Meghan R. Longacre

Longitudinal Study of Viewing Smoking in Movies and Initiation of Smoking by Children

BACKGROUND. Previous studies showed an association between viewing of smoking in movies and initiation of smoking among adolescents. However, all studies except one were cross-sectional, and none updated movie smoking exposure prospectively or assessed its influence on children. METHODS. We enrolled elementary school students, 9 to 12 years of age, in a longitudinal study to assess the influence of movie smoking exposure on smoking initiation among children. Movie smoking content was coded for the most popular movie releases; exposure was assessed by asking children which movies they had seen, on the basis of unique lists of 50 movies sampled randomly from top box office hits and video rentals. Data collection occurred in 3 waves (the baseline survey and 2 follow-up surveys), ∼1 year apart. Movie lists were updated for each data collection wave, to reflect recent releases. Movie smoking exposure was analyzed in relation to smoking initiation by the end of the study period. RESULTS. Approximately 80% of the childrens smoking exposure occurred through movies rated G, PG, or PG-13. Childrens movie smoking exposure predicted smoking initiation significantly, after adjustment for multiple covariates including child and parent characteristics. The relative risks were 1.09, 1.09, and 1.07 for a 1-decile increase of movie smoking exposure measured at the baseline, second, and third data collection waves, respectively. The adjusted attributable risk of smoking initiation attributable to movie smoking exposure was 0.35. CONCLUSION. Our study, which is the first to enroll children in elementary school and to update movie smoking exposure longitudinally, indicates that early exposure has as much influence on smoking risk as does exposure nearer the outcome. Overall, movie smoking may be responsible for at least one third of smoking initiation for children in this age group.

Children with a TV in their bedroom at higher risk for being overweight

Objective:We examined having a TV in the bedroom as a risk factor for child overweight.Design:Cross-sectional study.Setting:School- and telephone-based surveys in New Hampshire and Vermont between 2002 and 2004.Participants:Two thousand three hundred and forty-three children enrolled in public schools, aged 9–12 years, and one of their parents.Main exposures:The child having a TV in the bedroom.Main outcome measures:Age- and gender-standardized child body mass index (zBMI). Overweight was defined as equal to or above the 95th percentile for zBMI.Results:Overall, 22.3% (N=523) of the children were overweight, and almost half of all children (48.2%, N=1130) had a TV in their bedroom. Children with a TV in their bedroom had a higher zBMI and were significantly more likely to be overweight compared to those without a TV in their bedroom (27.3 versus 17.7%, respectively; P<0.05). After controlling for sociodemographics, physical activity, frequency of TV or movie watching and internet use, children with a TV in their bedroom who watched at least one session of TV or movies per day were more likely to be overweight compared to those without a TV in their bedroom (odds ratio=1.32, 95% confidence interval: 1.03, 1.70).Conclusions:Having a TV in the bedroom is a risk factor for child overweight, independent of reported physical activity, participation in team sports, TV or movie watching time and internet use at home. Further study is needed to fully understand the mechanism by which having a TV in the bedroom increases childrens risk for overweight.

Parental Rules and Monitoring of Children’s Movie Viewing Associated With Children’s Risk for Smoking and Drinking

OBJECTIVES. Evidence suggests that media portrayals of tobacco and alcohol use are important predictors of adolescent smoking and drinking. We examined the role of parents in monitoring and limiting children’s movie exposure and whether or not this was associated with a lower risk of adolescent smoking and drinking. DESIGN. We surveyed 2606 child-parent dyads between 2002 and 2003. We asked children (9–12 years of age) how often their parents engaged in specific behaviors to monitor their movie viewing and if their parents allowed them to watch R-rated movies. We also surveyed children about parental monitoring of nonmedia-related behaviors. The primary outcomes were risk of smoking and drinking alcohol, defined by attitudinal susceptibility or early experimentation with either substance. RESULTS. Less than half (45.0%) the children were prohibited from watching R-rated movies. Of those who were allowed to watch R-rated movies, one third (34.7%) always viewed them with a parent and two thirds (65.3%) sometimes watched them without a parent. Less than 10% of the children reported that their parents consistently engaged in all 4 movie-monitoring behaviors. Even after controlling for parental monitoring of nonmedia-related behaviors and other covariates, children were at lower risk of smoking and drinking if their parents prohibited them from watching R-rated movies. Parental coviewing of R-rated movies was associated with a lower risk of child smoking but not drinking if parents consistently monitored what their children watched. CONCLUSIONS. Parental rules and monitoring of children’s movie viewing may have a protective influence on children’s risk for smoking and drinking, over and above parental monitoring of nonmedia related behaviors. This highlights a potential role for parents in preventing early initiation of tobacco and alcohol use among adolescents.

Early exposure to movie smoking predicts established smoking by older teens and young adults.

OBJECTIVE. Movie smoking exposure is a strong predictor of smoking initiation by adolescents; however, we do not know whether it is a long-term predictor of established smoking. We conducted a prospective study to determine whether movie smoking exposure during early adolescence predicts established smoking in older teens and young adults. DESIGN. We assessed movie smoking exposure and smoking status through a written school-based survey in 1999, when participants were 10 to 14 years of age. We enrolled 73% (n = 2603) of those who had never tried smoking in a follow-up study. In 2006–2007, we conducted telephone interviews with 69% (n = 1791) of the cohort to ascertain current smoking status. The primary outcome was established smoking, defined as having smoked >100 cigarettes. Mean age at follow-up was 18.7 years. RESULTS. Thirteen percent (n = 235) progressed from never smoking to established smoking during the follow-up period. Eighty-nine percent (n = 209) of established smokers smoked during the 30 days before the survey. Even after controlling for a wide range of baseline characteristics, the relative risk for established smoking increased by one third with each successive quartile of movie smoking exposure. Those in the highest quartile for baseline movie smoking exposure were twice as likely to be established smokers at follow-up compared with those in the lowest quartile. CONCLUSIONS. Movie smoking exposure significantly predicted progression to established smoking in long-term follow-up. We estimate that 34.9% of established smoking in this cohort can be attributed to movie smoking exposure.

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.

Public Directory Data Sources Do Not Accurately Characterize the Food Environment in Two Predominantly Rural States

Communities are being encouraged to develop locally based interventions to address environmental risk factors for obesity. Online public directories represent an affordable and easily accessible mechanism for mapping community food environments, but may have limited utility in rural areas. The primary aim of this study was to evaluate the efficacy of public directories vs rigorous onsite field verification to characterize the community food environment in 32 geographically dispersed towns from two rural states covering 1,237.6 square miles. Eight types of food outlets were assessed in 2007, including food markets and eating establishments, first using two publically available online directories followed by onsite field verification by trained coders. χ(2) and univariate binomial regression were used to determine whether the proportion of outlets accurately listed varied by food outlet type or town population. Among 1,340 identified outlets, only 36.9% were accurately listed through public directories; 29.6% were not listed but were located during field observation. Accuracy varied by outlet type, being most accurate for big box stores and least accurate for farm/produce stands. Overall, public directories accurately identified fewer than half of the food outlets. Accuracy was significantly lower for rural and small towns compared to mid-size and urban towns (P<0.001). In this geographic sample, public directories seriously misrepresented the actual distribution of food outlets, particularly for rural and small towns. To inform local obesity-prevention efforts, communities should strongly consider using field verification to characterize the food environment in low-population areas.

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.

Influence of Movie Smoking Exposure and Team Sports Participation on Established Smoking

OBJECTIVE To examine the joint effects of movie smoking exposure and team sports participation on established smoking. DESIGN Longitudinal study. SETTING School- and telephone-based surveys in New Hampshire and Vermont between September 1999 through November 1999 and February 2006 through February 2007. PARTICIPANTS A total of 2048 youths aged 16 to 21 years at follow-up. Main Exposures Baseline movie smoking exposure categorized in quartiles assessed when respondents were aged 9 to 14 years and team sports participation assessed when respondents were aged 16 to 21 years. Main Outcome Measure Established smoking (having smoked > or =100 cigarettes in ones lifetime) at follow-up. RESULTS At follow-up, 353 respondents (17.2%) were established smokers. Exposure to the highest quartile of movie smoking compared with the lowest increased the likelihood of established smoking (odds ratio = 1.63; 95% confidence interval, 1.03-2.57), and team sports nonparticipants compared with participants were twice as likely to be established smokers (odds ratio = 2.01; 95% confidence interval, 1.47-2.74). The joint effects of movie smoking exposure and team sports participation revealed that at each quartile of movie smoking exposure, the odds of established smoking were greater for team sports nonparticipants than for participants. We saw a dose-response relationship of movie smoking exposure for established smoking only among team sports participants. CONCLUSIONS Team sports participation clearly plays a protective role against established smoking, even in the face of exposure to movie smoking. However, movie smoking exposure increases the risk of established smoking among both team sports participants and nonparticipants. Parents, teachers, coaches, and clinicians should be aware that encouraging team sports participation in tandem with minimizing early exposure to movie smoking may offer the greatest likelihood of preventing youth smoking.