Association Between Head Impact Exposure, Psychological Needs, and Indicators of Mental Health Among U.S. High School Tackle Football Players.

PURPOSE: Age of first exposure to tackle football and head impact kinematics have been used to examine the effect of head impacts on mental health outcomes. These measures coupled with retrospective and cross-sectional designs have contributed to conflicting results. The purpose of this study was to identify the effect of one season of head impact exposure, age of first exposure to football, and psychological need satisfaction on acute mental health outcomes in adolescent football players. METHODS: This prospective single-season cohort study used sensor-installed mouthguards to collect head impact exposure along with surveys to assess age of first exposure to football, psychological satisfaction, depressive symptoms, anxiety symptoms, and thriving from football players at four high schools (n = 91). Linear regression was used to test the association of head impact exposure, age of first exposure, and psychological satisfaction with acute mental health outcomes. RESULTS: A total of 9,428 impacts were recorded with a mean of 102 ± 113 impacts/player. Cumulative head impact exposure and age of first exposure were not associated with acute mental health outcomes at postseason or change scores from preseason to postseason. Greater psychological satisfaction was associated with fewer depressive symptoms (ß = -0.035, SE = 0.008, p = < .001), fewer anxiety symptoms (ß = -0.021, SE = 0.008, p = .010), and greater thriving scores (ß = 0.278, SE = 0.040, p = < .001) at postseason. DISCUSSION: This study does not support the premise that greater single-season head impact exposure or earlier age of first exposure to tackle football is associated with worse acute mental health indicators over the course of a single season in adolescent football players.

A 114% Cigarette Tax Hike and Drinking Behavior: Results From Nationally Representative Longitudinal Panel Data in Korea.

This study investigated whether or not drinking behavior changed among Korean adult smokers after a 114% cigarette tax hike in 2015. Data were drawn from waves 9 to 12 (collected yearly from 2014 to 2017) of the nationally representative longitudinal study, the Korean Welfare Panel Study. Korean adults who were ≥19 years comprised the analysis sample (N = 10 875). We applied a difference-in-differences approach to compare drinking behavior before and after the tax increase among three groups (i.e., quitters, continued smokers, and nonsmokers). We found that alcohol drinking significantly decreased among those who quit smoking after the tax increase, compared with nonsmokers (P = .022). Our findings support that a cigarette tax increase may have the beneficial spillover influence of reduction in drinking as well as smoking if the tax increase can induce smokers to quit, but such positive spillover influence may be short-term or null for continued smokers.

Identifying emerging predictors for adolescent electronic nicotine delivery systems use: A machine learning analysis of the Population Assessment of Tobacco and Health Study.

Intervention strategies to prevent adolescents from using electronic nicotine delivery systems (ENDS) should be based on robust predictors of ENDS use that may differ from predictors of conventional cigarette use. Literature points to the need for uncovering emerging predictors of ENDS use. This study identified emerging predictors of adolescent ENDS use using machine learning (ML) techniques. We analyzed nationally representative multi-wave longitudinal survey data (2013-2018) drawn from the Population Assessment of Tobacco and Health Study. A sample of adolescents (12-17 years) who never used any tobacco products at baseline and completed Wave 2 (n = 7958), Wave 3 (n = 6260) and Wave 4 (n = 4544) were analyzed. We developed a supervised ML prediction model using the penalized logistic regression to assess self-reported past-month ENDS use (i.e., current use) at Waves 2-4 based on the variables measured at the previous wave. We then extracted important predictors from each model. The penalized logistic regression models showed suitable capability to discriminate between ENDS uses and non-uses at each wave based on the area under the receiver operating characteristic curve and the area under the precision-recall curve. Interestingly, social media use emerged as an important variable in predicting adolescent ENDS use. ML models appear to be a promising method to identify unique population-level predictors for U.S. adolescent ENDS use behaviors. More research is warranted to investigate emerging predictors of ENDS use and experimentally examine the mechanism by which these emerging predictors affect ENDS use behavior across different spectrum of populations.

Effects of an 80% cigarette price increase on quit attempts, successful quitting and smoking intensity among Korean adult smokers: results from nationally representative longitudinal panel data.

OBJECTIVES: South Korea implemented an unprecedented cigarette tax increase in 2015, raising its cigarette price by 80%. This study evaluated the extent to which the 2015 cigarette tax increase affected Korean adult smokers in terms of quit attempts, successful quitting and smoking intensity. METHODS: Data were drawn from a nationally representative longitudinal study, the Korean Welfare Panel Study (waves 9-12, 2014-2017). Korean adults who smoked before the 2015 cigarette tax increase comprised the sample (n=2114). We used the multiple logistic regressions to examine factors of quit attempts and successful quitting and the generalised estimating equations to estimate changes in smoking intensity among continued smokers. RESULTS: After the cigarette tax increase, 60.9% (n=1334) of baseline smokers attempted to quit and 34.7% of the attempters succeeded in quitting. The smokers aged ≥ 65 years and light smokers both attempted more (p<0.01) and succeeded more (p<0.05) in quitting than smokers aged 35-44 years and heavy smokers, respectively. The successful quitting was not significantly associated with income levels. Depressive symptoms, first cigarette use before age 19 and smoking a pack or more a day at baseline were associated with failures in quitting. Smoking intensity among continued smokers decreased after the cigarette tax increase (p<0.001), but such a decrease was not observed in light smokers, young smokers and high-income smokers. CONCLUSION: The current study findings imply that the Korean government may consider implementing periodic increases in cigarette tax which should reflect the rate of inflation and income growth. Smoking cessation programmes need to address depressive symptoms.

Financial strain and electronic nicotine delivery systems use among U.S. young adults: A longitudinal panel analysis, 2013-2018.

INTRODUCTION: Financial strain is associated with an increased likelihood of cigarette smoking, but less is known about its association with electronic nicotine delivery systems (ENDS) use. This study examined longitudinal associations of financial strain with ENDS use behaviors among young adults. METHODS: We analyzed in 2020 four waves (2013-2018) of the Population Assessment of Tobacco and Health, a nationally representative longitudinal study. A total of 5740 U.S. young adults (aged 18-24 years at baseline) had matched data for all four waves. We used generalized linear mixed modeling which accounts for correlations between repeated measures. Weighted logistic regressions assessed the association between financial strain and three different types of ENDS use behaviors (i.e., everyday, some-day, and experimental use), adjusting for major confounders including poverty, mental health symptoms, and other substance use behaviors. RESULTS: Frequency and proportion of everyday ENDS use showed a linear increase over time whereas some-day and experimental uses showed quadratic trends, increasing with a peak at Wave 2 and then decreasing over time. Financial strain prospectively predicted some-day (adjusted odds ratio [AOR] = 1.32; 95% CI = 1.03-1.69) and experimental (AOR = 1.25; 95% CI = 1.02-1.52) ENDS use, but not everyday use. CONCLUSIONS: The findings of the current study indicate the need for distinctly different approaches for non-daily ENDS users from daily users. Our findings further suggest that ENDS use prevention and cessation efforts should consider financial strain of young adults particularly for non-daily users to thwart them from progressing towards nicotine dependence and long-term use.

Socioeconomic Disparities in Health Risk Behavior Clusterings Among Korean Adolescents.

PURPOSE: This study aims to investigate the socioeconomic disparities in health risk behavior clusterings among Korean adolescents and to assess the mediating role of stress on this association. METHOD: We analyzed the 2015 Korean Youth Risk Behavior Survey, a nationally representative sample of Korean middle and high school students aged 12-18 years (N = 68,043). The co-occurrence of multiple health risk behaviors (i.e., cigarette smoking, drinking, and unprotected sex) was used to operationalize health risk behavior clusterings that ranged from zero to three. Ordinal and multinomial logistic regressions were conducted to examine socioeconomic disparities in health risk behavior clusterings and mediating effect of perceived stress between socioeconomic status (SES) and health risk behaviors. RESULTS: When SES was grouped into five groups, adolescents in the lowest SES [adjusted odds ratio (AOR) = 2.15, 95% confidence interval (CI) = 1.90-2.44] and the highest SES (AOR = 1.29, 95% CI = 1.18-1.40) showed a higher likelihood of risk behavior clusterings than any other SES groups. Stress partially mediated the relationship between SES and co-occurrence of multiple health risk behaviors while accounting for their demographic characteristics. Adolescents in the lowest and highest SES reported higher stress than other SES groups, which, in turn, was associated with the co-occurrence of multiple health risk behaviors. CONCLUSION: The results suggest that perceived stress level partly explains why affluent as well as low-SES adolescents engage in multiple risk behaviors. The findings also discourage use of a linear approach in socioeconomic disparity investigation in relation to adolescent health behaviors.

Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States.

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004-2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005-2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults' overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

Cumulative family risks across income levels predict deterioration of children's general health during childhood and adolescence.

Family is considered an important agent in the health development of children. This process is significant but quite complex because the prevalence of potential risk factors in the family can hinder children's health. This study examined if multiple family risks might have cumulative effect on children and youth's health across various levels of household income. The data in this study were drawn from the 2011-2012 U.S. National Survey of Children's Health (N = 79,601). A cumulative family risk (CFR) index was developed, which included such constructs as single-parenthood, unstable employment, large family, parenting stress, poor maternal education, poor maternal general health and poor maternal mental health. Multiple logistic regression analyses showed that CFR level was significantly related to children and youth's poor health outcome (p < .001). When poverty levels were considered, however, the impact of CFRs on children and youth's health was attenuated. The impact of CFRs was higher on children and youth from affluent families than on those from poor families. Overall there was a consistent pattern of trend in the point estimate as well as confidence limits as levels of affluence and numbers of family risk increased although some of the confidence intervals overlapped. Living in disadvantaged families might serve as a protective factor against CFRs possibly through repeated exposure to hardships and subsequent formation of resilience among some of the disadvantaged children.

Evaluation of Internet-Based Interventions on Waist Circumference Reduction: A Meta-Analysis.

BACKGROUND: Internet-based interventions are more cost-effective than conventional interventions and can provide immediate, easy-to-access, and individually tailored support for behavior change. Waist circumference is a strong predictor of an increased risk for a host of diseases, such as hypertension, diabetes, and dyslipidemia, independent of body mass index. To date, no study has examined the effect of Internet-based lifestyle interventions on waist circumference change. OBJECTIVE: This study aimed to systematically review the effect of Internet-based interventions on waist circumference change among adults. METHODS: This meta-analysis reviewed randomized controlled trials (N=31 trials and 8442 participants) that used the Internet as a main intervention approach and reported changes in waist circumference. RESULTS: Internet-based interventions showed a significant reduction in waist circumference (mean change -2.99 cm, 95% CI -3.68 to -2.30, I(2)=93.3%) and significantly better effects on waist circumference loss (mean loss 2.38 cm, 95% CI 1.61-3.25, I(2)=97.2%) than minimal interventions such as information-only groups. Meta-regression results showed that baseline waist circumference, gender, and the presence of social support in the intervention were significantly associated with waist circumference reduction. CONCLUSIONS: Internet-based interventions have a significant and promising effect on waist circumference change. Incorporating social support into an Internet-based intervention appears to be useful in reducing waist circumference. Considerable heterogeneity exists among the effects of Internet-based interventions. The design of an intervention may have a significant impact on the effectiveness of the intervention.

The relationship between school-level characteristics and implementation fidelity of a coordinated school health childhood obesity prevention intervention.

BACKGROUND: Curtailing childhood obesity is a public health imperative. Although multicomponent school-based programs reduce obesity among children, less is known about the implementation fidelity of these interventions. This study examines process evaluation findings for the Healthy, Energetic Ready, Outstanding, Enthusiastic, Schools (HEROES) Initiative, a tri-state school-based childhood obesity prevention intervention based on the coordinated school health (CSH) model. METHODS: Site visits were conducted that included key stakeholder interviews, observation, and document review. Scores were given for 8 domains, and a total implementation score was calculated. Two-way analyses of variance were conducted to examine the relationship of 4 school-level characteristics: elementary vs. middle/high schools, public vs. private schools, district vs. building level implementation, and socioeconomic status on each implementation area. RESULTS: Overall, schools had high fidelity scores, although some domains were implemented more successfully than others. Three school-level characteristics were associated with 1 or more domains, with elementary schools and schools implementing at the building level consistently having higher implementation scores than their counterparts. CONCLUSIONS: Process evaluation findings provide insight into successes and challenges schools implementing the CSH approach may encounter. Although preliminary, these findings on school-level characteristics establish a new area of research related to school-based childhood obesity prevention programs' implementation fidelity.

Predictors for Persistent Overweight, Deteriorated Weight Status, and Improved Weight Status During 18 Months in a School-Based Longitudinal Cohort.

PURPOSE: To examine predictors for persistent overweight/obesity, deteriorated weight status, and improved weight status among students who participated in a school-based obesity prevention intervention from fall 2009 to spring 2011. DESIGN: Longitudinal assessment of a school-based cohort was conducted to determine the characteristics of students who remained overweight/obese, improved their weight status, or showed deteriorated weight status during an 18-month period. SETTING: Eleven schools in southern Indiana, northwestern Kentucky, and southeastern Illinois. SUBJECTS: N = 5309 students in 4th through 12th grade. MEASURES: Weight, height, and self-reported physical activity and nutrition behaviors of students were measured at baseline and 6, 12, and 18 months. ANALYSIS: SAS 9.3 was employed to examine predictors for the three different weight categories using logistic regression. RESULTS: Low socioeconomic status (SES) (adjusted odds ratio [AOR] = 1.56 and p < .001, AOR = 1.35 and p = .0069, respectively) and higher soda intake (AOR = 1.07 and p = .0016, AOR = 1.08 and p = .0278, respectively) increased the odds of belonging to persistent overweight/obesity (30.6%) and deteriorated weight status (6.9%), compared to the persistent nonoverweight status group. CONCLUSION: While SES is an important determinant of weight category change, students' screen time and soda consumption may be important factors. Schools and families may be able to successfully focus on these modifiable risk factors, decreasing the burden of childhood obesity.

Implementation and evaluation of the HEROES initiative: a tri-state coordinated school health program to reduce childhood obesity.

This article describes the design, implementation, and evaluative findings of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative, a school-based multilevel childhood obesity prevention intervention. Based on the Centers for Disease Control and Prevention's recommended coordinated school health approach, the HEROES Initiative works to alleviate the burden of childhood obesity in Southern Indiana, Northwestern Kentucky, and Southeastern Illinois in the United States. Process evaluation was conducted with the 17 participating schools in spring 2012 based on interviews with school personnel and observation of the school environment. Findings showed that despite some variability, schools were generally able to implement the intervention with fidelity. School-level outcome evaluation was also based on observation of the school environment, and revealed that schools had implemented a number of new practices to encourage physical activity and healthy eating. Assessment of student-level outcomes was based on professionally collected physiological measurements and self-reported behavioral data collected over an 18-month period of time, last collected in spring 2012. Findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity, and sedentary behaviors. Strategies that have facilitated success and challenges related to the intervention are discussed.

Correlates of moderate-to-vigorous physical activity participation in adults with intellectual disabilities.

Adults with intellectual disabilities (ID) have low levels of physical activity and higher than average rates of related chronic health conditions. Understanding correlates of their physical activity participation may improve health promoting interventions. Forty-two adults with ID participated in a physical activity study. Physical activity knowledge and skills, awareness of recommendations and demographic characteristics were analyzed for their association with moderate-to-vigorous physical activity (MVPA) participation measured by accelerometers. Five variables were significantly correlated with MVPA. Body mass index was inversely correlated with MVPA, and gender, job location, job tasks, and place of residence were all significantly associated with MVPA. Understanding correlates of physical activity in this population will help inform disability service and health promotion professionals in future research and health intervention design.

Social-ecological factors of leisure-time physical activity in Black adults.

OBJECTIVES: To develop and test an explicative model of leisure-time physical activity (LTPA), including 6 selected contributory factors: self-efficacy, self-regulation, social support, perceived physical environment, outcome-expectancy value, and policy beliefs. METHODS: A social-ecological model of LTPA using the structural equation modeling technique was estimated in a regional, church-going sample of 649 African Americans. RESULTS: The results indicated this model is good fit to the data. LTPA was associated with self-regulation and gender directly (P<.05) and social support, self-efficacy, perceived access to LTPA facilities, and positive outcome-expectancy value indirectly (P<.05). CONCLUSIONS: Multitiered interventions considering cultural relevance are recommended to improve LTPA engagement.

Association of school nutrition policy and parental control with childhood overweight.

BACKGROUND: Schools and parents may play important roles in preventing childhood obesity by affecting children's behaviors related to energy balance. This study examined how school nutrition policy and parental control over children's eating and physical activity habits are associated with the children's overweight/obesity (hereafter overweight) status. METHODS: Data were analyzed from a total of 246 pairs of children and parents who were recruited in the 2008-2009 academic year from 10 randomly selected public secondary schools in Indiana (school response rate = 66.7%; participant response rate = 73.5%). Logistic regression analyses were performed to examine odds ratios of different levels of school nutrition policies and parental control with and without adjusting for sociodemographic characteristics. RESULTS: Children who attended schools where soda pop (OR = 3.79, p < .01) and non-low-fat salty snacks (OR = 2.46, p = .05) could be purchased were more likely to be obese than those at schools where such items were not sold. Children whose parents rarely or never ensured that their child was avoiding eating too many sweets (OR = 2.33, p = .08), avoiding spending too much time watching TV (OR = 2.24, p = .06), or engaging in physical activity (OR = 2.35, p = .09) were more likely to be obese than children whose parents did so always or most of the time. CONCLUSIONS: School nutrition policy and parental control over children's eating and physical activity habits are associated with the children's overweight status.

Health of adolescents and young adults: trends in achieving the 21 Critical National Health Objectives by 2010.

PURPOSE: The 21 Critical National Health Objectives (CNHOs) for Adolescents and Young Adults derived from Healthy People 2010 addressed the most significant threats to the health of individuals aged 10-24 years. This study assessed trends in the 21 CNHOs between 1991 and 2009, and from baseline years for which 2010 targets were established to 2009, and the extent to which targets were achieved. METHODS: For one CNHO (new HIV diagnoses), national data were not available. For CNHOs measured by census systems, the percentage of change in each health outcome was calculated between 1991 and 2009 and between baseline years and 2009. Any change ≥5% was considered as an improvement or deterioration. For CNHOs measured by national probability-based surveillance surveys, multivariate logistic regression was conducted using Stata Version 10.0 (StataCorp, College Station, TX) to calculate odds ratios for each outcome from 1991, and from baseline years to 2009, controlling for gender, race/ethnicity, and age or school grade-level. To calculate the percentage of targets being achieved, the difference between baseline data and 2009 data was divided by that between baseline data and target. RESULTS: Adolescents and young adults achieved two targets (rode with a driver who had drunk alcohol, physical fighting), improved for 12 CNHOs, made mixed progress by sub-objective for two, showed no progress in four, and regressed in achieving two (Chlamydia infections; overweight). Progress varied by demographic variables. CONCLUSION: Although encouraging trends were seen in young people's health, the United States achieved only two CNHOs. Attention is needed to improve the health and reduce disparities among young people.

Lessons learned from a black and minority health fair's 15-month follow-up counseling.

BACKGROUND: Little is known about the impact of community health fairs on participants' health knowledge, literacy, attitudes, or behaviors. Few health fairs have provided followup services for participants. OBJECTIVE: To evaluate the short-term (baseline) and long-term (10-month follow-up) health effects of exposure to the Indiana Black and Minority Health Fair (BMHF) and to assess the impact of personalized 15-month follow-up health counseling sessions for the BMHF participants who agreed to the sessions. METHODS: A prospective panel study design was utilized with a pre-post test in addition to a cross-sectional survey design. RESULTS: Although few behavioral changes were observed between the baseline and the precounseling 10-month follow-up, more people perceived themselves as overweight (68.1% vs 65.3%, p < .01) and fewer people watched TV/videos 4 hours or more on a usual weekday (25.6% vs 47.0%, p <.001) than 10 months before. After the 15-month follow-up health counseling sessions, the intervention group reported substantial and meaningful improvements in self-reported general health status, health status compared to 6 months earlier, percentage of overweight or obese people, choosing leaner meats over those higher in fat, snacking while watching TV or videos, and placing a high priority on exercise when planning a schedule. CONCLUSIONS: A follow-up component to the health fair is not only necessary but also in demand for improving health literacy and healthy outcomes for participants. Efforts should be made to transform health fair encounters from episodic experiences to long-term educational experiences that spur individuals to make the necessary changes to enhance their health.

Trends in overweight among school children and adolescents in seven Chinese Provinces, from 1991-2004.

OBJECTIVE: To examine trends in body mass index (BMI) in relation to energy intake and expenditure among Chinese school children and adolescents from seven Provinces during 1991-2004, a time of rapid economic development in China. METHODS: Combined cross-sectional data derived from the China Health and Nutrition Survey (N = 1,977 in 1991, 2, 048 in 1993, 2,350 in 1997, 1,872 in 2000, and 1,275 in 2004) was utilized to assess BMI and prevalence of overweight. Sequential multiple regressions were conducted to assess the extent to which changes in energy intake and expenditure accounted for variation in BMI. RESULTS: Overall, the prevalence of overweight among school children and adolescents doubled from 1991 to 2004. It increased from 6.5% to 16.1% for children aged 6-11 years and from 3.3% to 6.2% for adolescents aged 12-18 years. Changes in energy intake, physical activity, and sedentary activity explained 12% and 28% of variance in BMI, respectively, for children and adolescents. CONCLUSIONS: Chinese youths, especially children aged 6-11 years, became overweight rapidly during 1991-2004, which coincided with rapid economic growth in China. Effective policies and interventions are needed to curb the overweight epidemic among Chinese youths.

Salient environmental and perceptual correlates of current and established smoking for 2 representative cohorts of Indiana adolescents.

PURPOSE: A secondary analysis of 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) data was conducted to investigate salient environmental and perceptual correlates of adolescents' current and established smoking while controlling for demographic variables such as gender, grade, and race/ethnicity and to compare the pattern of significant correlates between the years. METHODS: The IYTS was an anonymous school-based survey regarding tobacco use; familiarity with pro- and anti-tobacco media messages; exposure to environmental tobacco smoke (ETS); minors' access to tobacco products; and general knowledge, attitudes, and beliefs about tobacco. In 2000, a representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed. In 2004, 3433 public high school students and 1990 public middle school students (63.04% and 65.44 % response rates, respectively) were surveyed. RESULTS: Significant predictors of adolescents' current and established smoking habits included exposure to ETS either in homes or in cars, exposure to pro-tobacco messages, perceived benefit of smoking, and perceived peer acceptance of smoking. The influence of exposure to pro-tobacco messages greatly outweighed exposure to any anti-tobacco messages. CONCLUSIONS: The findings of this study warrant that more efforts and resources be placed on preventing youth from being exposed to ETS, and to control pro-tobacco marketing and improve the tobacco counter-marketing messages. The perceived benefits of smoking found here indicate that smoking for relaxation and weight control may be major influencing factors on adolescent smoking.