Middle school food environments and racial/ethnic differences in sugar-sweetened beverage consumption: findings from the Healthy Choices study.

BACKGROUND: Prior studies have demonstrated disproportionate clustering of fast food outlets around schools. PURPOSE: The purpose of this study is to determine if racial/ethnic differences in middle school student self-reported sugar-sweetened beverage (SSB) consumption is explained by differential distributions of food outlets surrounding their schools. METHODS: Baseline (2005) data were analyzed from 18,281 middle school students in 47 Massachusetts schools participating in Healthy Choices, an obesity prevention program. Linear mixed effects models were used to examine the association of individual race/ethnicity and daily SSB consumption and the potential mediating effect of the density of food outlets (the number of fast food outlets and convenience stores in a 1500 m buffer area surrounding the school) on this association adjusting for individual and school demographics. RESULTS: More SSB consumption was reported by students of all racial/ethnic minority groups compared to their White peers except Asians. The density of fast food restaurants and convenience stores was not associated with individual SSB consumption (ß=0.001, p=0.875) nor did it mediate the association of race/ethnicity and SSB consumption. CONCLUSIONS: Racial and ethnic differences in SSB consumption among MA middle school students cannot be fully explained by the location of fast food restaurants and convenience stores.

Safety and tolerability of linaclotide for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation: pooled Phase 3 analysis.

BACKGROUND: Linaclotide is approved for treating irritable bowel syndrome with constipation (IBS-C; 290 µg QD) and chronic idiopathic constipation (CIC; 145 µg or 72 µg QD). These analyses aimed to assess linaclotide safety in a large, pooled Phase 3 population. METHODS: In six randomized controlled trials (RCTs), patients received linaclotide (72 µg, 145 µg, 290 µg) or placebo daily for 12-26 weeks; in two long-term safety (LTS) studies, patients received open-label linaclotide for ≤78 additional weeks. Laboratory values, vital signs, and treatment-emergent adverse events (TEAEs) were assessed. RESULTS: Overall, 3853 patients received ≥1 dose of linaclotide. The most common TEAE was diarrhea (majority [90.5% in RCTs] mild/moderate). Linaclotide patients experienced 1.1 diarrhea TEAE per patient-year in the RCTs (0.2 in placebo), and 0.3 in the LTS studies. In RCTs, 6.9% linaclotide and 3.0% placebo patients discontinued due to any adverse event (AE); 4.0% linaclotide and 0.3% placebo patients discontinued due to diarrhea. In LTS studies, 9.4% patients discontinued due to any AE, and 3.8% due to diarrhea. Serious AEs (SAEs) were rare and similar across treatment groups; there were no SAEs of diarrhea. CONCLUSION: These pooled analyses of patients treated for ≤104 weeks confirm linaclotide's overall safety.

School social capital and body mass index in the National Longitudinal Study of Adolescent Health.

BACKGROUND: Social capital in neighborhoods and workplaces positively affects health. Less is known about the influence of school social capital on student health outcomes, in particular weight status. We sought to examine the association between individual- and school-level social capital and student body mass index (BMI). METHODS: Analyzing data from the National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7-12 (N = 13,428), we used principal components analysis to define 3 school social capital factors: "connectedness" (feel part of/close to people/safe in school), "treatment" (get along with teachers/students, teachers treat students fairly), and "parental involvement" (school administrator reported percent family/parent self-reported participation in Parent Teacher Organization, average daily school attendance). We examined the associations between individual- and school-level social capital and individual BMI using multilevel modeling techniques. RESULTS: In girls, both feeling connected to one's school (ß = -0.06, p < .05) and attending schools with overall high connectedness (b = -0.43, p < .01) were associated with lower BMIs. In boys only attending a school with high "treatment" was inversely associated with BMI (b = -0.61, p < .01), adjusting for individual and school demographics. CONCLUSIONS: Although further studies are needed, our findings suggest enhancing school social capital as a novel approach to addressing student obesity.

School programs and characteristics and their influence on student BMI: findings from healthy passages.

BACKGROUND: Little is known about the contribution of school contextual factors to individual student body mass index (BMI). We set out to determine if school characteristics/resources: (1) are associated with student BMI; (2) explain racial/ethnic disparities in student BMI; and (3) explain school-level differences in student BMI. METHODS: Using gender-stratified multi-level modeling strategies we examined the association of school characteristics/resources and individual BMI in 4,387 5(th) graders in the Healthy Passages Longitudinal Study of Adolescent Health. Additionally, we examined the association of race/ethnicity and individual BMI as well as the between-school variance in BMI before and after adding individual and school characteristics to test for attenuation. RESULTS: The school-level median household income, but not physical activity or nutrition resources, was inversely associated with female BMI (ß = -0.12, CI: -0.21,-0.02). Neither school demographics nor physical activity/nutrition resources were predictive of individual BMI in males. In Black females, school characteristics attenuated the association of race/ethnicity and BMI. Individual student characteristics-not school characteristics/resources-reduced the between-school variation in BMI in males by nearly one-third and eliminated it in females. CONCLUSIONS: In this cohort of 5(th) graders, school SES was inversely associated with female BMI while school characteristics and resources largely explained Black/White disparities in female weight status. Between-school differences in average student weight status were largely explained by the composition of the student body not by school characteristics or programming.

The association of adolescent socioeconomic position and adult height: variation across racial/ethnic groups.

Numerous studies have demonstrated the association of childhood socioeconomic position and adult height. Many have suggested the use of adult height as a marker of overall childhood well-being. However, few studies have examined the relationship between child/adolescent socioeconomic position and adult height in a racially/ethnically diverse cohort. Using the National Longitudinal Study of Adolescent Health, we examined the association of child/adolescent SEP (maternal education and maternal report of household income) and measured adult height in a diverse cohort of US adolescents/young adults. We found a positive gradient effect of maternal education on height in the overall population and in White and Mixed race males and females; no such gradient existed in Hispanic, Asian, or Black males or females. Only in Mixed race females was household income positively associated with height. These findings emphasize the need to recognize differential effects of socioeconomic status on height in different racial/ethnic and gender subpopulations.

Characteristics of screen media use associated with higher BMI in young adolescents.

OBJECTIVES: This study investigates how characteristics of young adolescents' screen media use are associated with their BMI. By examining relationships between BMI and both time spent using each of 3 screen media and level of attention allocated to use, we sought to contribute to the understanding of mechanisms linking media use and obesity. METHODS: We measured heights and weights of 91 13- to 15-year-olds and calculated their BMIs. Over 1 week, participants completed a weekday and a Saturday 24-hour time-use diary in which they reported the amount of time they spent using TV, computers, and video games. Participants carried handheld computers and responded to 4 to 7 random signals per day by completing onscreen questionnaires reporting activities to which they were paying primary, secondary, and tertiary attention. RESULTS: Higher proportions of primary attention to TV were positively associated with higher BMI. The difference between 25th and 75th percentiles of attention to TV corresponded to an estimated +2.4 BMI points. Time spent watching television was unrelated to BMI. Neither duration of use nor extent of attention paid to video games or computers was associated with BMI. CONCLUSIONS: These findings support the notion that attention to TV is a key element of the increased obesity risk associated with TV viewing. Mechanisms may include the influence of TV commercials on preferences for energy-dense, nutritionally questionable foods and/or eating while distracted by TV. Interventions that interrupt these processes may be effective in decreasing obesity among screen media users.

Dietary and physical activity factors related to eating disorder symptoms among middle school youth.

BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth. METHODS: Self-reported data on dietary weight management behaviors, strengthening/toning exercises, moderate-to-vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools. RESULTS: Disordered weight control behaviors were reported by 3.6% of girls and 3.1% of boys. Youth who engaged in strengthening/toning exercises 7 days per week versus 0-3 days per week had increased odds of DWCB (girls odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.3 - 3.0; boys OR = 1.5; 95% CI = 1.0 - 2.2). Dietary weight management behaviors were associated with increased odds of DWCB (girls OR = 1.2; 95% CI = 1.1 - 1.3; boys OR = 1.3; 95% CI = 1.2 - 1.4) for each additional behavior. These associations did not differ by race/ethnicity or weight status. CONCLUSIONS: Persons promoting healthy dietary and PA behaviors among youth should consider the co-occurrence of strengthening/toning and dietary weight management behaviors with DWCB and the consistency in these associations across racial/ethnic and weight status groups.

Sexual orientation and bias in self-reported BMI.

Our objective was to determine if sexual orientation groups differ in accuracy of BMI (kg/m(2)) calculated from self-reported height and weight and if weight status modifies possible differences. Using gender-stratified multiple linear regression to analyze Wave III of the National Longitudinal Study of Adolescent Health (n = 12,197), we examined the association of sexual orientation with BMI calculated from self-reported height and weight (self-reported BMI), controlling for BMI calculated from objectively measured height and weight (objectively measured BMI) as well as demographic, health, and behavioral variables. We tested for effect modification of the relationship between sexual orientation and self-reported BMI by objectively measured BMI. The population underestimated their BMI (females: ß = 0.87, P < 0.001; males = 0.86, P < 0.001). Sexual orientation groups differed little in their accuracy of reporting; only gay males had significant underreporting (ß = -0.37, P = 0.038) relative to their heterosexual peers. We found no evidence of effect modification of the relationship of sexual orientation and self-reported BMI by objectively measured BMI. With the exception of gay males, sexual orientation groups are consistent in their underreporting of BMI thus providing confidence in most comparisons of weight status based on self-report. Self-reporting of weight and height by gay males may exaggerate the differences in BMI between gay and heterosexual males.

Food insecurity and increased BMI in young adult women.

Food insecurity has been associated with weight status in children and adults although results have been mixed. We aimed to identify whether food insecurity was associated with BMI in young adults and whether this association differed by gender and was modified by food stamp use and the presence of children in the home. Cross-sectional data from wave 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were analyzed. Multiple linear regression was used to investigate the association between food insecurity and BMI in gender stratified models of young adult women (n = 7,116) and men (n = 6,604) controlling for age, race/ethnicity, income, education, physical activity, smoking, alcohol use, the presence of children in the home, and food stamp use in young adulthood and/or adolescence. Food insecurity was more common in young adult women (14%) than young adult men (9%). After controlling for a variety of individual variables, food insecure women had a BMI that was on average 0.9 kg/m(2) units higher than women who were food secure. This difference in BMI persisted after controlling for recent or past food stamp use and was not different among women with or without children in the household. No relationship was found between food insecurity and BMI in young adult men. Providers should inquire about food insecurity, especially when treating obesity, and policy initiatives should address the role of access to healthy food in those facing food insecurity.

The association of body mass index and externally perceived attractiveness across race/ethnicity, gender, and time.

PURPOSE: Being perceived by others as unattractive is associated with negative health and social consequences. Overweight individuals may be more likely to be perceived by others as unattractive, thereby further endangering their well-being. Our objective was to determine whether body mass index (BMI) was associated with perceptions by others regarding attractiveness and whether this relationship was similar across race/ethnicity, gender, and time. METHODS: We analyzed Waves I and III of the National Longitudinal Study of Adolescent Health, a nationally representative longitudinal study of adolescents. We used participant gender- and race/ethnicity-stratified multinomial logistic regression to examine the association between BMI and interviewer-rated attractiveness (1 = unattractive, 2 = average, 3 = attractive, 4 = very attractive) controlling for participant age, household income, and maternal education. RESULTS: BMI was positively associated with risk of being categorized as unattractive (relative to very attractive) by the interviewer in black (Wave I: relative risk ratio [RRR] = 1.26, CI: 1.18, 1.33; Wave III: RRR = 1.14, CI: 1.08, 1.20), Hispanic (Wave I: RRR = 1.23, CI: 1.11, 1.36; Wave III: RRR = 1.22, CI: 1.12, 1.34), and white (Wave I: RRR = 1.25, CI: 1.19, 1.32; Wave III: RRR = 1.22, CI: 1.17, 1.28) females in both waves of data collection. Only in African American females, the risk of being rated unattractive with increasing BMI declined significantly between waves (p = .00018). Trends were similar in males, although the magnitude of risk was smaller and nonsignificant in most groups. CONCLUSIONS: Interviewers were more likely to rate those with higher BMIs as unattractive; this finding was similar across gender and racial/ethnic groups with few exceptions and was stable across time.

The context of desire to use marijuana: momentary assessment of young people who frequently use marijuana.

Drawing on factors identified in the literature, this study explored in-the-moment associations of social, emotional, and temporal contexts and perceived marijuana availability with desire to use the drug, using momentary sampling methodology with young people who frequently use marijuana. Forty-one adolescent/young adult medical outpatients aged 15 to 24 years who reported using marijuana at least twice a week completed 2,912 brief questionnaires on a handheld computer in response to signals emitted at random four to six times a day for 2 weeks. The questionnaires assessed, for the moment when signaled, desire to use marijuana, location, companionship, perceived ease of getting marijuana (availability), positive affect, and negative affect. Participants reported any desire to use marijuana on 1,528 reports (55%). Companionship, perceived availability, and positive affect were independently associated with having any desire to use marijuana. Once desire to use marijuana was present, time of day, positive affect, and negative affect were independently associated with strength of desire. By collecting data in real time, in real life, this study highlights the importance of examining and intervening on emotional, environmental, and temporal contexts for youth who frequently use marijuana in order to reduce their desire to use the drug.

Television viewing is not predictive of BMI in Black and Hispanic young adult females.

Previous studies have observed that television (TV) viewing is predictive of obesity and weight gain. We examined whether the cross-sectional association between TV viewing and BMI varied by racial/ethnic subgroups among young women in Wave III (collected in 2001-2002) of the National Longitudinal Study of Adolescent Health. We used multivariate linear regression to examine the relationship between TV viewing and BMI among 6,049 females while controlling for sociodemographic and health attributes. We stratified the sample by race/ethnicity to better understand the association between TV viewing and BMI across different groups. Black and Hispanic females had higher BMIs (black: 28.5 kg/m(2), Hispanic: 27.3 kg/m(2), white: 26.0 kg/m(2)) than white females, while black females reported higher numbers of hours spent watching TV (black: 14.7 h/week, Hispanic: 10.6 h/week, white: 11.2 h/week) when compared to their white and Hispanic peers. TV viewing was positively associated with BMI (beta = 0.79, P = 0.003 for 8-14 vs. < or =7 h/week; beta = 1.18, P = 0.01 for >14 vs. < or =7 h/week) independent of race/ethnicity, age, maternal education, history of pregnancy, parental obesity, and household income. However, in models stratified by race/ethnicity, increased TV viewing was associated with increased BMI only among white females; TV viewing was not predictive of higher BMI in black or Hispanic young adult females. Among black and Hispanic females, counseling to decrease TV viewing may be important but insufficient for promoting weight loss.

Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa.

OBJECTIVE: To determine the effects of malnutrition on hemodynamic status of adolescents hospitalized for anorexia nervosa. DESIGN: Longitudinal observational study. SETTING: Tertiary care pediatric hospital. Patients Thirty-eight adolescents with anorexia nervosa, aged 13 to 21 years, with a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 15.9 (1.8). Intervention Subjects received standard care, including bed rest and graded nutritional therapy. A subsample of subjects (n=19) returned 11 to 57 weeks following hospitalization for a second cardiac evaluation. MAIN OUTCOME MEASURES: Results from a 15-lead electrocardiogram, echocardiogram, treadmill stress test, and spinal bone mineral density measurement. RESULTS: On admission, 26 subjects (68%) had sinus bradycardia. Bradycardia was less common in participants with a longer duration of illness (P=.04). Left ventricle mass was lower than predicted for age (Z score<-1.0) in 11 subjects (31%). Exercise tolerance was normal by all measures. Both heart rate and QT interval were predictors of spinal bone mineral density. In those who returned for follow-up, absolute measures of left ventricle mass did not change (P=.27). However, the corresponding Z scores declined over time (mean [SD] change, -0.9 [1.3]; P=.02). CONCLUSIONS: In acutely malnourished adolescents with anorexia nervosa, few truly pathologic cardiac findings were identified. Sinus bradycardia was observed in most cases. Mild reductions in left ventricle mass and left ventricle function were seen both at baseline and at follow-up, suggesting early sparing of cardiac muscle in the face of moderate malnutrition as well as a relative delay of cardiac muscle restoration. The association of hemodynamic status with altered spinal bone mineral density emphasizes the range of systems affected by malnutrition in anorexia nervosa.