends as compared to weekdays is associated with lower body fat (β = −0.80, s.e. = 0.40: P = 0.05) and a healthy weight status (β = −0.28, s.e. = 0.14: P = 0.05). This study adds to the evidence that, particularly for middle‐school boys and girls, inadequate sleep is a risk factor for early adolescent obesity. Future research needs to examine the relationship longitudinally and to study potential mediators of the relationship.

Multilevel predictors of adolescent physical activity: a longitudinal analysis.

BackgroundTo examine how factors from a social ecologic model predict physical activity (PA) among adolescents using a longitudinal analysis.MethodsParticipants in this longitudinal study were adolescents (ages 10-16 at baseline) and one parent enrolled in the Transdisciplinary Research on Energetics and Cancer-Identifying Determinants of Eating and Activity (TREC-IDEA) and the Etiology of Childhood Obesity (ECHO). Both studies were designed to assess a socio-ecologic model of adolescent obesity risk. PA was collected using ActiGraph activity monitors at two time points 24 months apart. Other measures included objective height and weight, adolescent and parent questionnaires on multilevel psychological, behavioral and social determinants of PA, and a home PA equipment inventory. Analysis was conducted using SAS, including descriptive characteristics, bivariate and stepped multivariate mixed models, using baseline adjustment. Models were stratified by gender.ResultsThere were 578 adolescents with complete data. Results suggest few statistically significant longitudinal associations with physical activity measured as minutes of MVPA or total counts from accelerometers. For boys, greater self-efficacy (B = 0.75, p = 0.01) and baseline MVPA (B = 0.55, p < 0.01) remained significantly associated with MVPA at follow-up. A similar pattern was observed for total counts. For girls, baseline MVPA (B = 0.58, p = 0.01) and barriers (B = -0.32, p = 0.05) significantly predicted MVPA at follow-up in the full model. The full multilevel model explained 30% of the variance in PA among boys and 24% among girls.ConclusionsPA change in adolescents is a complex issue that is not easily understood. Our findings suggest early PA habits are the most important predictor of PA levels in adolescence. Intervention may be necessary prior to middle school to maintain PA through adolescence.

Longitudinal associations between family dinner and adolescent perceptions of parent-child communication among racially diverse urban youth.

We examined changes in adolescent self-reported parent-child communication using growth curve models conditional on family meal frequency over a 3.5-year period among a population of racially diverse, low-income adolescents from an urban environment (n = 4,750). Results indicated that although both family dinner frequency and adolescent perceptions of parent-child communication scores were characterized by negative linear growth over time (both p < .001), family dinner frequency was positively associated with adolescent perceptions of parent-child communication scores over time (p < .001). Study findings suggest that families with teenagers may enhance parent-child communication and ultimately promote healthy adolescent development by making family dinner a priority. In addition, the communication benefits of family dinner at the beginning of sixth grade may be protective through eighth grade.

Adolescent Physical Activity and Screen Time: Associations With the Physical Home Environment

BackgroundPrevious research on the environment and physical activity has mostly focused on macro-scale environments, such as the neighborhood environment. There has been a paucity of research on the role of micro-scale and proximal environments, such as that of the home which may be particularly relevant for younger adolescents who have more limited independence and mobility. The purpose of this study was to describe associations between the home environment and adolescent physical activity, sedentary time, and screen time.MethodsA total of 613 parent-adolescent dyads were included in these analyses from two ongoing cohort studies. Parents completed a Physical Activity and Media Inventory (PAMI) of their home environment. Adolescent participants (49% male, 14.5 ± 1.8 years) self-reported their participation in screen time behaviors and wore an ActiGraph accelerometer for one week to assess active and sedentary time.ResultsAfter adjusting for possible confounders, physical activity equipment density in the home was positively associated with accelerometer-measured physical activity (p < 0.01) among both males and females. Most of the PAMI-derived measures of screen media equipment in the home were positively associated with adolescent females screen time behavior (p ≤ 0.03). In addition, the ratio of activity to media equipment was positively associated with physical activity (p = 0.04) in both males and females and negatively associated with screen time behavior for females (p < 0.01).ConclusionsThe home environment was associated with physical activity and screen time behavior in adolescents and differential environmental effects for males and females were observed. Additional research is warranted to more comprehensively assess the home environment and to identify obesogenic typologies of families so that early identification of at-risk families can lead to more informed, targeted intervention efforts.

Examining the longitudinal relationship between change in sleep and obesity risk in adolescents.

Evidence is building regarding the association between inadequate amounts of sleep and the risk of obesity, especially in younger children. Less is known about the relationship between change in sleep and change in weight during adolescence. The objective of this study was to examine the longitudinal relationship between change in sleep duration and change in body mass index (BMI) and percent body fat (PBF) in a cohort of adolescents. The cohort included 723 adolescents (mean age = 14.7 years at baseline) from Minnesota. Total sleep duration was assessed via self-report. BMI and PBF were objectively assessed. Covariates used in the multivariate analyses included energy intake as assessed through 24-hour recalls, activity levels as assessed by accelerometers, screen time/sedentary behavior, depression, and sociodemographic characteristics. For both males and females, average BMI and PBF increased slightly over the 2 years and average sleep duration decreased by about 30 minutes. The authors saw no statistically significant longitudinal relationships between change in total sleep and change in BMI or PBF over time in either girls or boys. The only longitudinal relationship that approached statistical significance was a positive association between sleep and PBF in females (p = .068). This research contributes to the literature as the only study to date to examine how change in sleep duration during adolescence may be related to a concomitant change in BMI and body fat. The findings of this study do not support the hypothesis that a decline in sleep duration during adolescence increases obesity risk.

Two Years Later: Wellness Councils and Healthier Vending in a Cohort of Middle and High Schools

PURPOSE To examine the association between school wellness council structure over 2 years and low-nutrient, energy-dense vending fare assessed as a food score (range: 0-7), following enactment of federal legislation. METHODS Multivariate linear regression was used to examine 2006/2007 and 2008/2009 data among a cohort of middle (n = 16) and high (n = 38) schools located in a Midwest metropolitan area. RESULTS Schools with district and school councils had a significantly lower mean food score (3.28) than schools with district-only (4.50) and no councils (4.99). CONCLUSIONS Wellness councils, particularly a structure that includes both a district and school council, may contribute to decreasing low-nutrient, energy-dense food/beverage availability in middle and high schools.

Are School Vending Machines Loaded With Calories and Fat: An Assessment of 106 Middle and High Schools

BACKGROUND The purpose of this study was to describe the extent to which vending offerings in 106 schools in the St. Paul-Minneapolis, Minnesota metropolitan area, met criteria for types of beverages, fat, and calories based on selected criteria offered by the Institute of Medicine. METHODS Schools where youth participants were attending for the 2006-2007 school year were identified and invited to participate in the study (n = 143); 81% of schools (n = 116) agreed to participate. RESULTS Of the 116 schools, 106 had vending machines. Across schools with vending machines (n = 106), 5085 food and 8442 beverage items were offered. Overall, only 18% of beverage items met criteria for calories and type of beverage; significantly more items in public schools met the criteria as compared to private schools (19% vs 12%; p < .01). This difference was also significant for high schools as compared to middle schools (18% vs 22%; p < .01). For food items, 41% met calorie criteria, 45% met fat criteria, and 22% met both fat and calorie criteria. Significantly more food items met both criteria in public than private schools (22% vs 18%; p = .01), while high schools (22%) and middle schools (21%) were similar. A very small proportion of foods (< 5%) would have met the full criteria suggested by the Institute of Medicine for competitive foods. CONCLUSION Overall, foods and beverages offered in vending machines continue to be high in fat and calories. Public schools are doing a slightly better job of providing healthy foods as compared to private schools.

The Relationship Between Adolescent Alcohol Use and Delinquent and Violent Behaviors

ABSTRACT Longitudinal and cross-sectional relationships between alcohol use, psychological risk (as measured by four MMPI-A scales), and delinquent and violent behaviors were analyzed using self-reported data from eighth and ninth grade students from a rural and small town population. Alcohol use and acknowledgement of alcohol and drug-related problems were statistically associated with delinquent and violent behaviors, even after adjusting for personality and behavioral risk. These results suggest that alcohol use is an independent risk factor for delinquent and violent behaviors among young people. Violence prevention efforts among adolescents, therefore, should recognize and address alcohol use. Alcohol use prevention efforts among adolescents should evaluate the effects of reducing alcohol use on subsequent violent behaviors.