Nutritional problems in childhood and adolescence: a narrative review of identified disparities.

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.

Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010-2018.

PURPOSE: To examine longitudinal associations of intuitive eating (IE), defined as eating according to internal hunger and satiety cues, with psychological health outcomes and disordered eating behaviors. METHODS: Data from a diverse sample of 1491 participants (54.1% female, 19.7% non-Hispanic white) followed from adolescence (baseline; Mage = 14.5 years) into young adulthood (follow-up; Mage = 22.2 years) came from the population-based EAT 2010-2018 (Eating and Activity over Time) study. Logistic regression models predicting psychological health outcomes and disordered eating behaviors at follow-up simultaneously included baseline IE and change in IE from baseline to follow-up as predictors, adjusting for demographic covariates, body mass index, and outcome at baseline. RESULTS: Greater baseline IE and increases in IE from baseline to follow-up were both associated with lower odds of high depressive symptoms, low self-esteem, high body dissatisfaction, unhealthy weight control behaviors (e.g., fasting, skipping meals), extreme weight control behaviors (e.g., taking diet pills, vomiting), and binge eating at 8-year follow-up. Particularly strong protective associations were observed for binge eating, such that a one-point higher IE score at baseline was associated with 74% lower odds of binge eating at follow-up, and a one-point higher increase in IE score from baseline to follow-up was associated with 71% lower odds of binge eating at follow-up. CONCLUSIONS: These results indicate that IE longitudinally predicts better psychological and behavioral health across a range of outcomes and suggest that IE may be a valuable intervention target for improving psychological health and reducing disordered eating behaviors, particularly binge eating. LEVEL OF EVIDENCE: Level III, cohort study.

Higher Diet Quality in Adolescence and Dietary Improvements Are Related to Less Weight Gain During the Transition From Adolescence to Adulthood.

OBJECTIVES: To examine the previously validated A Priori Diet Quality Score (APDQS), and weight change among adolescents transitioning into young adulthood. STUDY DESIGN: Young people were recruited in middle/high schools and followed for 10 years. Participants reported diet and weight in 1999 (mean age, 15 years), 2004 (20 years), and 2009 (25 years). The analytic sample (n = 2656) had dietary intake assessments in 1999 and at least one other assessment. The APDQS (without alcoholic items) was based on 13 beneficial food groups, 12 adverse food groups, and 9 neutral food groups to capture aspects of Mediterranean/prudent diets, focusing on foods that are varied, based on nutritionally rich plants, and less processed. RESULTS: From mean age 15 to 25 years, mean (SD) weight increased from 61.0 (14.7) kg to 76.1 (18.8) kg, and APDQS increased from 43.1 (11.1) points to 45.6 (10.7) points. Within-person tracking correlation of the APDQS was 0.35 at mean age 15-20 years, increasing to 0.49 at 20-25 years. Independent of lifestyle factors and energy intake, a 15-point (IQR) higher APDQS in 1999 was associated with 1.5 kg (95% CI, 0.7-2.3 kg) less weight gain over 10 years, The increase in APDQS over time was similarly associated with less concurrent weight gain. Findings were stronger for models of excess weight gain. CONCLUSION: Higher diet quality, based on an assessment of dietary patterns in and after adolescence, was associated with reduced weight gain during the next 10 years. Establishment of high-quality dietary patterns in adolescence may help mitigate excess weight gain by young adulthood.

Adolescent Snacking Behaviors Are Associated with Dietary Intake and Weight Status.

BACKGROUND: Most adolescents consume ≥1 snack/d; exploring the relevance of snacking patterns for overall diet and weight status is important to guide dietary counseling and public health strategies for obesity prevention. OBJECTIVE: This study examined intake of common energy-dense snack foods, total number of snacks consumed, frequency of consuming snacks prepared away from home, and frequency of snacking while watching television in adolescents and how these behaviors may be linked to diet and weight status. Relations were examined with attention to potential confounders that may help explain the mixed findings of previous research. METHODS: Survey measures of snacking behavior, a food-frequency questionnaire, and anthropometric measurements were completed by 2793 adolescents (53.2% girls, mean age = 14.4 y) in Minneapolis-St. Paul school classrooms in 2009-2010. Linear regression was used to examine associations with adjustment for sociodemographic characteristics and other potential confounding factors, such as meal skipping, underreporting energy intake, dieting to lose weight, and physical activity. RESULTS: Adolescents reported consuming a mean of 2.2 energy-dense snack food servings/d and 4.3 snacks/d and purchasing snacks prepared away from home on 3.2 occasions/wk. More than two-thirds of adolescents reported that they sometimes, usually, or always consumed a snack while watching television. The measures of snacking were directly associated (P < 0.01) with higher energy, lower fruit/vegetable, higher sugar-sweetened beverage, and more frequent fast-food intakes in all models except for one: energy-dense snack food servings were not related to sugar-sweetened beverage intake. A direct relation between daily servings of energy-dense snack foods and body mass index (BMI) z score was found; however, the snacking behaviors were inversely related to BMI z score (P < 0.01). CONCLUSIONS: The observed cross-sectional associations suggest that snack consumption is a risk factor for poor diet, but unless energy-dense foods are consumed, snacking does not consistently contribute to overweight in US adolescents.

Adolescents who engage exclusively in healthy weight control behaviors: Who are they?

BACKGROUND: Little is known about the exclusive adoption of healthy weight control behaviors in the absence of unhealthy weight control behaviors among adolescents. The current study aimed to determine (i) the prevalence of the exclusive adoption of healthy weight control behaviors, (ii) the pattern of eating behaviors and physical activity reported by those engaging exclusively in healthy weight control behaviors, and (iii) the socio-demographic and psychosocial factors associated with the exclusive use of healthy weight control behaviors among adolescents. METHODS: In a large and diverse population-based sample of US adolescents (N = 2793) who participated in EAT 2010 (Eating and Activity in Teens) the current study examined the exclusive use of healthy weight control behaviors, which included healthy eating behaviors (eating more fruits and vegetables, eating less high-fat foods, eating less sweets, drinking less soda, and being aware of portion sizes) and engaging in physical activity for the purpose of weight management. Data were analyzed using multinomial logistic regression in STATA. RESULTS: Overall, 24.0% of girls and 29.2% of boys exclusively used healthy weight control behaviors in the absence of unhealthy weight control behaviors. The exclusive use of healthy weight control behaviors was more prevalent among girls who were not overweight (27.5%) as compared to girls who were overweight (21.0%) or obese (17.5%), controlling for age, socio-economic status, and ethnicity/race. In addition, the exclusive use of healthy weight control behaviors was more prevalent among girls and boys who had lower body dissatisfaction, higher self-esteem and lower depressive symptoms. CONCLUSION: Findings indicate that psychosocial health and body satisfaction may be important targets for promoting the exclusive use of healthy weight control behaviors among adolescents.

Snacking on Television: A Content Analysis of Adolescents' Favorite Shows.

INTRODUCTION: Snacking is a complex behavior that may be influenced by entertainment media. Research suggests that snacking and unhealthy foods are commonly shown in programming that targets young audiences, but shows selected for study have been limited. We conducted a content analysis on shows that were named as favorites by adolescents to characterize portrayals of snacking on popular television. METHODS: A diverse sample of 2,130 adolescents (mean age, 14.3 y) listed 3 favorite television shows in a 2010 school-based survey. Three episodes each of the 25 most popular shows were coded for food-related content, including healthfulness, portion size, screen time use, setting, and social context. We also analyzed the characteristics of characters involved in eating incidents, the show type, and the show rating. We used χ(2) tests, binomial tests, and multilevel regression models to compare incidence of snacks versus meals, the characteristics of those involved, and snacking across show characteristics. RESULTS: Almost half of food incidents on television shows were snacks. Snacks were significantly more likely than meals to be "mostly unhealthy" (69.3% vs 22.6%, P < .001) and were more likely to include screen time use (25.0% of snacking incidents vs 4.0% of meals, P < .001). Young characters and those coded as being of low socioeconomic status or overweight were overrepresented in snacking incidents. Sitcoms and shows rated for a youth audience were significantly more likely to portray snacking than were shows for adult audiences. CONCLUSION: Media awareness and literacy programs should include foods and snacking behaviors among the issues they address. More healthful portrayals of food and dietary intake in entertainment shows' content would create a healthier media environment for youth.

Does involvement in food preparation track from adolescence to young adulthood and is it associated with better dietary quality? Findings from a 10-year longitudinal study.

OBJECTIVES: To examine whether involvement in food preparation tracks over time, between adolescence (15-18 years), emerging adulthood (19-23 years) and the mid-to-late twenties (24-28 years), as well as 10-year longitudinal associations between home food preparation, dietary quality and meal patterning. DESIGN: Population-based, longitudinal cohort study. SETTING: Participants were originally sampled from Minnesota public secondary schools (USA). SUBJECTS: Participants enrolled in Project EAT (Eating Among Teens and Young Adults)-I, EAT-II and EAT-III (n 1321). RESULTS: Most participants in their mid-to-late twenties reported an enjoyment of cooking (73 % of males, 80 % of females); however, few prepared meals including vegetables most days of the week (24 % of males, 41 % of females). Participants in their mid-to-late twenties who enjoyed cooking were more likely to have engaged in food preparation as adolescents and emerging adults (P < 0·01); those who frequently prepared meals including vegetables were more likely to have engaged in food preparation as emerging adults (P < 0·001), but not as adolescents. Emerging adult food preparation predicted better dietary quality five years later in the mid-to-late twenties, including higher intakes of fruit, vegetables and dark green/orange vegetables, and less sugar-sweetened beverage and fast-food consumption. Associations between adolescent food preparation and later dietary quality yielded few significant results. CONCLUSIONS: Food preparation behaviours appeared to track over time and engagement in food preparation during emerging adulthood, but not adolescence, was associated with healthier dietary intake during the mid-to-late twenties. Intervention studies are needed to understand whether promoting healthy food preparation results in improvements in eating patterns during the transition to adulthood.

Dietary patterns and home food availability during emerging adulthood: do they differ by living situation?

OBJECTIVE: The objective of the present work was to cross-sectionally examine and compare dietary behaviours and home food environments by young adults' living situation. DESIGN: Using data from Project EAT (Eating Among Teens)-II, a large diverse youth cohort originally sampled in Minnesota, linear regression was used to examine self-reported meal frequency, dietary intake and home food availability outcomes by living situation (i.e. living with parents, renting an apartment/house or living on a college campus). SUBJECTS: Young adults (n 1687), mean age 20.5 years. RESULTS: Results suggested that young adults living with their parents or in rented apartments/houses had less frequent meals, poorer dietary intake and less healthy home food availability compared with those living on campus. These findings were evident even after controlling for sociodemographic factors (e.g. race/ethnicity, socio-economic status), particularly among females. CONCLUSIONS: Although few emerging adults consume diets that are consistent with national recommendations, those living with parents and in rented apartments/houses may represent particularly at-risk groups. These differences in dietary factors across living situations appear to exist beyond the sociodemographic differences in these populations. Effective nutrition and healthy eating promotion strategies are needed for young adults.

Family meals and adolescents: what have we learned from Project EAT (Eating Among Teens)?

OBJECTIVE: The purpose of the present paper is to provide an integrated overview of the research methodology and key findings from a decade of research on family meals as part of Project EAT (Eating Among Teens), a large, population-based study of adolescents. DESIGN: Focus groups conducted with 141 middle-school and high-school adolescents suggested the importance of family meals in influencing adolescents' food choices. These findings led to the inclusion of questions on family meals in the Project EAT-I survey, completed by 4746 middle-school and high-school students, and in the Project EAT-II longitudinal survey, completed by 2516 of the original participants five years later. A subset of 902 parents also participated in telephone interviews as part of Project EAT-I. RESULTS: Findings indicate that many adolescents and parents view family meals in a positive light, but there is great diversity in the context and frequency of family meal patterns in the homes of adolescents. Findings further suggest that family meals may have benefits in terms of dietary intake, disordered eating behaviours, substance use and psychosocial health. CONCLUSIONS: Findings from Project EAT, in conjunction with other research studies on family meals, suggest the importance of working with families to increase the frequency and improve the quality of family meals. Further research is needed in order to elucidate the pathways that underpin the relationships between family meals and health outcomes. Suggestions for a future research agenda based on what was learned from Project EAT are provided.

Does exposure to controlling parental feeding practices during adolescence predict disordered eating behaviors 8 years later in emerging adulthood?

OBJECTIVES: To examine how exposure to controlling parental feeding practices during adolescence is associated with disordered eating behaviors in emerging adulthood. METHODS: Data were analyzed from 543 males and 769 females (Mage at baseline = 14.5 years, Mage at follow-up = 22.7 years) and their parents who participated in the population-based EAT 2010-2018 and Project F-EAT studies. Parental food restriction and pressure-to-eat practices were assessed with items from the Child Feeding Questionnaire. Regression models predicted chronic dieting, unhealthy weight control behaviors, and binge eating, adjusted for demographic covariates, adiposity, and outcome at baseline. RESULTS: Overall, exposure to controlling parental feeding practices during adolescence was not associated with disordered eating behaviors at eight-year follow-up, with one exception. Among males, maternal pressure-to-eat was associated with greater risk of chronic dieting in emerging adulthood. CONCLUSIONS: By emerging adulthood, other factors may be more salient with regard to disordered eating outcomes than parental feeding practices during adolescence.

Disparities in dietary intake, meal patterning, and home food environments among young adult nonstudents and 2- and 4-year college students.

We examined whether young adult meal patterning, dietary intake, and home food availability differed among nonstudents, 2-year college students, and 4-year college students (N = 1687; mean age = 20.5 years). Unadjusted analyses showed that few young adults consumed optimal diets and, compared with 4-year college students, nonstudents and 2-year students consumed fewer meals and poorer diets. After controlling for sociodemographics and living arrangements, we found that over half of the observed associations remained significant (P < .05). Nutrition interventions are needed for young adults, particularly specific at-risk groups.

Does television viewing predict dietary intake five years later in high school students and young adults?

BACKGROUND: Prior research has found that television viewing is associated with poor diet quality, though little is known about its long-term impact on diet, particularly during adolescence. This study examined the associations between television viewing behavior with dietary intake five years later. METHODS: Survey data, which included television viewing time and food frequency questionnaires, were analyzed for 564 middle school students (younger cohort) and 1366 high school students (older cohort) who had complete data available at Time 1 (1998-1999) and five years later at Time 2 (mean age at Time 2, 17.2 +/- 0.6 and 20.5 +/- 0.8 years, respectively). Regression models examined longitudinal associations between Time 1 television viewing behavior and Time 2 dietary intake adjusting for sociodemographic characteristics, Time 1 dietary intake, and Time 2 total daily energy intake. RESULTS: Respondents were categorized as limited television users (<2 hours/daily), moderately high television viewers (2-5 hours/daily), and heavy television viewers (>/=5 hours/daily). Among the younger cohort, Time 1 heavy television viewers reported lower fruit intake and higher sugar-sweetened beverage consumption than the other two groups. Among the older cohort, watching five or more hours of television per day at Time 1, predicted lower intakes of fruits, vegetables, whole grain and calcium-rich foods, and higher intakes of trans fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages (products commonly advertised on television) five years later. CONCLUSION: Television viewing in middle and high school predicted poorer dietary intake five years later. Adolescents are primary targets of advertising for fast food restaurants, snack foods, and sugar-sweetened beverages, which may influence their food choices. Television viewing, especially during high school, may have long-term effects on eating choices and contribute to poor eating habits in young adulthood.

Fast food intake among adolescents: secular and longitudinal trends from 1999 to 2004.

OBJECTIVES: To examine secular and longitudinal changes (1999-2004) in fast food intake among adolescents. METHODS: Adolescents from Minnesota participating in Project EAT (n=2516) were surveyed in 1999 and 2004. Mixed-model regressions were used to assess secular and longitudinal changes in percentage reporting frequent fast food intake (> or =3 times/week) and weekly fast food intake. RESULTS: Between 1999 and 2004, a secular increase in the percent of adolescents of middle (high school-aged) adolescents reporting frequent fast food consumption was observed (females: 18.9% to 27.3%, p<.01, males: 23.6% to 30.2%, p=.06). Longitudinal increases in frequent fast food consumption were seen from early to middle adolescence (females: 15.8% to 27.3%, p<.01, males: 16.8% to 30.2%, p<.01), and among males, from middle to late adolescence (23.6% to 32.0%, p<.01). CONCLUSIONS: The secular increase in fast food consumption among middle adolescents suggests that socio-environmental changes between 1999 and 2004 may have contributed to adolescents' fast food intake, while the longitudinal trends indicate the importance of developmental influences on fast food intake. The transition from early to middle adolescence, and for males, from middle into late adolescence, are key periods during which efforts to reduce fast food consumption are needed.

Making time for meals: meal structure and associations with dietary intake in young adults.

BACKGROUND: Prior studies have found that family meals and other aspects of meal structure are associated with dietary intake during adolescence, but little research has characterized meals in young adulthood. OBJECTIVE: This study was designed to describe attitudes regarding the social nature of meals, time constraints on meals, and meal regularity in young adults. In addition, this study aimed to describe the sociodemographic characteristics of young adults who report eating dinner with others and "eating on the run," and examine associations of these behaviors with meal attitudes and dietary intake. DESIGN: Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a Minnesota population-based study. SUBJECTS/SETTING: Mailed surveys and food frequency questionnaires were completed in 2003-2004 by 1,687 young adult (mean age=20.5 years; 44% male) participants. MAIN OUTCOMES MEASURED AND STATISTICAL ANALYSES PERFORMED: chi(2) tests were calculated to examine differences in meal attitudes and behaviors according to sociodemographic characteristics. Relationships between meal attitudes and behaviors were explored using Spearman's correlation coefficients. Linear regression models adjusted for demographic characteristics were used to examine associations between meal behaviors and dietary intake variables. RESULTS: The majority of young adults reported they enjoy and value eating with others, but 35% of males and 42% of females reported lacking time to sit down and eat a meal. Eating dinner with others was significantly associated (P

Socio-environmental, personal and behavioural predictors of fast-food intake among adolescents.

OBJECTIVE: To identify the socio-environmental, personal and behavioural factors that are longitudinally predictive of changes in adolescents' fast-food intake. DESIGN: Population-based longitudinal cohort study. SETTING: Participants from Minnesota schools completed in-class assessments in 1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while in high school. SUBJECTS: A racially, ethnically and socio-economically diverse sample of adolescents (n 806). RESULTS: Availability of unhealthy food at home, being born in the USA and preferring the taste of unhealthy foods were predictive of higher fast-food intake after 5 years among both males and females. Among females, personal and behavioural factors, including concern about weight and use of healthy weight-control techniques, were protective against increased fast-food intake. Among males, socio-environmental factors, including maternal and friends' concern for eating healthy food and maternal encouragement to eat healthy food, were predictive of lower fast-food intake. Sports team participation was a strong risk factor for increased fast-food intake among males. CONCLUSIONS: Our findings suggest that addressing socio-environmental factors such as acculturation and home food availability may help reduce fast-food intake among adolescents. Additionally, gender-specific intervention strategies, including working with boys' sports teams, family members and the peer group, and for girls, emphasizing the importance of healthy weight-maintenance strategies and the addition of flavourful and healthy food options to their diet, may help reduce fast-food intake.

Longitudinal trajectories and prevalence of meeting dietary guidelines during the transition from adolescence to young adulthood.

BACKGROUND: Establishing healthy dietary habits during adolescence and young adulthood is critical for long-term health. OBJECTIVES: This study assessed the prevalence of meeting US Dietary Guidelines and trajectories in dietary intake for 4 MyPlate food groups during the transition from adolescence to young adulthood. METHODS: Three waves of surveys and food frequency questionnaires were collected as part of Project EAT (Eating and Activity in Teens and Young Adults), a 15-y longitudinal study. Adolescents (n = 1177, 57% female, mean ± SD age 15.0 ± 1.5 y) were recruited in 1998-1999 in Minneapolis-St Paul, Minnesota public schools and were resurveyed twice in young adulthood at mean ± SD ages 25.3 ± 1.5 and 31.1 ± 1.5 y. The prevalence of meeting guidelines for each MyPlate food group was calculated at each time point. Mean daily servings were compared over 5 y in young adulthood through the use of paired t tests. Adjusted least-squares means were calculated to compare dietary intake in young adulthood across quartiles of adolescent intake. RESULTS: Adolescents had the highest prevalence of meeting dietary guidelines for fruit (37% for females and 30% for males) and dairy (53% for females and 61% for males); young adults >30 y had the highest prevalence of meeting dietary guidelines for vegetables (19% for females and 8% for males) and whole grains (23% for females and 17% for males). From the mid-twenties to early thirties, vegetable intake increased, whereas dairy intake decreased. Dietary intake generally tracked over time with individuals in the lower quartiles of intake at adolescence generally continuing to have low intake in young adulthood. CONCLUSIONS: Although the prevalence of meeting dietary guidelines for whole grains and vegetables, and daily servings of vegetables increased with age, improving intake of whole fruit, whole grains, dairy, and vegetables remains key during the transition from adolescence to young adulthood.

Fruit and vegetable intake correlates during the transition to young adulthood.

BACKGROUND: During the transition from adolescence to young adulthood, the intake of fruit and vegetables tends to decline, and national survey data indicate that few young adults consume the recommended amounts. This study aimed to identify longitudinal correlates of follow-up fruit and vegetable intake in early young adulthood. METHODS: Surveys and food frequency questionnaires were completed by 1495 adolescent participants in high school classrooms at baseline (in 1998-1999; mean age=15.9 years, SD=0.8) and by mail at follow-up (in 2003-2004; mean age=20.4 years, SD=0.8). In 2007, linear regression methods were used to identify baseline factors associated with follow-up fruit and vegetable intake. RESULTS: Baseline taste preferences, perceived benefits of healthy eating, fast-food intake, time spent watching television, family-meal frequency, and home food availability were correlates of both fruit and vegetable intake during young adulthood across gender. After adjusting for baseline intake, the only correlate of both fruit and vegetable intake during young adulthood across gender was taste preferences. CONCLUSIONS: The findings suggest that nutrition interventions for adolescents should provide opportunities for them to taste more fruit and vegetables, and should address supports for healthy eating both within and outside the home environment.

Factors associated with overweight among urban American Indian adolescents: findings from Project EAT.

OBJECTIVES: To determine the prevalence of overweight in a sample of urban American Indian adolescents and identify associated behavioral, personal, and socioenvironmental factors. DESIGN AND PARTICIPANTS: Participants were 246 American Indian boys and girls from the Saint Paul-Minneapolis metropolitan area of Minnesota who completed classroom surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study of adolescent nutrition and weight. MEASURES: Survey items assessed behavioral factors (physical activity, television/video viewing, snacking and meal patterns, weight control behaviors), personal factors (body satisfaction, nutrition knowledge, nutrition/fitness attitudes, self-efficacy to make healthy food choices, perceived benefits/barriers to healthy eating), and socioenvironmental factors (family meal routines, family connectedness, parental attitudes regarding nutrition/fitness, availability of household foods, peer attitudes about weight and fitness). RESULTS: Overweight prevalence (body mass index > or =85th percentile) was 43% and 39% for American Indian boys and girls. Compared to nonoverweight American Indian youth, overweight American Indian youth reported watching more hours of television/videos, greater use of weight control behaviors, less frequent snacking, caring less about fitness, lower body satisfaction, and greater parental concern about weight. CONCLUSION: Obesity prevention programs targeting American Indian adolescents should focus on reducing time spent watching television/videos, screening for unhealthy weight-control behaviors, improving body satisfaction, and providing support for families to integrate healthy eating into their busy lifestyles.

Eating, Activity, and Weight-related Problems From Adolescence to Adulthood.

INTRODUCTION: Determining the population-based scope and stability of eating, activity, and weight-related problems is critical to inform interventions. This study examines: (1) the prevalence of eating, activity, and weight-related problems likely to influence health; and (2) the trajectories for having at least one of these problems during the transition from adolescence to adulthood. METHODS: Project EAT I-IV (Eating and Activity in Teens and Young Adults) collected longitudinal survey data from 858 females and 597 males at four waves, approximately every 5 years, from 1998 to 2016, during the transition from adolescence to adulthood. Analyses were conducted in 2017-2018. Measures included high fast-food intake (≥3 times/week), low physical activity (<150 minutes/week), unhealthy weight control, body dissatisfaction, and obesity status. RESULTS: Among females, the prevalence of having at least one eating, activity, or weight-related problems was 78.1% at Wave 1 (adolescence) and 82.3% at Wave 4 (adulthood); in males, the prevalence was 60.1% at Wave 1 and 69.2% at Wave 4. Of all outcomes assessed, unhealthy weight control behaviors had the highest prevalence in both genders. The stability of having at least one problem was high; 60.2% of females and 34.1% of males had at least one problematic outcome at all four waves. CONCLUSIONS: The majority of young people have some type of eating, activity, or weight-related problem at all stages from adolescence to adulthood. Findings indicate a need for wide-reaching interventions that address a broad spectrum of eating, activity, and weight-related problems prior to and throughout this developmental period.

Multicontextual correlates of adolescent sugar-sweetened beverage intake.

PURPOSE: To examine personal, home, peer, school, neighborhood, and media correlates of sugar-sweetened beverage (SSB) intake in a diverse sample of adolescents. METHODS: Cross-sectional, population-based study (EAT 2010: Eating and Activity in Teens) of 2793 adolescents (54% female, mean age [SD] = 14.5 [2.0], 80% nonwhite) attending public secondary schools in Minneapolis-St. Paul, Minnesota. Adolescents completed a food frequency questionnaire and answered survey questions about their diet/health perceptions and behaviors. Socio-environmental data were collected from parents/caregivers, peers, school personnel, Geographic Information Systems (e.g., distance to food outlet), and a content analysis of favorite TV shows. Individual and mutually adjusted mixed-effects regression models examined associations between multi-contextual factors and estimated daily servings of SSB, controlling for relevant covariates. RESULTS: The contextual factors examined accounted for 24% of the variance in adolescents' SSB consumption. The proportion of variance explained by each context was 13% personal, 16% home/family, 3% peer, 1% school, 0.1% media, and 0% neighborhood. The strongest correlate of SSB intake was home soda availability (adjusted for covariates: ß = 0.26, p < 0.01; adjusted for all multi-contextual factors: ß = 0.18, p < 0.01). Other significant correlates of SSB intake included personal behaviors (e.g., fast food intake, sleep), home/family factors (e.g., parent modeling) and peer influences (e.g., friends' SSB intake). CONCLUSIONS: Public health policies and programs to reduce adolescent SSB intake should target personal behaviors (e.g., limit fast food, encourage adequate sleep), address the home setting (e.g., help parents to reduce SSB availability and model healthy eating habits) and involve peers (e.g., identify and enable peers to model healthy eating behaviors).