Sexual Minority Status and Adolescent Eating Behaviors, Physical Activity, and Weight Status.

INTRODUCTION: This study examined sexual orientation differences in eating behaviors, physical activity, and weight status among adolescents in the U.S. Moreover, this study tested whether parental and peer influences contribute to sexual orientation disparities in adolescent eating behaviors, physical activity, BMI, and examined disparities in weight misperception. METHODS: Cross-sectional data were from 1,926 adolescents who participated in the NEXT Generation Health Study in 2010-2011. Linear and multinomial logistic regressions conducted in 2017-2018 were used to test disparities and interactions with social influences. RESULTS: Relative to their heterosexual peers, sexual minority males and females consumed fruits and vegetables more frequently; sexual minority males engaged in less frequent physical activity; and sexual minority females were more likely to be overweight, perceive themselves as overweight, and to overestimate their weight. High parental expectation for physical activity was associated with more frequent vigorous physical activity among heterosexual adolescents, but less frequent vigorous physical activity among sexual minority males. Exercising with a same-sex peer buffered against the risk of higher BMI among sexual minority females. CONCLUSIONS: Parental and peer influences may serve as potential intervention targets to reduce disparities in weight-related behaviors. Longitudinal research is needed to understand the consequences of weight misperception among sexual minority females.

Prospective associations between cannabis use and negative and positive health and social measures among emerging adults.

BACKGROUND: In light of on-going policy changes related to cannabis use in the United States, it is important to examine possible associations between cannabis use and subsequent behaviors of public health interest. This study identified prospective associations between cannabis use during first-year post high-school and a wide range of positive and negative health and social measures one year later. METHODS: Data were from Waves 4 (Time 1; 1st year after high-school) and 5 (Time 2; one year later) of the NEXT Generation Health Study, a national sample of emerging adults in the United States (n = 1915; mean age = 20.2; 61% female). Multinomial logistic regressions adjusting for pertinent covariates were conducted to examine odds of substance use, nutrition, physical activity, sedentary behaviors, school performance, family relations, mental health, driving behaviors and health perceptions at Time 2. RESULTS: Compared with non-use, frequent use (20+ times in the past year) at Time 1 was associated with Time 2 negative health and social measures, including risky driving behaviors (AOR = 1.78, CI-1.45-2.19), depressive symptoms (AOR = 1.68, CI-1.43-1.98), unhealthy weight control behaviors (AOR = 1.55, CI-1.31-1.84), psycho-somatic symptoms (AOR = 1.55, CI-1.30-1.83), and low school achievement (AOR = 1.46, CI-1.23-1.75). Frequent users relative to non-users had a lower probability of being overweight and obese (AOR = 0.75, CI-0.60-0.92). Regarding positive measures frequent users relative to non-users had a higher probability of meeting recommendation of physical activity (AOR = 1.28, CI-1.09-1.51), but a lower probability of consuming fruits and vegetables (AOR = 0.82, CI-0.70-0.96) or attending college/university (AOR = 0.57, CI-0.44-0.75). FINDINGS: on occasional cannabis use (1-19 times in the past year) were more similar to frequent cannabis use for negative than positive health and social measures. CONCLUSION: Results demonstrate complex prospective patterns in which significant prospective associations with most adverse measures were found for both occasional and frequent users, and with few significant associations of positive health measures mostly among occasional cannabis users.

Personal Income and Substance Use among Emerging Adults in the United States.

BACKGROUND: Taxation and other policy measures have been implemented across the United States to curb the accessibility of substance use, especially among youth. While the inverse relationship between price and youth consumption is well known, available research on youth earned income and substance use is sparser, particularly among emerging adults. OBJECTIVES: We examined the association between emerging adult past-year personal income and 30-day substance use. METHODS: We analyzed data from Wave 5 (n = 2,202) of the NEXT Generation Health Study, an annual survey study administered to a nationally representative sample of emerging adults in the U.S. Wave 5 (mean age = 20.28 years, SE = 0.02 years) was administered during the 2013-2014 academic year. After grouping participants into five levels of self-reported, pre-tax personal income, we used binomial logistic regression to examine the association between personal income and cigarette smoking, marijuana use, alcohol use, and heavy episodic drinking (HED). RESULTS: In unadjusted models, those at certain levels of higher past-year income were more likely to smoke cigarettes, consume alcohol, or engage in HED at least once in the past 30 days. Several associations remained significant after controlling for covariates. Most associations were no longer significant after including perceived peer norms as additional covariates. Personal income was not associated with 30-day marijuana use in unadjusted or adjusted models. Conclusions/Importance: Higher earned income may provide emerging adults greater economic access to cigarettes and alcohol, but the association might be partly attenuated by social factors, particularly perceived peer norms.

Sexual Orientation Differences in Adolescent Health Care Access and Health-Promoting Physician Advice.

PURPOSE: Physician screening and advice on health-related behaviors are an integral part of adolescent health care. Sexual minority adolescents encounter more barriers to health services; yet, no prior research has examined whether they also experience disparity in physician screening and advice. We examined possible sexual orientation disparities in health care access, physician screening, and advice on six health-related behaviors. METHODS: Data were from a national sample of U.S. adolescents who participated in wave 2 of the NEXT Generation Health Study (n = 2023). Poisson regressions were conducted separately for males and females to estimate sexual orientation differences in health care access and health-related screening and advice. RESULTS: Compared with heterosexual males, sexual minority males were more likely to report unmet medical needs in the past year (adjusted relative risk [ARR] = 2.23) but did not differ with respect to receiving physician advice concerning health-related behaviors. Compared with heterosexual females, sexual minority females were more likely to report no routine physical checkup in the past year (ARR = 1.67) but were more likely to receive physician advice to reduce or stop drinking, smoking, drug use, increase physical activity, and improve diet (ARRs = 1.56-1.99), even after controlling for corresponding health-related behaviors. Sexual minority females were also more likely to receive advice about risk associated with sexual behavior (ARR = 1.35) and advice to avoid sexually transmitted diseases (ARR = 1.49). CONCLUSIONS: Both sexual minority males and females experienced disparities in some aspects of health care access. Improved health-promoting advice would better serve sexual minority males.

Trajectories of eating behaviors in a nationally representative cohort of U.S. adolescents during the transition to young adulthood.

BACKGROUND: Diets of U.S. adolescents and adults do not meet recommendations, increasing risk of chronic disease. This study examined trajectories and predictors of eating behaviors in U.S. youth from age 16-20 years, and evaluated longitudinal associations of eating behaviors with weight outcomes. METHODS: Data come from the first four waves (years) of the NEXT Generation Health Study, a nationally representative cohort of U.S. students in 10(th) grade during the 2009-2010 school year (n = 2785). Annual surveys queried frequency of food group intake (times/day of fruit and vegetables, whole grains, sugar-sweetened soda, sweet and salty snacks), and meal practices (days/week of breakfast, family meals, fast food, and television during meals). Body mass index (BMI, kg/m(2)) was calculated from self-reported height and weight. Adjusted generalized estimating equations and linear mixed models with multiple imputation for missing data estimated eating behavior trajectories overall and by baseline weight status (normal weight = 5 ≤ BMI%ile < 85, overweight = 85 ≤ BMI%ile < 95, obese = BMI%ile ≥ 95), accounting for the complex sampling design. Separate GEE models estimated longitudinal associations of food group frequencies with meal practices and of BMI with eating behaviors. RESULTS: Eating behaviors tracked strongly from wave 1-4 (residual intraclass correlation = 41% - 51%). Across all baseline weight categories, frequency of food group intake and meal practices decreased over time, except for fast food, which remained stable. Fruit/vegetable intake frequency was associated positively with family meals (ß ± SE = 0.33 ± 0.05) and breakfast (0.18 ± 0.03), and inversely with fast food (-0.31 ± 0.04), while whole grain intake frequency was associated positively with family meals (0.07 ± 0.02), television meals (0.02 ± 0.009) and breakfast (0.04 ± 0.01). Soda and snacks were positively associated with television meals (0.08 ± 0.008 and 0.07 ± 0.009, respectively) and fast food (0.24 ± 0.02 and 0.20 ± 0.03, respectively), while soda was inversely associated with breakfast frequency (-0.05 ± 0.01). Time-varying BMI was unrelated to eating behaviors other than an inverse association with time-varying snacks (-0.33 ± 0.12). CONCLUSIONS: Strong tracking over time supports the importance of early establishment of health-promoting eating behaviors in U.S. adolescents. Findings suggest meal practices may be important intervention targets. Lack of evidence for hypothesized associations of BMI and eating behaviors indicates the need for research confirming these findings using more precise measures of dietary intake.

Using the theory of planned behavior to predict aggression and weapons carrying in urban African American early adolescent youth.

Aggressive and weapons carrying behaviors are indicative of youth violence. The theory of planned behavior is used in the current analysis to improve our understanding of violence-related behaviors. We examine the influence of perceived behavioral control (self-control and decision making) as a part of the overall framework for understanding the risk and protective factors for aggressive behaviors and weapons carrying. As the baseline assessment of an intervention trial, survey data were collected on 452 sixth-grade students (50% girls; 96.6% African American; mean age 12.0 years) from urban middle schools. A total of 18.4% carried a weapon in the prior 12 months, with boys more likely to carry a weapon than girls (22.5% vs. 14.2%, p = .02). Of the youth, 78.4% reported aggressive behaviors with no significant differences found between girls (81.3%) and boys (75.5%). In logistic regression models, having peers who engage in problem behaviors was found to be a significant risk factor. Youth with peers who engaged in numerous problem behaviors were five times more likely to be aggressive than those who reported little or no peer problem behaviors. Teens who reported that their parents opposed aggression (odds ratio [OR] = 0.76; confidence interval [CI] = 0.66, 0.88) and who used self-control strategies (OR = 0.59; CI = 0.39, 0.87) were found to report less aggressive behaviors. For weapons carrying, being a girl (OR = 0.56; CI = 0.32, 0.97) and self-control (OR = 0.52; CI = 0.29, 0.92) were protective factors. This study demonstrated that the theory of planned behavior may provide a useful framework for the development of violence prevention programs. Practitioners should consider integrating strategies for developing healthy relationships and improving self-control.

Motivation and planning as mediators of the relation between social support and physical activity among U.S. adolescents: a nationally representative study.

BACKGROUND: More than half of U.S. high-school students do not meet the moderate and vigorous physical activity (MVPA) 5 hours per week recommendation. The purpose of this study was to determine how individual dimensions (motivation and planning) mediate the relationship of social context with physical activity by integrating available measures of personal characteristic including internal/external motivations (derived from Self-Determination Theory -SDT]) for MVPA, MVPA planning, peer MVPA, and parental support to better understand adolescent MVPA. METHODS: Survey responses of a nationally representative cohort of 11th graders (N=2439) in the NEXT Generation Health Study were analyzed with structural equation modeling. RESULTS: Adolescent MVPA was directly, significantly associated with MVPA planning (ß=0.17), peer MVPA (ß=0.21), and internal motivation (ß=0.50). Internal motivation was associated with peer MVPA (ß=0.31), parental support for MVPA (ß=0.16), and external motivation (ß=0.40). A significant relation between parental support and external motivation (ß=0.31) was also found. CONCLUSIONS: Adolescents with higher internal motivation and more active friends were more likely to engage in MVPA. The results are consistent with SDT and suggest that planning is an important construct for adolescent MVPA.

Relationships among parent and youth healthful eating attitudes and youth dietary intake in a cross-sectional study of youth with type 1 diabetes.

BACKGROUND: Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents. METHODS: Youth (n=252) ages 8-18 years with diabetes duration ≥1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling. RESULTS: Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling ß^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) ß^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes ß^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling ß^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality. CONCLUSIONS: Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.

Dating violence perpetration and victimization among U.S. adolescents: prevalence, patterns, and associations with health complaints and substance use.

PURPOSE: This research identified conceptually cohesive latent classes of youth dating violence (DV) and examined associations between covariates and classes by gender. METHODS: A nationally representative sample of 2,203 10th grade students completed assessments of physical and verbal DV victimization and perpetration, depressive symptoms, health complaints, and substance use. A Factor Mixture Model was used to identify patterns of DV. Gender differences among classes were examined for depressive symptoms, health complaints, and substance use. RESULTS: Prevalence of DV victimization was 35% and perpetration was 31%. A three-class model fit adequately and provided conceptual cohesion: Class 1 = non-involved (65%); Class 2 = victims/perpetrators of verbal DV (30%); and Class 3 = victims/perpetrators of verbal and physical DV (5%). Compared with Class 1 adolescents, those in Classes 2 and 3 were more likely to report depressive symptoms, psychological complaints, and alcohol use. Females in Classes 2 and 3 were also more likely to report physical complaints, cigarette use, and marijuana use. Among females involved in DV, those in Class 3 compared with Class 2 reported more depressive symptoms, physical and psychological complaints, and cigarette and marijuana use. CONCLUSIONS: The three-class model distinguished involvement in verbal acts from involvement in verbal and physical acts. Adolescents involved in DV had similar probabilities of reporting perpetration and victimization, suggesting violence within relationships may be mutual. Involvement in DV was associated with more health issues and concurrent problem behaviors. For females in particular, the increased involvement in DV was associated with other health indicators.

Tobacco control policy and adolescent cigarette smoking status in the United States.

INTRODUCTION: Tobacco policies that limit the sale of cigarettes to minors and restrict smoking in public places are important strategies to deter youth from accessing and consuming cigarettes. METHODS: We examined the relationship of youth cigarette smoking status to state-level youth access and clean indoor air laws, controlling for sociodemographic characteristics and cigarette price. Data were analyzed from the 2001 to 2002 U.S. Health Behavior in School-Aged Children survey, a cross-sectional survey conducted with a nationally representative sample of 13,339 students in the United States. RESULTS: Compared with students living in states with strict regulations, those living in states with no or minimal restrictions, particularly high school students, were more likely to be daily smokers. These effects were somewhat reduced when logistic regressions were adjusted for sociodemographic characteristics and cigarette price, suggesting that higher cigarette prices may discourage youth to access and consume cigarettes independent of other tobacco control measures. DISCUSSION: Strict tobacco control legislation could decrease the potential of youth experimenting with cigarettes or becoming daily smokers. The findings are consistent with the hypothesis that smoking policies, particularly clean indoor air provisions, reduce smoking prevalence among high school students.

Psychosocial predictors of smoking trajectories during middle and high school.

AIMS: Little is known about the heterogeneity in and risk factors associated with trajectories of smoking during adolescence. This study aimed to (1) identify smoking trajectories empirically and (2) identify risk factors for trajectory group membership. DESIGN: Latent growth mixture models were used to identify population smoking trajectories, and logistic regression was used to estimate risk factors for group membership. SETTING: The participants were drawn from seven middle schools in a Maryland school district. PARTICIPANTS: Participants consisted of 1320 6th graders who were followed to the 9th grade. MEASUREMENTS: Measurements of smoking risk factors were made in the fall of 6th grade and smoking stage was assessed on five different occasions between the fall of 6th and 9th grades. FINDINGS: Five distinct smoking trajectories were identified. Overall, being female, having friends who smoked, deviance acceptance and outcome expectations were associated with an increased likelihood of being an intender, delayed escalator, early experimenter and early user compared to a never smoker. Additionally, comparisons with never smokers revealed unique identifiers for intenders, early experimenters and early users, but not delayed escalators. CONCLUSIONS: There is much heterogeneity in the manner in which middle-schoolers progress from having no intention of smoking to becoming smokers. Implications for prevention programs are discussed.

Latent growth curve analyses of peer and parent influences on smoking progression among early adolescents.

Social influences on smoking uptake were examined in latent growth curve analyses of data from 1,320 youths assessed 5 times during 6th to 9th grade. Initial smoking stage predicted increases in number of friends who smoked, indicating selection; however, initial number of friends who smoked did not predict smoking stage progression, indicating no significant effect of socialization. Associations over time among smoking stage progression, affiliation with friends who smoke, and parenting behaviors were significant, suggesting dynamic, reciprocal relationships. Parental involvement, monitoring, and expectations provided direct protective effects against smoking progression as well as indirect effects, by limiting increases in number of friends who smoke. These results are consistent with the peer selection hypothesis, confirm the powerful association over time of social influences with smoking, and provide the first evidence that parenting behavior may protect against smoking progression by limiting increases in number of friends who smoke.

Psychosocial predictors of increased smoking stage among sixth graders.

OBJECTIVES: To identify predictors of increases in smoking stage among sixth graders. METHODS: At the beginning and end of sixth grade, 973 students completed surveys. Multivariate, partial proportional odds analyses were conducted. RESULTS: Time 1 intenders were 4 times more likely than never users to smoke at Time 2. In adjusted analyses, female sex, white race, peers, and perceived prevalence were positively associated with an increase in smoking stage, and social competence, parental expectations, and parental monitoring were negatively associated with an increase in smoking stage. CONCLUSIONS: Early adolescent smoking advanced in stages; intent predicted initiation; peer and parent influences were independently associated with increases in smoking stage.