S. Bryn Austin

Clustering of Fast-Food Restaurants Around Schools: A Novel Application of Spatial Statistics to the Study of Food Environments

OBJECTIVES We examined the concentration of fast food restaurants in areas proximal to schools to characterize school neighborhood food environments. METHODS We used geocoded databases of restaurant and school addresses to examine locational patterns of fast-food restaurants and kindergartens and primary and secondary schools in Chicago. We used the bivariate K function statistical method to quantify the degree of clustering (spatial dependence) of fast-food restaurants around school locations. RESULTS The median distance from any school in Chicago to the nearest fast-food restaurant was 0.52 km, a distance that an adult can walk in little more than 5 minutes, and 78% of schools had at least 1 fast-food restaurant within 800 m. Fast-food restaurants were statistically significantly clustered in areas within a short walking distance from schools, with an estimated 3 to 4 times as many fast-food restaurants within 1.5 km from schools than would be expected if the restaurants were distributed throughout the city in a way unrelated to school locations. CONCLUSIONS Fast-food restaurants are concentrated within a short walking distance from schools, exposing children to poor-quality food environments in their school neighborhoods.

Sexual Orientation and Bullying Among Adolescents in the Growing Up Today Study

PURPOSE To examine the relationship between sexual orientation and past-year reports of bullying victimization and perpetration in a large sample of American youth. METHODS Survey data from 7,559 adolescents aged 14-22 who responded to the 2001 wave questionnaire of the Growing Up Today Study were examined cross-sectionally. Multivariable generalized estimating equations regression was performed using the modified Poisson method. We examined associations between sexual orientation and past-year bully victimization and perpetration with heterosexuals as the referent group, stratifying by gender and controlling for age, race/ethnicity, and weight status. RESULTS Compared to heterosexual males, mostly heterosexual males (risk ratio [RR]: 1.45; 95% confidence interval [CI]: 1.13, 1.86) and gay males (RR 1.98; CI: 1.39, 2.82) were more likely to report being bullied. Similarly, mostly heterosexual females (RR: 1.72, 95% CI: 1.45, 2.03), bisexual females (RR: 1.63, 95% CI: 1.14, 2.31), and lesbians (RR: 3.36, 95% CI: 1.76, 6.41) were more likely to report being bullied than were heterosexual females. Gay males (RR: 0.34, 95% CI: 0.14, 0.84) were much less likely to report bullying others than were heterosexual males. Mostly heterosexual females (RR: 1.70, 95% CI: 1.42, 2.04) and bisexual females (RR: 2.41, 95% CI: 1.80, 3.24) were more likely to report bullying others than heterosexual females. No lesbian participants reported bullying others. CONCLUSIONS There are significant differences in reports of bullying victimization and perpetration between heterosexual and sexual minority youth. Clinicians should inquire about sexual orientation and bullying, and coordinate care for youth who may need additional support.

“How Can We Stay Healthy when you’re Throwing All of this in Front of Us?” Findings from Focus Groups and Interviews in Middle Schools on Environmental Influences on Nutrition and Physical Activity

This study aimed to identify factors in school physical and social environments that may facilitate or compete with programs and policies to improve student physical activity and nutrition. Focus groups and interviews were conducted with students, faculty, and staff of two public middle schools. Participants identified numerous aspects of the school environments as significant. Competition, teasing and bullying, time, and safety were described as major barriers for students to be physically active during physical education class, on sports teams, and before and after school. The quality of the food served, easy access to nonnutritious snacks, limited time for lunch period, and weight concerns emerged as significant reasons why students do not eat nutritious meals in school. When developing programs and policies to improve the health of students, environmental influences that undermine efforts to improve student health behaviors must be addressed.

The Health and Health Care of Lesbian, Gay, and Bisexual Adolescents

Adolescents face a variety of challenges in their transition to adulthood; lesbian, gay, and bisexual adolescents face these typical challenges as well as additional challenges that are related to the social stigma of their sexual orientation. For some lesbian, gay, and bisexual adolescents, this stigma may induce psychosocial stress, leading to increased health risk behaviors and poorer health outcomes. In this article, we review data on the health and health care of LGB adolescents. We examine health indicators and health risks for LGB youth, including substance use, eating disorders, suicidality, risky sexual behaviors, violence exposure and victimization, and homelessness. We also examine health care provision and utilization for LGB youth. Lastly, we discuss ways in which researchers and clinicians can improve LGB adolescent health and health care.

Patterns and Determinants of Physical Activity in U.S. Adolescents

PURPOSE The objectives of this study were to describe longitudinal trends in adolescent physical activity in a sample of U.S. adolescents and to assess the effect of multiple individual, parental, and environmental factors on initial level and rates of change in adolescent physical activity. METHODS Study subjects were 12,812 boys and girls 10 to 18 years of age who were participating in the Growing Up Today Study and their mothers. We used accelerated longitudinal analysis to describe trajectories of physical activity from 1997-1999, and random effects linear mixed models to determine which factors were independently associated with baseline physical activity and changes in physical activity over time. RESULTS Mean hours of physical activity ranged from 7.3-11.6 hours per week in boys and from 8.0-11.2 hours per week in girls. Physical activity was best modeled as a quadratic function of age, increasing until early adolescence and declining after age 13 in boys and girls. Multivariable modeling demonstrated that variables associated with physical activity level at baseline in boys and girls were age, body mass index, psychosocial variables, personal attitudes about body shape, perceived peer attitudes about body shape/fitness, parental attitudes about physical activity, parental physical activity, and environmental barriers to physical activity. Age was the only factor that predicted change in physical activity over time. CONCLUSIONS Interventions to increase physical activity in adolescents should begin before adolescence. Interventions may be more effective if they are multimodal and focus on modifiable individual, parental, and environmental factors.

Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents.

Adolescents with a minority sexual orientation (e.g., lesbian, gay, and bisexual) are more likely to use substances than their heterosexual peers. This study aimed to increase understanding of the development of drug use in this vulnerable population by: 1) comparing longitudinal patterns of past-year illicit drug use (e.g., marijuana, cocaine, and ecstasy) and misuse of prescription drugs among minority sexual orientation youth relative to heterosexual youth and, 2) examining how sexual orientation sub-group, gender, and age relate to variation in the risk of drug use. Data come from the Growing Up Today Study, a community-based cohort of U.S. adolescents who were assessed three times between 1999 and 2005 with self-administered questionnaires when they ranged in age from 12 to 23 years (N=12,644; 74.9% of the original cohort). Multivariable repeated measures generalized estimating equations using modified Poisson regression were used to estimate relative risks. Participants indicating their sexual orientation was mostly heterosexual, bisexual, or lesbian/gay were more likely than completely heterosexual youth to report past-year illicit drug use and misuse of prescription drugs. Gender was an important modifier; bisexual females were most likely to report drug use. Age was also an important modifier of risk; differences in drug use between minority sexual orientation and heterosexual youth were larger during adolescence (12-17 years) than during emerging adulthood (18-23 years). Research must focus on identifying reasons why minority sexual orientation youth are at disproportionate risk for drug use. Such information is essential for developing interventions that are critically needed to reduce drug use in this population. Efforts need to begin early because large sexual orientation disparities in drug use are evident by adolescence.

Sexual Orientation Disparities in Longitudinal Alcohol Use Patterns Among Adolescents: Findings From the Growing Up Today Study

OBJECTIVE To compare sexual orientation group differences in the longitudinal development of alcohol use behaviors during adolescence. DESIGN Community-based prospective cohort study. SETTING Self-reported questionnaires. PARTICIPANTS A total of 13,450 Growing Up Today Study participants (79.7% of the original cohort) aged 9 to 14 years at baseline in 1996 were followed up for more than 7 years. Main Exposure Self-reported sexual orientation classified as heterosexual, mostly heterosexual, bisexual, or gay/lesbian. MAIN OUTCOME MEASURES Age at alcohol use initiation, any past-month drinking, number of alcoholic drinks usually consumed, and number of binge drinking episodes in the past year. RESULTS Compared with heterosexual participants, youth reporting any minority sexual orientation reported having initiated alcohol use at younger ages. Greater risk of alcohol use was consistently observed for mostly heterosexual males and females and for bisexual females, whereas gay and bisexual males and lesbians reported elevated levels of alcohol use on only some indicators. Gender was an important modifier of alcohol use risk; mostly heterosexual and bisexual females exhibited the highest relative risk. Younger age at alcohol use initiation among participants with minority sexual orientations significantly contributed to their elevated risk of binge drinking. CONCLUSIONS Our findings suggest that disparities in alcohol use among youth with a minority sexual orientation emerge in early adolescence and persist into young adulthood. Health care providers should be aware that adolescents with a minority sexual orientation are at greater risk of alcohol use.

The Development of Associations Among Body Mass Index, Body Dissatisfaction, and Weight and Shape Concern in Adolescent Boys and Girls

PURPOSE To examine how the associations among body mass index (BMI) and body dissatisfaction and weight and shape concern evolve from late childhood through late adolescence in boys and girls. METHODS We analyze data from subjects aged 9-18 years from the Growing Up Today Study, a national prospective cohort of U.S. youth (n = 16,882, yielding 59,750 repeated-measures observations during five waves of data collection). Generalized additive models produced curves of association for body dissatisfaction and weight concern across BMI percentiles. Generalized estimating equations (adjusting for correlated within-subject repeated measures, sibling clusters, pubertal maturation, and region of residence) tested main and interactive effects of BMI, age, and gender. RESULTS Girls above the 50th BMI percentile reported greater body dissatisfaction than girls below the 50th percentile. By contrast, boys who reported the most body dissatisfaction were either above the 75th BMI percentile (approaching overweight) or below the 10th percentile (approaching underweight). Body dissatisfaction increased with age for both girls and boys, but the gender-specific patterns of BMI effects remained constant. Male and female participants in the overweight/obese BMI range reported the greatest weight concern, but among older adolescents (particularly girls), healthy weight became increasingly associated with greater weight and shape concern. CONCLUSIONS Body dissatisfaction and weight and shape concern intensify across adolescence, but associations between the constructs and BMI remain gender specific. Findings have important implications for eating disorder risk assessment and prevention.

Examination of shared risk and protective factors for overweight and disordered eating among adolescents

OBJECTIVE To identify shared risk and protective factors for purging, binge eating, and overweight. DESIGN Prospective cohort study. SETTING Population-based questionnaires of children and adolescents residing across the United States. PARTICIPANTS Girls (n = 6022) and boys (n = 4518), aged 11 to 17 years in 1998, in the ongoing Growing Up Today Study. MAIN EXPOSURES Putative risk and protective factors within the psychological, behavioral, and socioenvironmental domains. MAIN OUTCOME MEASURES Overweight, use of laxatives or purging (vomiting), and binge eating. Because of the low prevalence of purging, we did not examine shared factors for this behavior among boys. RESULTS In 1998, a total of 219 girls (3.7%) and 30 boys (0.7%) reported purging behaviors, 426 girls (7.1%) and 90 boys (2.0%) reported binge eating, and 1019 girls (17.4%) and 1040 boys (24.6%) were overweight. From 1999 through 2001, 331 girls (7.8%) initiated purging behaviors, 503 girls (11.8%) and 132 boys (4.5%) initiated binge eating behaviors, and 424 girls (10.0%) and 382 boys (13.6%) became overweight. Concern for weight was directly associated with all 3 weight-related problems among boys and girls. Among girls, dieting, parental weight-related teasing, and family meal frequency had a shared effect on the weight-related problems examined. CONCLUSIONS Factors within the psychological, behavioral, and socioenvironmental domains may have a shared effect on purging, binge eating, and overweight. Further research is needed to determine if an intervention designed to address these shared risk and protective factors is effective in simultaneously reducing these weight-related problems.

Fertility Concerns and Sexual Behavior in Adolescent Girls with Polycystic Ovary Syndrome: Implications for Quality of Life

OBJECTIVE To examine the fertility concerns and sexual behavior of adolescent girls with polycystic ovary syndrome (PCOS) as compared to healthy adolescent girls and the effect of these concerns on health-related quality of life. DESIGN AND SETTING A cross-sectional study of adolescent girls with PCOS (n = 97) and healthy comparisons (n = 186) was conducted at an urban, hospital-based adolescent medicine practice. Participants completed the Child Health Questionnaire Version CF-87 as a measure of health-related quality of life and a general health history questionnaire that included items regarding sexual activity, contraception, fertility concerns, and severity of illness. Findings were evaluated using multivariate logistic and linear regression models. RESULTS Healthy subjects were 2.8 times more likely to have had sexual intercourse than PCOS participants, though the mean age at initiation of sexual intercourse among sexually active girls was not significantly different between the two groups. Severity of illness and the worry about fertility were not associated with odds of being sexually active. Girls with PCOS were 3.4 times more likely to be worried about their ability to become pregnant than comparisons and concern about future fertility was associated with significant reductions in quality of life. CONCLUSION Adolescents with PCOS are more concerned about fertility than their healthy peers and this concern may affect their overall quality of life. The finding that more than a third of the adolescents with PCOS in this study were sexually active underscores the importance of providing ongoing counseling on fertility issues, contraception, and STD prevention in the care of adolescent girls with PCOS.