Wasantha Jayawardene

Discrepant body mass index: behaviors associated with height and weight misreporting among US adolescents from the National Youth Physical Activity and Nutrition Study.

BACKGROUND The accuracy and reliability of self-reported height and weight among adolescents in the process of calculating BMI is usually subject to bias. The aim of this study was to determine whether over- and under-reporting of self-reported height and weight existed among US high school students by weight category; if so, to examine anthropometric, behavioral, and demographic factors associated with over- and under-reporting. METHODS Data were retrieved from the National Youth Physical Activity and Nutrition Study, 2010, a nationally representative sample (7160 students, grades 9-12). Analysis of variance was performed to determine any significant difference between weight categories in misreporting. Discriminant function analysis and sequential logistic regression were executed to detect behavioral and demographic predictors of reporting accuracy, respectively. RESULTS The mean over-reporting of height and under-reporting of weight were 1.1 cm and 1.020 kg, respectively, which underestimated BMI and BMI percentile by 0.671 and 2.734, respectively. Use of self-reported height and weight for BMI calculation overestimated prevalence of healthy weight by 3.8% and underestimated prevalence of obesity by 4.1%. Underweight students under-reported height and over-reported weight, whereas overweight and obese students over-reported height and under-reported weight. Reporting accuracy of females was significantly higher. Weight loss behaviors, both healthy and unhealthy, were associated with BMI underestimation, whereas fast foods and screen time were associated with overestimation. CONCLUSION Whenever possible, measuring height and weight is essential. However, because many studies must rely on self-reported values alone, additional research should examine the relationships between misreport of anthropometric data and lifestyle features in diverse adolescent samples to better interpret self-reported anthropometric data.

Trends in Body Mass Index and Prevalence of Extreme High Obesity Among Pennsylvania Children and Adolescents, 2007–2011: Promising but Cautionary

OBJECTIVES We determined current trends and patterns in overweight, obesity, and extreme high obesity among Pennsylvania pre-kindergarten (pre-K) to 12th grade students and simulated future trends. METHODS We analyzed body mass index (BMI) of pre-K to 12th grade students from 43 of 67 Pennsylvania counties in 2007 to 2011 to determine trends and to discern transition patterns among BMI status categories for 2009 to 2011. Vinsem simulation, confirmed by Markov chain modeling, generated future prevalence trends. RESULTS Combined rates of overweight, obesity, and extreme high obesity decreased among secondary school students across the 5 years, and among elementary students, first increased and then markedly decreased. BMI status remained constant for approximately 80% of normal and extreme high obese students, but both decreased and increased among students who initially were overweight and obese; the increase in BMI remained significant. CONCLUSIONS Overall trends in child and adolescent BMI status seemed positive. BMI transition patterns indicated that although overweight and obesity prevalence leveled off, extreme high obesity, especially among elementary students, is projected to increase substantially over time. If current transition patterns continue, the prevalence of overweight, obesity, and extreme high obesity among Pennsylvania students in 2031 is projected to be 16.0%, 6.6%, and 23.2%, respectively.

Exercise in Young Adulthood with Simultaneous and Future Changes in Fruit and Vegetable Intake

Objectives: Regarding weight management, changes in exercise behavior can also influence nutrition behavior by application of self-regulatory psychological resources across behaviors (transfer effect). This study aimed to determine: (1) if changes in exercise frequency in young adulthood predict simultaneous changes in fruit/vegetable intake (transfer as co-occurrence); and (2) if exercise frequency affects future fruit/vegetable intake (transfer as carry-over). Methods: 6244 respondents of the National Longitudinal Survey of Youth 1997 were followed at ages 18–22 (Time-1), 23–27 (Time-2), and 27–31 (Time-3). Repeated measures analysis of variance and hierarchical multiple regression determined if the change in exercise frequency between Time-1 and Time-2 was associated with simultaneous and sequential changes in fruit/vegetable intake frequency, controlling for sex, race/ethnicity, education, income, body mass index, and baseline fruit/vegetable intake. Results: Only 9% continued exercising for 30 minutes more than 5 days/week, while 15% transitioned to adequate exercise and another 15% transitioned to inadequate exercise; for both fruits and vegetables, intake of once per day or more increased with age. Males were more likely to exercise adequately and females to consume fruits/vegetables adequately. Exercise frequency transition was linearly associated with concurrent fruit/vegetable intake during Time-1 and Time-2. The highest increase in mean fruit/vegetable intake occurred for participants who transitioned from inadequate to adequate exercise. A significant Time-2 exercise frequency effect on Time-3 fruit/vegetable intake emerged, after accounting for baseline intake. Increase in Time-2 exercise by one day/week resulted in increased Time-3 fruit and vegetable intakes by 0.17 and 0.13 times/week, respectively. Conclusion: Transfer effects, although usually discussed in interventions, may also be applicable to voluntary behavior change processes. Newly engaging in and continuing exercise behavior over time may establish exercise habits that facilitate improved fruit/vegetable consumption. Interventions that facilitate transferring resources across behaviors likely will enhance this effect.

Use of data mining to reveal body mass index (BMI): patterns among Pennsylvania schoolchildren, pre-k to grade 12.

BACKGROUND Health eTools for Schools was developed to assist school nurses with routine entries, including height and weight, on student health records, thus providing a readily accessible data base. Data-mining techniques were applied to this database to determine if clinically significant results could be generated. METHODS Body mass index (BMI) data collected and entered in eTools by school nurses from 657,068 students attending 1156 schools in 49 of 67 Pennsylvania counties during 2005-2009 were analyzed. Students in each BMI category were sorted; regression was used to model mean and percentage trends. A chi-square test of individually matched BMI percentages was computed and migration across normal, overweight, and obese states determined. RESULTS The highest percentage of obese students occured in middle school. The mean trends for obesity and overweight had increasing slopes of 0.189 and 0.227, respectively; with regression slope for overweight >59%. Within groups, substantial percentages of individually matched BMIs changed significantly (p < .0001) over 2 years, migrating between normal weight, overweight, and obese. A comparison of 2009 measured BMI for grades 9-12 from eTools with 2009 Pennsylvania Youth Risk Behavior Survey self-reported BMI yielded substantial diferences. CONCLUSION A pattern of increasing BMI for elementary students with a corresponding decrease among middle and high school students emerged. The means trends for both overweight and obesity were greater in 2009 than in 2005, increasing steadily to 2008 and slightly declining to 2009. The dominant overall pattern flows from overweight to obese. If continued unabated, percentage of students who are obese will dominate over time.

Prevention of dengue Fever: an exploratory school-community intervention involving students empowered as change agents(*).

BACKGROUND Dengue fever and dengue hemorrhagic fever (DF/DHF) are epidemic and endemic in tropical and subtropical countries including Sri Lanka. Numerous structural and community interventions have been shown to be effective in interrupting the life cycle of mosquitoes that transmit DF/DHF; however, these interventions are not always implemented intensely and/or consistently enough to control the mosquito populations and suppress the disease. Following a planned and systematic training and mobilizing program, in conjunction with a public information campaign, seventh-, eighth-, and ninth-grade students in 2 schools performed multiple mosquito control and education interventions in their communities once a week for 8 weeks. METHODS Five actions identified in previous literature and executed by students were tracked and secondary entomology data were obtained from public health surveillance systems. The Z-test for determining differences between proportions was utilized to determine significant changes between pre- and post-entomological survey findings in 2 intervention areas, 1 rural and 1 urban. Pre- and post-incidence rates from the intervention areas and comparable control areas were compared. RESULTS In intervention areas, all proportions of larval indexes were found to be significantly lower following the intervention. Surveillance data showed a 73% reduction in case load for the urban area and a 61% reduction in the rural area during the year following intervention. CONCLUSION If properly involved and guided, school children can be an asset to mosquito-borne disease control; the education sector could be an important partner in DF/DHF control.

Psychological distress among nurses caring for victims of war in Sri Lanka.

OBJECTIVE To determine prevalence and factors associated with psychological distress among nurses caring for war victims in Sri Lanka. METHODS Descriptive, cross-sectional study design was used to collect data from 241 nurses from 2 hospitals with stratified random sampling according to workstation. Self-administered 30-item General Health Questionnaire was used to detect psychological distress. RESULTS The prevalence of psychological distress was 21%. Female sex was found to be the most significant predictor of psychological distress among nurses. Factors, such as being married, having children, or both, were found to be protective. High exposure to war victims, measured by the frequency with which a nurse tended to those patients, also resulted in less psychological distress. CONCLUSIONS The prevalence of psychological distress is higheramong nurses in this study compared with that among the general population. Brief screening instruments, such as the General Health Questionnaire, can be used to identify individuals at risk for psychological distress. Results suggest that the presence of a social support network helped to psychologically buffer these nurses. Findings also imply the importance of promoting positive attitudes and beneficial stress (eustress) to complement a well-developed focus on distress prevention.

Examining Sequences of Adolescent Substance Use Initiation Involving Over-the-Counter (OTC) Drug Abuse

Over-the-counter (OTC) drug abuse among adolescents is an increasingly visible and meaningful trend in the United States, but little research has been done to contextualize OTC drug abuse. This study examined a large sample of 152,678 middle school and high school adolescents in an attempt to understand sequences of OTC drug abuse initiation, and the sociodemographic and risk factor-related precursors thereof. We found that while many adolescents who had ever abused an OTC drug and used one or more “gateway” drugs (alcohol, cigarettes, or marijuana) initiated the use of the gateway drug first, there was also a subset of adolescents whose sequence of initiation began with OTC drug abuse. We also found that different risk factors and sociodemographic characteristics predicted different sequences of use. For example, interaction with antisocial peers predicted initiating gateway drug use prior to OTC drug abuse, but not the reverse sequence. Other predictor variables, including gender, grade, and parental attitudes toward drug abuse also differentiated these sequences; we discuss both the theoretical and practical implications of these findings.

Upper-Air Observation Indicators Predict Outbreaks of Asthma Exacerbations among Elementary School Children: Integration of Daily Environmental and School Health Surveillance Systems in Pennsylvania

Objective. To determine whether a relationship exists between asthma exacerbations among elementary school children and daily upper-air observations (temperature, relative humidity, dew point, and mixing ratio) and, if so, to derive a mathematical model that predicts asthma exacerbations among children. Methods. Using an ecological study design, school health records of 168,825 elementary school students enrolled in the Health eTools for Schools program within 49 Pennsylvania counties were analyzed. Data representing asthma exacerbations were originally recorded by school nurses as the type of treatment given to a student during a clinic visit on a particular day. Daily upper-air measurements from ground level to the 850 mb pressure level, covering a radius of 800 km around Pittsburgh, PA, were obtained. The Wilcoxon two-sample test was used to identify associations. A generalized estimating equation model was used to predict the occurrence of more than 48 asthma exacerbations, the daily mean for 2008–2010. Results. Surveillance of asthma among school children in Pennsylvania increased over 3 years. The greatest occurrence was in the fall, followed by summer, spring, and winter. Annual averages of upper-air observations were significantly different between seasons (p < .02). Upper-air temperature, dew point, and mixing ratio above their 3-year mean values and upper-air relative humidity ≥ 50% were significantly associated with occurrence of asthma exacerbations (p < .011). Conclusions. Monitoring of upper-air observation data over time can be a reliable means for predicting increases of asthma exacerbations among elementary school children. Such predictions could help parents and school nurses implement effective precautionary measures.

Clinical measures of obesity and cumulative cardiometabolic risk in adolescents

Obesity tracks from childhood to adulthood most strongly of all cardiometabolic risk factors. To determine relationship of body mass index (BMI) and waist circumference (WC) with cardiometabolic risk (dyslipidemia, hyperglycemia and elevated blood pressure) in a large U.S. population ages 12–19 and demographic subgroups. Pooled 1999–2014 National Health and Nutrition Examination Survey data were analyzed (N = 23 438). In addition to standard cutoffs of BMI and WC, risk levels were identified for each laboratory variable: HDL‐cholesterol, LDL‐cholesterol, triglycerides, total cholesterol (category = lipids); fasting glucose, glycated haemoglobin (category = glucose); systolic/diastolic pressures (category =blood pressure). Within each category, being high‐risk on any of the variables was high‐risk; being borderline‐risk on any, without being high‐risk on any, was borderline‐risk. Obesity severity was strongly associated with increased cardiometabolic risk, with prevalence of borderline‐risk greater than high‐risk. Anthropometric indicators in males and Hispanics, versus females and Whites/Blacks, respectively, had stronger associations with cardiometabolic risks. BMI and WC performed well for identifying adolescents with at least one borderline‐risk or high‐risk level measure for lipids, glucose and blood pressure; relationship strength varying by gender and race/ethnicity. Thus, to prevent or better manage clinical diseases of adolescents with elevated BMI and/or WC, all recommended laboratory tests are warranted.

Effects of preventive online mindfulness interventions on stress and mindfulness: A meta-analysis of randomized controlled trials

Empirical evidence suggested that mind-body interventions can be effectively delivered online. This study aimed to examine whether preventive online mindfulness interventions (POMI) for non-clinical populations improve short- and long-term outcomes for perceived-stress (primary) and mindfulness (secondary). Systematic search of four electronic databases, manuscript reference lists, and journal content lists was conducted in 2016, using 21 search-terms. Eight randomized controlled trials (RCTs) evaluating effects of POMI in non-clinical populations with adequately reported perceived-stress and mindfulness measures pre- and post-intervention were included. Random-effects models utilized for all effect-size estimations with meta-regression performed for mean age and %females. Participants were volunteers (adults; predominantly female) from academic, workplace, or community settings. Most interventions utilized simplified Mindfulness-Based Stress Reduction protocols over 2–12 week periods. Post-intervention, significant medium effect found for perceived-stress (g = 0.432), with moderate heterogeneity and significant, but small, effect size for mindfulness (g = 0.275) with low heterogeneity; highest effects were for middle-aged individuals. At follow-up, significant large effect found for perceived-stress (g = 0.699) with low heterogeneity and significant medium effect (g = 0.466) for mindfulness with high heterogeneity. No publication bias was found for perceived-stress; publication bias found for mindfulness outcomes led to underestimation of effects, not overestimation. Number of eligible RCTs was low with inadequate data reporting in some studies. POMI had substantial stress reduction effects and some mindfulness improvement effects. POMI can be a more convenient and cost-effective strategy, compared to traditional face-to-face interventions, especially in the context of busy, hard-to-reach, but digitally-accessible populations.