Tammie M. Johnson

Water Pipe Tobacco Smoking Among Middle and High School Students

OBJECTIVES We examined prevalence rates of water pipe tobacco smoking among young people as a first step in assessing the health implications of this form of tobacco use. METHODS We examined water pipe use with data from the 2007 Florida Youth Tobacco Survey, which assessed tobacco-related beliefs, attitudes, and behaviors among the states middle and high school students. RESULTS Four percent of middle school students and 11% of high school students reported ever having used a water pipe. Adolescent boys were significantly more likely than adolescent girls to use water pipes, and African American adolescents were significantly less likely than adolescents from other racial/ethnic backgrounds to do so. Those who indicated ever having tried cigarettes and those who reported positive attitudes toward the social nature of cigarette use were more likely to have tried water pipes. CONCLUSIONS Water pipe use appears to be widespread among middle and high school students. Further research is needed to assess the health risks associated with water pipe tobacco smoking as well as young peoples attitudes toward this form of tobacco use.

Muscular strengthening activity patterns and metabolic health risk among US adults

Background:  Many studies have examined the relationship between physical activity and metabolic disorders. However, few have focused on specific associations between these disorders and muscular strengthening activity (MSA) patterns. The aim of the present study was to examine the association(s) for each metabolic syndrome criterion and MSA patterns.

New Evidence: Data Documenting Parental Support for Earlier Sexuality Education

BACKGROUND Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. METHODS As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). RESULTS Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. CONCLUSIONS Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education.

Sexual behaviors of middle school students: 2009 Youth Risk Behavior Survey results from 16 locations.

BACKGROUND The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey-Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Preventions Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t-tests were calculated for these 5 items by gender, age, and race for each location. RESULTS Data show that 5-20% of sixth graders and 14-42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.

Association between alcohol consumption patterns and metabolic syndrome

AIMS Examine associations between self-reported alcohol consumption patterns and metabolic syndrome. MATERIALS AND METHODS Sample (N=7432) included adult (≥20 years) participants in the 1999-2006 National Health and Nutrition Examination Survey. RESULTS Above moderate alcohol consumption (AMAC) was negatively associated with waist circumference among those in the 20-29, 40-49, and 70-79 age groups (β=-6.21, β=-8.34, and β=-6.60, respectively) and moderate alcohol consumption (MAC) was negatively associated with waist circumference among those in the 30-39, 40-49, and 70-79 age groups (β=-4.60, β=-5.69, and β=-2.88, respectively). AMAC was negatively associated with triglycerides among those in the 70-79 and 80+ age groups (β=-23.62 and β=-34.18, respectively) and positively associated with HDL-C levels in all groups (β range 8.96-18.25). MAC was positively associated with HDL-C in the age groups spanning 20-69 years (β range 3.05-5.34) and those over 80 (β=5.26). AMAC and MAC were negatively associated with fasting glucose levels in the 20-29 and 70-79 age groups (β=-3.38 and -15.61, respectively). MAC was negatively associated with fasting glucose levels among those 70-79 and those over 80 years of age (β=-7.06 and β=-5.00, respectively). CONCLUSION MAC and AMAC may favorably impact metabolic health.

Descriptive analysis of resistance exercise and metabolic syndrome

BACKGROUND Resistance exercise (RE) is an important mode of physical activity in the management of metabolic syndrome (MetS). However, little is known about the patterns of RE participation among U.S. adults with and without MetS. METHODS Utilizing data from 1999-2006 National Health and Nutrition Examination Survey, we examined the association(s) between MetS and RE in a representative sample (n=7432) of the U.S. adult population. RESULTS U.S. adults with MetS were found to be approximately 50% less likely to report engaging in RE compared to U.S. adults without MetS. Across all demographic categories those who did not meet the criteria for MetS reported engaging in significantly greater levels of RE compared to their counterparts with MetS. Furthermore, a potential inverse dose-response relationship was seen for engaging in RE and the prevalence of MetS. CONCLUSIONS In a diverse representative sample, significantly fewer U.S. adults with MetS report engaging in RE compared to adults without MetS. Engaging in two or more days per week of RE may attenuate MetS prevalence and risk estimates in U.S. adults.

Associations Between Self-Management Education and Comprehensive Diabetes Clinical Care

Abstract Objective. This study examines the relationship between receiving diabetes self-management education (DSME) and having higher levels of comprehensive diabetes clinical care, a summation of up to five clinical services recommended for individuals with type 2 diabetes and those who have had type 1 diabetes for ≥ 5 years. Design. Analysis of data from a population-based, cross-sectional study. Methods. Data for this study were from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS), a statewide, random, cross-sectional survey of adults. A dichotomous comprehensive diabetes clinical care variable was constructed based on responses to questions from the BRFSS diabetes module, and a logistic regression model was fitted. Adjusted odds ratios (ORs) are reported. Results. Among Florida adults with diabetes, 51.5% had received DSME. About 51.4% of adults with diabetes who received DSME had a high level of comprehensive care compared to 31.8% of those who did not receive DSME. The OR for having a high level of comprehensive care was statistically significantly higher among adults who received DSME (OR = 2.48) compared to their counterparts who did not receive DSME. Other significant covariates were having health insurance (OR = 3.65), having graduated from high school (OR = 1.55), having a college education (OR = 2.70), being 45-64 years of age (OR = 2.31), and being ≥ 65 years of age (OR = 5.29). Conclusions. These data show that receiving DSME is positively associated with receiving higher levels of comprehensive diabetes clinical care.

The associations between increasing degrees of homeostatic model assessment for insulin resistance and muscular strengthening activities among euglycaemic US adults

Purpose: To examine the associations between the homeostatic model assessment for insulin resistance and self-reported muscular strengthening activity in a nationally representative sample of euglycaemic US adults. Methods: Sample included euglycaemic adults (⩾20 years of age (n = 2009)) from the 1999 to 2004 National Health and Nutrition Examination Survey. Homeostatic model assessment for insulin resistance was categorized into quartiles and was the primary independent variable of interest. No reported muscular strengthening activity was the dependent variable. Results: Following adjustment for covariates, those with homeostatic model assessment for insulin resistance values in fourth (odds ratio: 2.04, 95% confidence interval: 1.35−3.06, p < 0.001) quartile were found to have significantly greater odds of reporting no muscular strengthening activity. Following further adjustment for non-muscular strengthening activity specific aerobic leisure-time physical activity, results remained significant for the fourth (odds ratio: 2.30, 95% confidence interval: 1.50−3.52, p < 0.001) quartile. A significant trend was seen across quartiles of homeostatic model assessment for insulin resistance for increasing prevalence of no muscular strengthening activity (p < 0.001). Conclusion: Having a higher homeostatic model assessment for insulin resistance value is associated with greater odds of reporting no muscular strengthening activity among euglycaemic US adults. This implies that subjects with an increasing degree of insulin resistance are more likely to not engage in muscular strengthening activity, an exercise modality that has been shown to reduce the risk of several cardiometabolic diseases and improve glycaemic status.

Associations Between Low Back Pain and Muscle-strengthening Activity in U.S. Adults

Study Design. This was a cross-sectional study. Objective. The primary aim of the study was to examine the association between low back pain (LBP) and muscle-strengthening activity (MSA) among U.S. adults using gender-stratified analyses. Summary of Background Data. LBP is a common medical condition that impacts quality of life and professional productivity and increases the financial burden on the health care system by augmenting medical treatment costs. Previous studies analyzing gender-dependent relationships between MSA and LBP have produced mixed results. Methods. Our sample included 12,721 participants from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into one of three levels of self-reported MSA: no MSA, insufficient MSA (1 day/wk), or meeting the 2008 Department of Health and Human Services (DHHS) recommendation for MSA (≥2 days/wk). Results. Gender-stratified analyses revealed significantly lower odds of reporting LBP among women [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70–0.96, P = 0.03] and men (OR 0.86; 95% CI 0.70–0.96, P = 0.01) who reported amounts of MSA that met the DHHS recommendation compared with those reporting no MSA. Following adjustment for smoking status, the odds remained significant among women (P = 0.03) but not among men (P = 0.21). Conclusion. These findings indicate that engaging in MSA at least 2 days/wk is associated with lower odds of LBP and that smoking may be an important mediating factor that should be considered in future LBP research. Level of Evidence: 4

Associations between mental distress and physical activity in US adults: a dose–response analysis BRFSS 2011

Background To examine the associations between levels of severity of mental distress (MD) and meeting the 2008 physical activity (PA) recommendations using the MD Severity Index (MDSI). Methods Participants (n = 431 313) were adults (≥18 years of age) who responded to the 2011 Behavioral Risk Factor Surveillance System (BRFSS). MD was categorized into five levels of severity: 0-4, 5-10, 11-16, 17-22 and ≥23 days/month. The dependent variable was self-reported PA volume of at least 150 min/wk (or vigorous equivalent, 75 min/wk). Results Following adjustment for age, gender, race/ethnicity, education and body mass index, the odds of reporting meeting the PA recommendations were significantly lower among those reporting the following days per month of MD: 5-10 (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.87-0.96), 11-16 (OR = 0.76, 95% CI: 0.71-0.82), 17-22 (OR = 0.69, 95% CI: 0.62-0.76) and ≥23 (OR = 0.64, 95% CI: 0.60-0.67). An inverse dose-response (P < 0.01) was observed between the severity of MD and meeting the current PA recommendations. Conclusions An inverse dose-response relationship was found between the severity of MD and volumes of PA meeting the 2008 recommendation. These findings lend support for the epidemiological utility of the MDSI when examining the relationship between MD and PA.