Lloyd J. Kolbe

Comparison of Overweight, Weight Perception, and Weight-Related Practices Among High School Students in Three Large Chinese Cities and Two Large U.S. Cities

PURPOSE The study compared differences in overweight prevalence, weight perception, and weight-related practices among high school students in five large Chinese and U.S. cities, and informed interventions for childhood obesity in China and the U.S. METHODS The data used was collected in 2003 from a representative sample of high school students in Hong Kong, Macau, Taipei, New York and Los Angeles. RESULTS The prevalence of overweight high school students in New York City and Los Angeles was about twice as high as in Hong Kong, Macau, and Taipei; however, the proportion of Chinese students perceiving themselves to be overweight was 15% higher than their U.S. counterparts. Independent of actual weight status, perceived overweight was significantly associated with weight control practices (p < .05). U.S. students showed higher levels of moderate and vigorous physical activity, but more hours of watching television than their Chinese counterparts. CONCLUSION The continuing pandemic of overweight among youth fosters weight dissatisfaction, which may increase unhealthy weight control practices. Interventions should be designed to prevent overweight without precipitating unhealthy weight control practices by emphasizing an increase in physical activity and a reduction in time watching television.

Trends in overweight among school children and adolescents in seven Chinese Provinces, from 1991–2004

OBJECTIVE To examine trends in body mass index (BMI) in relation to energy intake and expenditure among Chinese school children and adolescents from seven Provinces during 1991-2004, a time of rapid economic development in China. METHODS Combined cross-sectional data derived from the China Health and Nutrition Survey (N = 1,977 in 1991, 2, 048 in 1993, 2,350 in 1997, 1,872 in 2000, and 1,275 in 2004) was utilized to assess BMI and prevalence of overweight. Sequential multiple regressions were conducted to assess the extent to which changes in energy intake and expenditure accounted for variation in BMI. RESULTS Overall, the prevalence of overweight among school children and adolescents doubled from 1991 to 2004. It increased from 6.5% to 16.1% for children aged 6-11 years and from 3.3% to 6.2% for adolescents aged 12-18 years. Changes in energy intake, physical activity, and sedentary activity explained 12% and 28% of variance in BMI, respectively, for children and adolescents. CONCLUSIONS Chinese youths, especially children aged 6-11 years, became overweight rapidly during 1991-2004, which coincided with rapid economic growth in China. Effective policies and interventions are needed to curb the overweight epidemic among Chinese youths.

Health of adolescents and young adults: trends in achieving the 21 Critical National Health Objectives by 2010.

PURPOSE The 21 Critical National Health Objectives (CNHOs) for Adolescents and Young Adults derived from Healthy People 2010 addressed the most significant threats to the health of individuals aged 10-24 years. This study assessed trends in the 21 CNHOs between 1991 and 2009, and from baseline years for which 2010 targets were established to 2009, and the extent to which targets were achieved. METHODS For one CNHO (new HIV diagnoses), national data were not available. For CNHOs measured by census systems, the percentage of change in each health outcome was calculated between 1991 and 2009 and between baseline years and 2009. Any change ≥5% was considered as an improvement or deterioration. For CNHOs measured by national probability-based surveillance surveys, multivariate logistic regression was conducted using Stata Version 10.0 (StataCorp, College Station, TX) to calculate odds ratios for each outcome from 1991, and from baseline years to 2009, controlling for gender, race/ethnicity, and age or school grade-level. To calculate the percentage of targets being achieved, the difference between baseline data and 2009 data was divided by that between baseline data and target. RESULTS Adolescents and young adults achieved two targets (rode with a driver who had drunk alcohol, physical fighting), improved for 12 CNHOs, made mixed progress by sub-objective for two, showed no progress in four, and regressed in achieving two (Chlamydia infections; overweight). Progress varied by demographic variables. CONCLUSION Although encouraging trends were seen in young peoples health, the United States achieved only two CNHOs. Attention is needed to improve the health and reduce disparities among young people.

Applying the Theory of Planned Behavior to Explore the Relation Between Smoke-Free Air Laws and Quitting Intentions

Smoke-free air policies have been shown to reduce smoking, but the mechanism of behavior change is not well understood. The authors used structural equation modeling to conduct a theory of planned behavior analysis with data from 395 smokers living in seven Texas cities, three with a comprehensive smoke-free air law and four without a comprehensive law. Agreement with regulating smoking in public places was significantly associated with attitudes and perceived normative pressure about quitting. Nicotine dependence was significantly associated with attitudes and perceived behavioral control. There was also a direct effect of nicotine dependence on intention to take measures to quit smoking. Smoke-free air laws appear to influence quitting intentions through the formation of positive attitudes about regulating smoking in public places and the perception of normative pressure to take measures to quit. Implications for smoke-free air policy campaigns and challenges in evaluating their effectiveness are discussed.

Effectiveness of the Energize Elementary School Program to Improve Diet and Exercise.

BACKGROUND The rate of childhood obesity has more than tripled during the past 30 years. Research shows that prevention at an early age is more effective than treatment later in life. Energize is a multicomponent intervention incorporated into the school day that combines nutrition education and physical activity aimed at maintaining healthy weight among elementary school youth. This study evaluated the effectiveness of the Energize program for changing dietary and physical activity habits compared to a control group of children not participating in the program. METHODS A total of 104, 3rd and 4th graders in 3 southern Indiana elementary schools took part in the study. A quasi-experimental design was used to assess dietary and exercise habits of students in Energize and control groups through 12-week diet/activity logs and post-test questionnaires after controlling for the pre-test results. RESULTS Energize reduced consumption of French fries and potato chips, but did not increase physical activity. CONCLUSIONS This study provides future researchers with a foundation for preparing longer studies of Energize or to compare multiple years of a standardized Energize curriculum.

Leisure-time physical activity and obesity in Black adults in Indianapolis.

OBJECTIVE To examine the relationship between the total volume of leisure-time physical activity (LTPA) and obesity among African American adults in Indianapolis. METHODS Logistic regression analysis with 649 African American adults. RESULTS The data show an inverse graded relationship between the total volume of LTPA and obesity for African American women, but not for men. CONCLUSIONS African American women who accumulate a high volume of LTPA (ie, 300 minutes or more per week) are less likely to be obese. Further research is needed to investigate the gender difference in the effect of LTPA on obesity.

What Have We Learned From Collaborative Partnerships to Concomitantly Improve Both Education and Health

BACKGROUND Collaborative partnerships are an essential means to concomitantly improve both education outcomes and health outcomes among K-12 students. METHODS We describe examples of contemporaneous, interactive, and evolving partnerships that have been implemented, respectively, by a national governmental health organization, national nongovernmental education and health organizations, a state governmental education organization, and a local nongovernmental health organization that serves partner schools. RESULTS Each of these partnerships strategically built operational infrastructures that enabled partners to efficiently combine their resources to improve student education and health. CONCLUSIONS To implement a Whole School, Whole Community, Whole Child Framework, we need to purposefully strengthen, expand, and interconnect national, state, and local collaborative partnerships and supporting infrastructures that concomitantly can improve both education and health.

Social-ecological factors of leisure-time physical activity in black adults.

OBJECTIVES To develop and test an explicative model of leisure-time physical activity (LTPA), including 6 selected contributory factors: self-efficacy, self-regulation, social support, perceived physical environment, outcome-expectancy value, and policy beliefs. METHODS A social-ecological model of LTPA using the structural equation modeling technique was estimated in a regional, church-going sample of 649 African Americans. RESULTS The results indicated this model is good fit to the data. LTPA was associated with self-regulation and gender directly (P<.05) and social support, self-efficacy, perceived access to LTPA facilities, and positive outcome-expectancy value indirectly (P<.05). CONCLUSIONS Multitiered interventions considering cultural relevance are recommended to improve LTPA engagement.

The Combined Effect of Behavioral Intention and Exposure to a Smoke-Free Air Law on Taking Measures to Quit Smoking

Because of the large burden of disease attributable to cigarette smoking, a variety of tobacco control interventions, some focused on changing individual behavior and others focused on influencing societal norms, have been introduced. The current study tested the combined effect of behavioral intention and exposure to a comprehensive smoke-free air law as a prospective predictor of taking measures to quit smoking. Participants were 187 adults living in 7 Texas cities, 3 with a comprehensive smoke-free air law and 4 without such a law, who reported current cigarette smoking at baseline and completed a 1-month follow-up interview. Data were collected by telephone administration of a questionnaire. Results showed that, compared with smokers with low behavioral intention to take measures to quit smoking and no exposure to a comprehensive smoke-free air law, the smokers with high behavioral intention and exposure to a comprehensive law had the greatest odds of taking measures to quit smoking. This longitudinal study provides further evidence that the most successful smoking cessation campaigns will be multifaceted addressing individual factors with educational strategies designed to change beliefs and intentions and environmental factors with policy-based interventions.

On national strategies to improve both education and health--an open letter.

Since the early-1900s, education and health professionals have been developing a wide range of means that K-12 schools, and colleges and universities, could use to concomitantly improve both the health and education of their students. These means efficiently can be organized into what sometimes are called school, or college, health programs. The implementation of such programs could become one of most effective strategies available to improve the health of all American students; and by doing so, could simultaneously become one of the most effective strategies available to improve educational achievement as well—especially among students at greatest risk for poor health and poor education outcomes. Health and education are reciprocally interactive—healthier students simply learn better; and more educated adults live longer and healthier. Education, health, and related organizations have recognized this for decades. Indeed, local schools and colleges increasingly are asking health and related organizations within their own communities to work with them more collaboratively. Yet we, as a nation, have not convened a purposeful discussion about national actions that education, health, and related organizations together might take to help local schools and colleges implement such programs. With this letter, I ask the national governmental and nongovernmental organizations listed below to consider whether their organizations might participate in a collaborative discussion about possible national actions they each might take independently and collaboratively with others. As