Martha Y. Kubik

School-Based Approaches to Affect Adolescents’ Diets: Results From the TEENS Study:

This article reports on the outcomes of the Teens Eating for Energy and Nutrition at School (TEENS) study, a 2-year intervention study conducted in 16 middle schools with a goal of increasing students’ intakes of fruits, vegetables, and lower fat foods. Despite positive interim results for students randomized to intervention schools, the positive effects of the intervention were not seen for the primary outcomes at the end of the 2nd year. Positive effects were seen only for a food choice score (suggesting that the students usually choose lower versus higher fat foods) and not for measures of food intake. Future studies may need to take a step back toward more controlled efficacy studies in working with this age-group. In addition, future work may consider the use of peer leaders, more intensive teacher training, ongoing formative assessment, and the testing of more powerful environmental change intervention strategies.

Prevalence and Correlates of Depressive Symptoms in Young Adolescents

OBJECTIVES To assess prevalence of elevated depressive symptoms in young adolescents and examine associations between symptoms and sociodemographic and behavioral factors. METHODS Cross-sectional survey data from 3621 seventh grade students from 16 middle schools were analyzed. RESULTS Elevated depressive symptoms were reported by 40% of girls and 30% of boys. Socioeconomic status, race/ethnicity, and age group were independently associated with depressive symptomatology. For girls, monthly alcohol use, monthly smoking, heavy drinking, and inhalant use were significant correlates. For boys, monthly alcohol use and inhalant use were significant. CONCLUSIONS Elevated depressive symptomatology was a prevalent problem. Substance use was often associated with depressive symptoms, especially among girls.

Are There Nutritional and Other Benefits Associated with Family Meals Among At-Risk Youth?

PURPOSE The literature suggests positive associations between family dinner frequency and dietary practices and psychosocial well-being, and inverse associations between family dinner frequency and overweight status among general adolescent populations. The present study aims to examine these associations among a population of adolescents at-risk of academic failure. METHODS A racially diverse sample of adolescents (n = 145, 52% male, 61% nonwhite) from six alternative high schools (AHS) completed surveys and had their heights and weights measured by trained research staff. Mixed-model logistic regression analyses assessed associations between family dinner frequency and overweight status, healthy and unhealthy weight management, and food insecurity, whereas mixed linear models assessed associations with breakfast consumption, fruit and vegetable consumption, high-fat food intake, fast food intake, substance use, and depressive symptoms. Analyses adjusted for race/ethnicity, age, gender, socioeconomic status, and the random effect of school. RESULTS Family dinner frequency was positively associated with breakfast consumption and fruit intake (p < .01 and p < .05, respectively), and inversely associated with depressive symptoms (p < .05). Adolescents who reported never eating family dinner were significantly more likely to be overweight (odds ratio [OR] = 2.8, confidence interval [CI] = 1.1-6.9) and food insecure (OR = 6.0, CI = 2.2-16.4) than adolescents who reported five to seven family meals per week. CONCLUSIONS In this at-risk sample of youth, some, but not all of the benefits of family meals found in other studies were apparent. Intervention programs to increase the availability and affordability of healthful foods and promote family meals for families of AHS students may be beneficial.

Healthy Home Offerings via the Mealtime Environment (HOME): Feasibility, Acceptability, and Outcomes of a Pilot Study

The primary objective was to develop and test the feasibility and acceptability of the Healthy Home Offerings via the Mealtime Environment (HOME) program, a pilot childhood obesity prevention intervention aimed at increasing the quality of foods in the home and at family meals. Forty‐four child/parent dyads participated in a randomized controlled trial (n = 22 in intervention and n = 22 in control conditions). The intervention program, held at neighborhood facilities, included five, 90‐min sessions consisting of interactive nutrition education, taste testing, cooking skill building, parent discussion groups, and hands‐on meal preparation. Children (8–10‐year olds) and parents (89% mothers) completed assessments at their home at baseline, postintervention, and 6‐month follow‐up, including psychosocial surveys, anthropometry, 24‐h dietary recalls, and home food availability and meal offering inventories. Feasibility/acceptability was assessed with participant surveys and process data. All families completed all three home‐based assessments. Most intervention families (86%) attended at least four of five sessions. Nearly all parents (95%) and 71% of children rated all sessions very positively. General linear models indicated that at postintervention, compared to control children, intervention children were significantly more likely to report greater food preparation skill development (P < 0.001). There were trends suggesting that intervention children had higher consumption of fruits and vegetables (P < 0.08), and higher intakes of key nutrients (all P values <0.05) than control children. Obesity changes did not differ by condition. Not all findings were sustained at 6‐month follow‐up. Obesity prevention programming with families in community settings is feasible and well accepted. Results demonstrate the potential of the HOME program.

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.

State but not district nutrition policies are associated with less junk food in vending machines and school stores in US public schools.

BACKGROUND Policy that targets the school food environment has been advanced as one way to increase the availability of healthy food at schools and healthy food choice by students. Although both state- and district-level policy initiatives have focused on school nutrition standards, it remains to be seen whether these policies translate into healthy food practices at the school level, where student behavior will be impacted. OBJECTIVE To examine whether state- and district-level nutrition policies addressing junk food in school vending machines and school stores were associated with less junk food in school vending machines and school stores. Junk food was defined as foods and beverages with low nutrient density that provide calories primarily through fats and added sugars. DESIGN A cross-sectional study design was used to assess self-report data collected by computer-assisted telephone interviews or self-administered mail questionnaires from state-, district-, and school-level respondents participating in the School Health Policies and Programs Study 2006. The School Health Policies and Programs Study, administered every 6 years since 1994 by the Centers for Disease Control and Prevention, is considered the largest, most comprehensive assessment of school health policies and programs in the United States. SUBJECTS/SETTING A nationally representative sample (n=563) of public elementary, middle, and high schools was studied. STATISTICAL ANALYSIS Logistic regression adjusted for school characteristics, sampling weights, and clustering was used to analyze data. Policies were assessed for strength (required, recommended, neither required nor recommended prohibiting junk food) and whether strength was similar for school vending machines and school stores. RESULTS School vending machines and school stores were more prevalent in high schools (93%) than middle (84%) and elementary (30%) schools. For state policies, elementary schools that required prohibiting junk food in school vending machines and school stores offered less junk food than elementary schools that neither required nor recommended prohibiting junk food (13% vs 37%; P=0.006). Middle schools that required prohibiting junk food in vending machines and school stores offered less junk food than middle schools that recommended prohibiting junk food (71% vs 87%; P=0.07). Similar associations were not evident for district-level polices or high schools. CONCLUSIONS Policy may be an effective tool to decrease junk food in schools, particularly in elementary and middle schools.

Depressive Symptoms and Physical Activity in Adolescent Girls

PURPOSE To evaluate the relationship between depressive symptoms and physical activity in a geographically and ethnically diverse sample of sixth-grade adolescent girls. METHODS The Trial of Activity for Adolescent Girls (TAAG) baseline measurement included a random sample (N = 1721) of sixth-grade girls in 36 schools at six field sites. Measurements were accelerometry and the 3-d Physical Activity Recall (3DPAR) for physical activity, and the Center for Epidemiological Studies-Depression scale (CES-D) for depressive symptoms. RESULTS Girls with complete data (N = 1397), mean age 12 yr, had an average CES-D score of 14.7 (SD = 9.25) and engaged in an average of about 460 min of sedentary activity, < 24 min of moderate to vigorous physical activity (MVPA), and < 6 min of vigorous physical activity (VPA) in an 18-h day. Thirty-minute segments of MVPA ranged in number from 3.9 to 1.2, and METS for these segments ranged from > 3.0 to > 6.5. Mixed-model regression indicated no relationship between depressive symptoms and physical activity; however, a significant but modest inverse relationship between sedentary activity and depressive symptoms was observed. CONCLUSION A sufficient sample size, standardized procedures, and validated instruments characterized this study; however, a relationship between depressive symptoms and physical activity was not observed for sixth-grade girls from diverse geographic locations. The average CES-D score was lower than is considered clinically meaningful for either adolescents or adults, and MET-minutes of sedentary activity were high. This combination of data may be different from other studies and could have contributed to the unexpected finding. This unexpected finding is informative, however, because it shows the need for additional research that includes a wider range of possible combinations of data, especially with young adolescent girls.

State School Nutrition and Physical Activity Policy Environments and Youth Obesity

BACKGROUND With the epidemic of childhood obesity, there is national interest in state-level school policies related to nutrition and physical activity, policies adopted by states, and relationships to youth obesity. PURPOSE This study develops a comprehensive state-level approach to characterize the overall obesity prevention policy environment for schools and links the policy environments to youth obesity for each state. METHODS Using 2006 School Health Policies and Programs Study (SHPPS) state data, qualitative and quantitative methods were used (2008-2009) to construct domains of state-level school obesity prevention policies and practices, establish the validity and reliability of the domain scales, and examine their associations with state-level obesity prevalence among youth aged 10-17 years from the 2003 National Survey of Childrens Health. RESULTS Nearly 250 state-level obesity prevention-policy questions were identified from the SHPPS. Three broad policy topic areas containing 100 food service and nutrition (FSN) questionnaire items; 146 physical activity and education (PAE) items; and two weight assessment (WA) items were selected. Principal components analysis and content validity assessment were used to further categorize the items into six FSN, ten PAE, and one WA domain. Using a proportional scaled score to summarize the number of policies adopted by states, it was found that on average states adopted about half of the FSN (49%), 38% of the PAE, and 17% of the WA policies examined. After adjusting for state-level measures of ethnicity and income, the average proportion of FSN policies adopted by states was correlated with the prevalence of youth obesity at r =0.35 (p=0.01). However, no correlation was found between either PAE or WA policies and youth obesity (PAE policies at r =0.02 [p=0.53] and WA policies at r =0.16 [p=0.40]). CONCLUSIONS States appear to be doing a better job adopting FSN policies than PA or WA policies, and adoption of policies is correlated with youth obesity. Continued monitoring of these policies seems to be warranted.

Developing School-Based BMI Screening and Parent Notification Programs: Findings From Focus Groups With Parents of Elementary School Students

School-based body mass index (BMI) screening and parent notification programs have been advanced as an obesity prevention strategy. However, little is known about how to develop and implement programs. This qualitative study explored the opinions and beliefs of parents of elementary school students concerning school-based BMI screening programs, notification methods, message content, and health information needs related to promoting healthy weight for school-aged children. Ten focus groups were conducted with 71 participants. Parents were generally supportive of school-based BMI screening. However, they wanted assurance that student privacy and respect would be maintained during measurement and that BMI results would be provided to parents in a neutral manner that avoided weight labeling. They also believed that aggregate results should be disseminated to the larger school community to support healthy change in the nutrition and physical activity environments of schools. Implications for practitioners and researchers are discussed.

Nutritional issues for adolescents

This chapter provides background on the nutritional health of adolescents, focusing on a public health or population-level approach. We detail some specific nutritional issues and related health outcomes that are particularly relevant to adolescents, including overweight and obesity, type 2 diabetes, eating-related disorders and bone health as it relates to calcium intake. We discuss implications of the trends in adolescent dietary habits for practitioners and propose a research agenda for better understanding and positively influencing future adolescent nutritional health.