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INTRODUCTION: Research has demonstrated disparities in depressive symptoms among people who are marginalized. However, more work should examine depressive symptoms through an intersectional lens, recognizing that multiple systems of privilege and oppression interlock to create unique struggles where multiple marginalized identities meet. Recent methodological developments have advanced quantitative intersectionality research using multilevel modeling to partition variance in depressive symptoms to person-level sociodemographic variables and intersectional-level social strata. The purpose of this study is to leverage these methods to examine trajectories of depressive symptoms among young adults in Texas through an intersectional lens. METHODS: Multilevel modeling was used to examine the longitudinal trajectories of depressive symptoms among 3,575 young adults from 24 colleges in Texas assessed seven times between Fall 2014 and Spring 2018. Intersectional identities included sex, race/ethnicity, and sexual and gender minority identities. The model examined time nested within individuals and individuals nested within intersectional social strata. RESULTS: Young adults in Texas experienced an increase in depressive symptoms from 2014–2018. Those with female, Hispanic, AAPI, Other race/ethnicity, or LGBTQ+ identities experienced more depressive symptoms. After controlling for the main effects of the sociodemographic variables, 0.08% of variance in depressive symptoms remained attributed to the effects of intersectional identities. CONCLUSION: Evaluating disparities in depressive symptoms through an intersectional lens offers a more complete description of the epidemiology of depressive symptoms. Communities and institutions that serve marginalized people should consider the elevated burden of depressive symptoms that marginalized people may carry, and integrate culturally competent psychoeducation, assessments, and therapies where possible.

Purpose The present study examined the longitudinal associations between exposure to tobacco advertisements in magazines popular among young adults and changes in the number of tobacco products used by young adults. Methods Participants were 4,824 students from 24 Texas colleges participating in a longitudinal study. Tobacco advertisements in 11 magazines, collected from 2015 to 2017, were objectively assessed and young adults self-reported the frequency of reading each magazine on five biannual surveys from 2015 to 2017. The objective and self-reported measures were multiplied to create a tobacco advertisement exposure score. Growth curve models were used to determine if exposure to tobacco advertisements in magazines predicted changes in the number of tobacco products used across the 2-year period, controlling for sociodemographic factors, ever tobacco use, recall of tobacco advertisements on the internet, and personality characteristics. Results Young adults with more exposure to tobacco advertisements reported a slower decline in the number of tobacco products they used across time. Conclusions Tobacco advertising in magazines contributes to the continuation of single-product and polyproduct use among young adults. Findings highlight the need for additional federal regulations limiting advertisements for all types of tobacco products in magazines, particularly those popular among young adults, the youngest legal targets of the tobacco industry.

ObjectiveTo examine (1) if tobacco retail outlets (TROs) closer to middle and high schools have more tobacco advertisements than TROs farther away and (2) the potential impact of two place-based tobacco control strategies on tobacco advertisements: a simulated ban of TROs (1) within 1000ft of schools and (2) within 500 ft of other TROs.MethodsTROs within half-mile of 53 middle and high schools in the four largest Metropolitan areas in Texas were audited for all tobacco marketing. ArcGIS was used for mapping and grouping TROs by distance from the schools and simulating the ban. Mean differences in the number of tobacco advertisements were examined with t-tests. Percentage reductions in tobacco advertisements were calculated after simulation of both bans, reported by school type and by location, product and flavour.ResultsTROs within 1000 ft of schools had significantly more tobacco advertisements as compared with TROs located within 1000-2000 ft (p=0.03) for all schools combined and middle schools. Simulation of the 1000 ft ban of TROs led to a slightly greater reduction in advertisements (19.4%) as compared with the 500 ft ban of TROs from other TROs (17.9%). The reduction in all advertisement types was greater around middle schools and greatest for e-cigarettes (23.6%).ConclusionStudents can be exposed to a great deal of tobacco advertising in TROs around their schools. The implementation of a 1000 ft ban of TROs, or at minimum a ban on tobacco advertising outside and within these outlets, is one way to prevent or reduce the use of tobacco among adolescents.

Diverse tobacco and nicotine products have altered the terrain of tobacco use behaviors. Limited research has examined contemporary patterns of use among young adults. This study identified tobacco and nicotine product use groups and examined changes in young adults’ use patterns, across a 1.5-year period. Participants were 5,482 18–29-year-old students (M age = 20.5, SD = 2.36; 63% female) from 24 Texas colleges who completed a four-wave bi-annual online survey. Latent transition analysis was used to identify groups from 10 items (ever and current use of cigarettes, cigars, smokeless tobacco, e-cigarettes, and hookah) and to examine probabilities of transitioning between groups over four waves. Five groups were identified: Non-users (30%), Poly-experimenters (26%), Hookah experimenters (18%), E-cigarette & hookah experimenters (15%), and Poly-cigarette users (11%). Few students transitioned between groups over time. Poly-cigarette users had the highest average probability of remaining stable over time (1.00), followed by E-cigarette & hookah experimenters (.97), Non-users (.94), Poly-experimenters (.93), and Hookah experimenters (.92). All groups became more stable over time except Hookah experimenters whose members were most likely to transition to Poly-cigarette users or other experimenter groups. The greatest transition was from Poly-experimenters to Poly-cigarette users with probabilities of .10, .08, and .03 for transitioning between waves one and two, two and three, and three and four, respectively. There was substantial poly-use and experimentation, which may explain little movement between groups over the 1.5-year time period and underscores the need for prevention programs targeting multiple product use among college students.

Background Factors associated with marijuana use in electronic nicotine delivery systems (ENDS) are largely unknown. ENDS advertising, through subtle normative cues as well as explicit and implicit messages suggesting ENDS products are socially condoned and healthier alternatives, may influence the use of marijuana in ENDS. The aim of our study was to examine the association between exposure to ENDS advertising and subsequent use of ENDS with marijuana among college students. Methods Data for this study were from waves 2 and 4 of the Marketing and Promotions across Colleges in Texas (M-PACT) study. Participants included 3720 college students (mean age = 21.4, SD = 2.3; 35.78% white; 35.7% male) across 24 colleges in Texas who completed online tobacco behavior surveys one year apart. Multilevel logistic regression was conducted to examine the association between ENDS advertising exposure at wave 2 (spring 2015) and use of marijuana in ENDS one year later at wave 4 (spring 2016), controlling for age, sex, race/ethnicity, and wave 2 sensation-seeking, impulsivity, current tobacco use, current marijuana use, and ever use of ENDS with marijuana. Use of ENDS to consume marijuana in the past six months was the outcome variable and ENDS advertising exposure was the independent variable. Results Nearly half of participants reported ever ENDS use at waves 2 and 4, and 10% used marijuana in ENDS in the past 6-months at wave 4. Multilevel logistic regression analyses indicated that for every unit increase in ENDS advertising exposure, the odds of subsequently using ENDS with marijuana one year later were 1.08 times (95% CI = 1.01–1.14) greater. Conclusions ENDS advertising uniquely contributed to the subsequent use of marijuana in an ENDS, over and above the effects of other risk factors.

OBJECTIVE: To develop an informed, reliable data collection tool to code restaurants found within the youth food environment. METHODS: Registered Dietitians were surveyed and academic literature review was reviewed to determine health centric food environment features. Features were incorporated into an electronic data collection tool. Inter-rater reliability was tested across coders of varying nutrition training on all restaurants located within a half-mile of three high schools. RESULTS: Sixteen restaurant food environment codes were generated. Data collection had a mean inter-rater reliability of 90.7% agreement (range=81.3–100%), suggesting that regardless of nutrition training, the restaurant food environment can be reliability coded. CONCLUSIONS: Academic and public health professionals can use this tool to collect reliable, informed local restaurant food environment data.

AIMS To examine the longitudinal trajectory of young Texan (US) adults' electronic nicotine delivery systems (ENDS) use from 2014 to 2019, and to determine if there are changes in the trajectory among younger and older young adults post-2017, when vape pods surged in popularity in the United States. DESIGN Nine-wave longitudinal study, with 6 months between each of the first eight waves and 1 year between the last two waves. Discontinuous, or piecewise, growth curve models were used to test the hypotheses that (a) the overall current/past 30-day ENDS use trajectory would decline from 2014 to spring 2017 but then increase from fall 2017 to 2019, and (b) the increasing trajectory from 2017 to 2019 would occur only for younger participants, but not older participants. All models included socio-demographic covariates of sex, race/ethnicity, type of college attended at baseline (2- or 4-year) and time-varying age. SETTING AND PARTICIPANTS A total of 5218 students (aged 18-25 years at baseline; 63.7% female) from 24 colleges in the five counties surrounding Austin, Dallas/Fort Worth, Houston and San Antonio, Texas, USA. MEASUREMENTS Participants completed on-line surveys regarding past 30-day ENDS use at all nine waves. FINDINGS Current ENDS use significantly declined from 2014 to spring 2017 [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.59-0.68], and then significantly increased from autumn 2017 to 2019 (OR = 1.14, 95% CI = 1.01-1.29). Further examination indicated the increase in current ENDS use from autumn 2017 to 2019 occurred only for younger [-1 standard deviation (SD) below the mean age, 22.6 years old], but not older (+1 SD above the mean age, 26.2 years old), participants. CONCLUSION The surge in the popularity of vape pods in the United States in late 2017 may have contributed to increasing use of electronic nicotine delivery systems among younger young adults (below 22.6 years) from late 2017 to 2019.

OBJECTIVE: In this study, we investigated the relationship between school e-cigarette policy and e-cigarette use among students. Secondarily, we examined whether this relationship varied by administrator perceptions about e-cigarette use being “an issue.” METHODS: Data were utilized from written school policies, a school tobacco surveillance study of 2755 students (N = 310,412), and administrator interviews in 54 Texas schools. RESULTS: When administrators perceived e-cigarettes as an issue, the odds of ever e-cigarette use, susceptibility to use e-cigarettes, and perceived peer use of e-cigarettes were 0.20–0.54 times lower for students attending schools that had an e-cigarette policy compared to those without a policy (p < .05). CONCLUSION: The impact of school policies on student e-cigarette use behavior is positive if policies are strongly implemented.

Although some research has focused on the food environment and food marketing, little has examined outdoor food and beverage (FB) advertising, particularly its relationship to the Hispanic composition in schools. Therefore, the purpose of this study was to determine if the prevalence of outdoor FB advertising was greater around middle and high schools with a majority Hispanic population as compared to schools with a lower Hispanic population.All FB advertisements located within a half-mile of 47 schools in Central Texas were documented. Advertisements were coded as free standing or on establishments. Advertisements were coded for theme including price (emphasizing price) and deals/value meals (promoting discounted price/meal deals). These two themes were combined to create an overall price promotion variable. In order to determine if the prevalence of FB advertising varied by the Hispanic composition of the students in the school, data from the Texas Education Agency was used to create a variable which dichotomized the schools into two groups: schools that reported ≥60% Hispanic students or 'Hispanic schools' (n = 21) and schools that reported60% Hispanic students or 'non-Hispanic schools' (n = 26). Linear regression analyses were conducted to determine if the prevalence of outdoor FB advertising was greater around Hispanic schools as compared to non-Hispanic schools.Hispanic schools had more overall outdoor FB advertisements as compared to non-Hispanic schools (p = 0.02). Similarly, we found significantly more outdoor FB establishment (p = 0.02) and price promotion (p = 0.05) around Hispanic schools as compared to non-Hispanic schools. Differences in freestanding advertisements by school type approached significance (p = 0.07) with Hispanic schools having more freestanding FB advertisements on average.Further research is needed that documents the content of these advertisements and determines the extent to which these advertisements affect Hispanic and other racial/ethnic minority youth's attitudes and behaviors toward the consumption of these products.

Introduction Few studies examine the impact of objective exposure to point-of-sale (POS) marketing for cigars including little cigars and cigarillos (LCCs) on tobacco use. The present study aimed to examine the relationship between exposure to LCC marketing at the POS and current and future use of LCCs and cigarettes among young adult college students. Method Data on LCC and cigarette use from 4201 young adult students (mean age = 22.8 [SD = 2.3]; 35.9% non-Hispanic whites) attending 24 Texas colleges was linked to objective assessments of POS marketing at 220 tobacco retail outlets within one mile of the colleges. Multilevel logistic regression analyses examined the impact of LCC marketing at the POS on use of LCCs and cigarettes currently and 6-months later. Results Participants were, on average, exposed to 43 LCC marketing materials per week. Results from cross-sectional analyses indicated that exposure to LCC POS marketing was associated with higher odds of current use of LCCs (AOR = 1.003, 95% CI = 1.0002, 1.0053) and cigarettes (AOR = 1.006, 95% CI = 1.0050, 1.0075). The relationship between LCC POS marketing exposure and LCC use was not significant in longitudinal models; however, exposure to LCC POS marketing at baseline did predict current cigarette use at 6-month follow-up (AOR = 1.004, 95% CI = 1.0021, 1.0052). Conclusion Findings suggest a substantial influence of LCC marketing exposure at the POS. Regulations on LCC marketing at the POS, especially around college campuses, should be considered.

Purpose E-cigarettes are currently the most commonly used tobacco product among US youth. However, unlike conventional cigarettes, e-cigarettes are not subject to marketing restrictions. This study investigates the association between exposure to e-cigarette marketing and susceptibility and use of e-cigarettes in youth. Methods Data were obtained from the 2014 National Youth Tobacco Survey. Participants were 22,007 US middle and high school students. Multivariate logistic regression models assessed the relationship between e-cigarette marketing (internet, print, retail, and TV/movies) and current and ever use as well as susceptibility to use e-cigarettes among never e-cigarette users. Results Exposure to each type of e-cigarette marketing was significantly associated with increased likelihood of ever and current use of e-cigarettes among middle and high school students. Exposure was also associated with susceptibility to use of e-cigarettes among current nonusers. In multivariate models, as the number of channels of e-cigarette marketing exposure increased, the likelihood of use and susceptibility also increased. Conclusions Findings highlight the significant associations between e-cigarette marketing and e-cigarette use among youth and the need for longitudinal research on these relationships.

OBJECTIVE: The purpose of this study is to examine differences between current and non-current cigarette users, focusing on sociodemographic factors, non-cigarette tobacco product use, parental and friend use, and alcohol and marijuana use; and to identify predictors of cigarette use six months later. PARTICIPANTS: Participants included young adults (n = 4,296) from 24 Texas colleges, participating in a young adult cohort study, beginning in fall 2014. METHODS: Mixed effects logistic regressions were conducted accounting for school-level variability. RESULTS: Cigarette users were older, more likely to report use of non-cigarette tobacco products and peer use of cigarettes than non-current users. Wave 1 cigarette and non-cigarette tobacco product use, marijuana use and binge drinking, and peer use all uniquely predicted cigarette use at wave 2. CONCLUSIONS: Colleges need prevention programs targeting multiple tobacco products, because non-cigarette tobacco use and other risky behaviors appear to be independent risk factors for cigarette use in young adults.

Aims: Numerous interventions have been designed to impact children’s diet in the elementary school setting. One popular strategy is to label foods in the elementary cafeteria as more or less healthy. An example is the Coordinated Approach To Child Health (CATCH) labels of ‘go’, ‘slow’, or ‘whoa’ foods. In many respects, this has been successful, as food purveyors have responded by offering more healthy versions of popular foods (e.g. hamburgers with a high soy content) in an effort to avoid the less healthy, ‘whoa’ label. While this provides an obvious benefit to children’s dietary choices and overall risk of obesity, it may have the unintended consequence of not setting up youth to make healthy choices in the environment outside of schools where these foods have not been altered. In response, the current study was designed to compare school labels and registered dietitian (RD) recommendations of common elementary lunch options. Methods: In the spring of 2010, 28 RDs provided their recommendation of ‘generally healthy, choose often’; ‘generally less healthy, choose less often’; and ‘generally unhealthy, choose rarely’ for 48 common school lunch options. RDs were not told how schools categorised each selection. Kappa analyses were used to determine agreement between school labels and RD recommendations. Results: Results indicate some disagreement between school labels and RD recommendations, with higher fat/calorie entrées showing greater discrepancies. Conclusions: Given these inconsistencies, nutrition education in schools should be designed to help children and their parents understand how foods offered in school may differ from those outside the school environment.

Objective We examined the impact of e-cigarette advertising on e-cigarette use behaviors among youth over time. Methods At baseline, 3907 students participated in a youth tobacco surveillance study from 2014-2015 and 2488 students completed a 6-month follow-up. Weighted logistic regression models investigated the recall of e-cigarette advertisements (TV/radio/billboards/retail/Internet) as a risk factor for e-cigarette perceived harm, use, and susceptibility. Results The odds of ever e-cigarette use was 3 times higher (AOR=2.99; 95% CI, 1.50-5.97) at 6-month follow-up among e-cigarette never-users who recalled e-cigarette advertisements in retail stores at baseline, compared to those who did not. Likewise, the odds of current e-cigarette use and susceptibility to e-cigarette use at 6-month follow-up were 2.03 (95% CI, 1.11-3.72) and 1.77 (95% CI, 1.20-2.61), respectively. Additionally, recall of e-cigarette advertisements on the Internet at baseline was significantly related to current use (AOR=2.17; 95% CI, 1.05-4.48) and susceptibility to use e-cigarettes (AOR=1.72;95% CI, 1.15-2.58) at 6-month follow-up. Conclusions Recall of e-cigarette advertisements at point-of-sale and on the Internet was significantly associated with adolescent e-cigarette susceptibility and use, which supports the need to minimize adolescent exposure to these advertisements.

An increasing body of research indicates that use of electronic nicotine delivery systems (ENDS) predicts cigarette initiation. However, no studies examine if risk for cigarette initiation varies for exclusive ENDS users versus users of ENDS and other tobacco products. This study examined if: a) cigarette-naïve young adults (i.e., never cigarette users) who ever used ENDS had a greater odds of initiating cigarettes than non-ENDS users over a 1.5year period and b) the odds of cigarette initiation was consistent across exclusive ENDS users and users of ENDS and at least one tobacco product.Participants were 2558 cigarette-naïve 18-25year old (M=19.71; SD=1.61) students from 24 Texas colleges who participated in a four-wave study, with six months between each wave.Overall, 11% of students reported cigarette initiation by wave 4. Of those, 20.1% were wave 1 ENDS users and 8.4% were non-ENDS users. Multivariable, multilevel discrete-time hazard models indicated that wave 1 ENDS use predicted subsequent cigarette initiation, over and above the significant effects of cigarette use susceptibility, family-of-origin tobacco use, friend cigarette use, and other tobacco use. Additional findings indicated that exclusive ENDS users had a greater odds than non-users of subsequent cigarette initiation. Among users of alternative tobacco products, ENDS users did not have a greater odds of initiation than non-ENDS users.Findings extend existing research by showing that ENDS use by young adults is a specific risk factor for later cigarette initiation and not an extension of a constellation of existing tobacco use behaviors.

Exposure to cigarette coupons is associated with smoking initiation and likelihood of cigarette purchase among adolescents. Some adolescents who are exposed to cigarette coupons take a step further by choosing to save or collect these coupons, a further risk factor for cigarette smoking. This study examines historical trends and disparities in cigarette coupon saving among adolescents in the United States from 1997 to 2013. National samples of 10th and 12th grade students (n=129,111) were obtained from Monitoring the Future surveys in 1997-2013. Prevalence of lifetime and current cigarette coupon saving was estimated in each year in the overall adolescent population, and in race/ethnicity, parent education level, sex, and urban/rural subgroups. Prevalence of lifetime and current cigarette coupon saving was then estimated in each year based on smoking status. Prevalence of cigarette coupon saving has decreased dramatically among adolescents; only 1.2% reported currently saving coupons in 2013. However, disparities in cigarette coupon saving remain with prevalence higher among rural, White, and low parental education level students. Adolescent smokers continue to save coupons at high rates; 21.2% had ever saved coupons and 6.9% currently saved coupons as of 2013. Despite overall declines in adolescent cigarette coupon saving, existing sociodemographic disparities and the considerably high prevalence of coupon saving among adolescent smokers suggest that cigarette coupons remain a threat to smoking prevention among youth. Additional research is needed to further elucidate longitudinal associations between cigarette coupon saving and smoking initiation and maintenance among adolescents.

Introduction: To identify the geospatial association between the presence of retail tobacco outlets (RTO) around school's neighborhoods, and current use of cigarettes and e-cigarettes among adolescents in four counties in Texas.Methods: Students in grades 6, 8 and 10th were surveyed in their schools in 2014-2015. The schools’ addresses was geocoded to determine the presence of at least one RTO within half a mile of the school. Two outcomes were considered: past 30-day use of (a) cigarettes and (b) e-cigarettes. Bayesian structured additive regression models and Kriging methods were used to estimate the geospatial associations between the presence of RTO and use in three counties: Dallas/Tarrant, Harris, and Travis.Results: We observed a geospatial association between the presence of RTO around the schools and current use of cigarettes in the eastern area of Dallas County and in the southeastern area of Harris County. Also, a geospatial association between the presence of RTO around the schools and current use of e-cigarettes was observed in the entire Tarrant County and in the northeastern area of Harris County.Conclusions: There were geospatial associations between the presence of RTO around some schools and cigarette/e-cigarette use among students, but this association was not consistent across all the counties. More research is needed to determine why some areas are at higher risk for this association.

A social multiplier effect is a social interaction in which the behavior of a person in a social network varies with the normative behavior of others in the network, also known as an endogenous interaction. Policies and intervention efforts can harness social multiplier effects because, in theory, interventions on a subset of individuals will have “spillover effects” on other individuals in the network. This study investigates potential social multiplier effects for violence in middle schools, and whether there is evidence for a social multiplier effect transmitted from girls to boys. Three years of longitudinal data (2003–2005) from Project Northland Chicago were used to investigate this question, with a sample consisting of youth in Grades 6 through 8 in 61 Chicago Public Schools (N = 4,233 at Grade 6, N = 3,771 at Grade 7, and N = 3,793 at Grade 8). The sample was 49.3 % female, and primarily African American (41.9 %) and Latino/a (28.7 %), with smaller proportions of whites (12.9 %), Asians (5.2 %) and other ethnicities. Results from two sets of regression models estimating the effects of 20th (low), 50th (average), and 80th (high) percentile scores for girls and boys on levels of violence in each gender group revealed evidence for social multiplier effects. Specifically, boys and girls were both influenced by social multiplier effects within their own gender group, and boys were also affected by normative violence scores among girls, typically those of the best-behaved (20th percentile) girls. The finding that girls may have positive social influence on boys’ levels of violent behavior extends prior findings of beneficial social effects of girls on boys in the domains of education and risky driving. Further, this social normative effect presents a potential opportunity to improve school-based intervention efforts for reducing violence among youth by leveraging girls as carriers of a social multiplier effect for reduced violence in the middle school environmental context, particularly among boys, who are at greater risk.

Many school-based interventions have been aimed at alcohol use prevention among youth, but with limited effectiveness.1,2 One potential avenue for making school-based drinking interventions more effective is through the use of social multipliers. A social-multiplier effect is produced when policies take advantage of the tendency of individual behaviors to vary with the behavior of the reference group.3 For example, recent research in the area of obesity suggests that young people’s social networks may be used as social multipliers, so that the benefits of obesity prevention activities can be extended beyond the direct target of the intervention.4,5 This approach of targeting social networks is likely to be cost-effective because scarce resources could be spent on reaching influential persons and changing their behaviors, rather than spreading efforts more thinly across all students. For example, a given funding level may be sufficient if it fully involves only 10% of students, whereas it might be insufficient if spread over 100% of students. In the former case, there might be a smaller number of influential -dents (eg, peer leaders) that could diffuse prevention messages and norms.6,7 However, identifying influential students is key to this strategy. In this paper, we start with the assumption that identifying overlapping friendship networks is too complex and time-consuming to be used as part of a broadly implemented intervention. Instead, we focus on the distribution of drinking behavior within grade levels at schools. Our primary goal is to address the questions: Which points in the drinking distribution, within school and grade, are important in the “contagion” of drinking over time? Are students who are extreme in drinking behavior more influential who are average or normal with regard to drinking more influential? Alcohol use, the focus of our investigation, is an important problem to address at younger ages because early-onset drinking is associated with problem drinking behaviors later in life. It is a well-replicated finding that the younger a person starts drinking, the greater the risk for alcohol-related problems.8,9 These problems include impaired brain development and intellect, alcohol-related cirrhosis, and alcohol dependence.5,9,10 Alcohol use also has immediate consequences for adolescents, including increased risk for traffic crashes, crime, unintentional injury, disease, risky sexual behavior, academic problems, depression, homicide, and suicide.11,12 Drinking is also a social behavior. Although some reasons to drink are intrapersonal, such as personality type and social skills,11 many influences to drink are social, including prevalence of drinking in the home, in the community, and among peers.12 Major social influences among adolescents are family members, peers, school colleagues and personnel, and media models.13–15 Adolescents are thought to observe, bond to, and in turn model the social behaviors of those who are influential. Peers are thought to be the most significant social-risk factor in adolescent experimentation with alcohol and drugs—more important than the influence from parents.13,16 For example, Keefe17 documented that as youths age, parental influence on sub -stance use decreases, but peer influence remains strong and consistent. Peer influence on substance use is thought to occur through several avenues. In terms of socialization, adolescents may adjust their behaviors based on attitudes and behaviors of others in the surrounding environment.18 There is also evidence for a false consensus effect among adolescents in which adolescents overestimate peer acceptance for drugs or alcohol as a social norm,19,20 with some studies showing that perceived use among peers is more influential for behavior than actual use.21 Finally, in terms of self-selection, adolescents may choose to associate with peers who are similar to them and who readily have drugs or alcohol available.22 Fortunately, focusing on the distribution of drinking behavior among grades within schools not only sidesteps the effort needed to identify peer networks, but also allows us to avoid selection problems because grade-level peers are assigned rather than selected. Our research questions were as follow. First, who has more influence on the alcohol consumption of classmates: students who are extreme for drinking, or students who are average or normal with regard to drinking? Second, do these effects differ by gender, or according to whether peers’ cognitions (intentions) versus actual behaviors are used as the marker of drinking? Last, is there evidence that either extreme or average drinking behaviors or intentions actually change the distribution of drinking behaviors in this age-group over time, highlighting their role as social multipliers for drinking? One hypothesis is that students in a grade or in a school gauge their behavior against that of higher-risk students, with the idea that anything up to that level is “okay.” On the other hand, students may gauge their behavior on the grade average. If the former hypothesis is true, scarce resources could be concentrated on the extreme students, which would lead to a social-multiplier effect because everyone else will be influenced.

Purpose Hookah is an increasingly popular tobacco product among college students. The purpose of this study was to determine if college students are aware of tobacco and nicotine content in hookah, and examine associations between college students’ knowledge and perceptions of hookah and their past 30-day hookah use. Methods Participants were 5451 young adults attending one of 24 2- and 4-year colleges. Analyses examined if hookah knowledge was uniquely associated with current hookah use, over and above perceptions of harm and addictiveness, number of other tobacco products currently used, and socio-demographic factors. Analyses were first conducted for the entire sample and then only for current hookah users. Results 26.9% of all students believed hookah did not contain tobacco and 38% believed that hookah did not contain nicotine. Students who believed that hookah contained tobacco were at increased odds of hookah use, and those with increased perceptions of harm were at decreased odds of hookah use. However, hookah knowledge was not associated with hookah users’ intensity of use. Moreover, although increased perceptions of harm were associated with lower intensity of use among current users, increased perceptions of addictiveness were associated with higher intensity of use. Conclusions This study shows gaps in knowledge of hookah contents, and adds to the body of literature, which provides evidence for mandating warning labels as well as tobacco interventions for college students.

Objectives We examined patterns of tobacco and electronic cigarette (e-cigarette) use among college students. Differences in sociodemographic characteristics between non-users of these products and 4 mutually exclusive groups of tobacco/e-cigarette users were assessed. Differences in cigarette cessation attempts and dependence between exclusive cigarette smokers and users of cigarettes and at least one alternative tobacco product also were examined. Methods Participants were 5468 18-29 year-old students from 24 colleges in Texas who completed an online survey. Results Multiple-product use was more prevalent than single-product use. All 4 current tobacco/e-cigarette-user groups were more likely than non-users to be men and older. College students who were younger when they smoked their first cigarette, and those reporting ever needing a cigarette, were more likely to be multiple-product users than cigarette-only users. There were no group differences in cigarette cessation attempts or any other variables. Conclusions Using multiple products is associated with some indicators of dependence, but does not seem to aid or deter college students' smoking cessation attempts. Longitudinal research is needed given that transitions in tobacco/e-cigarette use continue throughout young adulthood.

Evidence is building regarding the association between inadequate amounts of sleep and the risk of obesity, especially in younger children. Less is known about the relationship between change in sleep and change in weight during adolescence. The objective of this study was to examine the longitudinal relationship between change in sleep duration and change in body mass index (BMI) and percent body fat (PBF) in a cohort of adolescents. The cohort included 723 adolescents (mean age = 14.7 years at baseline) from Minnesota. Total sleep duration was assessed via self-report. BMI and PBF were objectively assessed. Covariates used in the multivariate analyses included energy intake as assessed through 24-hour recalls, activity levels as assessed by accelerometers, screen time/sedentary behavior, depression, and sociodemographic characteristics. For both males and females, average BMI and PBF increased slightly over the 2 years and average sleep duration decreased by about 30 minutes. The authors saw no statistically significant longitudinal relationships between change in total sleep and change in BMI or PBF over time in either girls or boys. The only longitudinal relationship that approached statistical significance was a positive association between sleep and PBF in females ( p = .068). This research contributes to the literature as the only study to date to examine how change in sleep duration during adolescence may be related to a concomitant change in BMI and body fat. The findings of this study do not support the hypothesis that a decline in sleep duration during adolescence increases obesity risk.

Despite the known deficits in sleep that occur during adolescence and the high prevalence of substance use behaviors among this group, relatively little research has explored how sleep and substance use may be causally related. The purpose of this study was to explore the longitudinal bi-directional relationships between sleep duration, sleep patterns and youth substance use behaviors. Participants included 704 mostly white (86.4 %) youth, 51 % female, with a baseline mean age of 14.7 years. Self-reported substance use behaviors included past month alcohol, cigarette, and marijuana use. Sleep measures included sleep duration on weekends and weekdays, total sleep, weekend oversleep, and weekend sleep delay. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between sleep and substance use adjusting for socio-demographic characteristics, pubertal status, body mass index z-score, and depressive symptoms. Cigarette use and weekend sleep were bi-directionally related as were marijuana use and total sleep. No other bi-directional associations were identified. However, alcohol use predicted shorter weekend oversleep and marijuana use predicted increased weekend sleep and weekend oversleep. Sleep patterns and duration also predicted adolescents' cigarette, alcohol, and marijuana use. Sleep, both patterns and duration, and substance use among youth are intertwined. Future research is needed to explore these bi-directional relationships, as well as other important contextual factors that may moderate these associations.

Cigarette smoking is the leading cause of death in the United States;1 these deaths are both premature and preventable.2,3 Most adult smokers begin to smoke in adolescence.4,5 By eighth grade, more than a quarter of US students have tried cigarettes, and by the end of high school, the percent who have tried smoking increases to more than half.6,7 In fact, every day nearly 5500 youth under age 18 try cigarettes for the first time, and almost 3000 more become daily smokers.3,8, Tobacco use also increases after school transitions, for example, the transition from middle to high school.8–10 The pattern for initiation of cigarette use is the same as that seen for other drugs (alcohol and marijuana): use begins gradually in elementary and middle school, accelerates in late middle and high school, continues to increase during young adulthood, and gradually stabilizes or decreases in middle adulthood.8 Given the addictive nature of smoking, the focus of public health efforts has been to prevent smoking among children.11–13 Recent research on health behaviors and peer influence, particularly in the area of obesity, has offered a hopeful sign: perhaps peer group effects,14 which partly cause poor health behavior, can also improve health behavior. If influential persons within peer groups change behavior, this may lead others in the peer group to improve behavior, even if they themselves are not a direct target of the intervention. The ripple effects of changes in health behaviors carrying over to others is known as a social multiplier.15 The existence of social multipliers means that scarce prevention resources could conceivably be concentrated on smokers or potential smokers rather than spreading resources more thinly across all children, who may or may not be at specific risk for smoking. Peer influence may be the most significant social risk factor in adolescent experimentation with drugs such as tobacco; it is more powerful than parental influence.16–18 Keefe19 showed that as youth age, parental influence on substance use decreases, but peer influence remains strong and consistent. The result that peers are more influential than parents in predicting adolescent substance use, and cigarette use in particular, is well replicated.19–21 Peers have also been shown to have a greater influence on adolescent substance use than antismoking information from the media,26 which makes sense intuitively because peers are more proximal or immediate.16,23 This influence of peer smoking on the individual is robust, whether the adolescent is in middle or high school and whether he or she is a trier or an experimenter.16 Interestingly, peer smoking seems to change middle school students’ strong intentions not to smoke more than it increases levels of smoking intentions.24 There are several reasons that peer effects have a strong effect on adolescent smoking. First, adolescents tend to spend most of their time interacting with peers and tend to disengage from parents.25,26 Second, cigarette use has been found to represent a symbol of identification with a particular peer group, moreso than alcohol and marijuana.8 Third, repeated exposure to nicotine may lead adolescents to develop a more favorable sense of the tobacco smell, or addiction to nicotine via chemical reactions, which increases desire for cigarettes.3,27 Fourth, there is evidence for a “false consensus effect” in which adolescents overestimate peer acceptance for smoking as a social norm.28–30 Finally, in terms of self-selection, adolescents may choose to associate with their peers because this increases cigarette availability.21

To determine whether alcohol use behaviors and alcohol-related consequences differed among students attending two-year versus four-year colleges.Participants (N=13,700) from 7 two-year and 11 four-year colleges completed the 2010 College Student Health Survey. Alcohol use behaviors included past year alcohol use, past month alcohol use, and binge drinking over the past two weeks. Alcohol-related factors included average calculated blood alcohol level and average number of alcohol-related consequences. Cross-sectional mixed-effects regression analyses were conducted to determine if the prevalence of alcohol-related behaviors and consequences differed among two-year and four-year students.Students attending four-year colleges, particularly males, were more likely to report past year alcohol use, past month alcohol use, and binge drinking, as well as a higher average blood alcohol content and a greater number of alcohol-related consequences than their two-year counterparts (p0.05). Among female students there were fewer differences between two-year and four-year college students. Many differences remained after adjusting for socio-demographic factors (e.g., age, race/ethnicity), however, with the addition of living situation as a covariate, several of the differences among males were no longer significant.Significant differences in alcohol-related behaviors and consequences exist among students attending two-year versus four-year colleges. While the prevalence of alcohol-related behaviors and consequences was lower among two-year college students, they are not a population to be over-looked. The prevalence of alcohol use remains high among both two-year and four-year college students, making it important for researchers to design appropriate interventions for all students regardless of the type of institution being attended.

Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed.

Obesity may cluster in families due to shared physical and social environments.This study aims to identify family typologies of obesity risk based on family environments.Using 2007-2008 data from 706 parent/youth dyads in Minnesota, we applied latent profile analysis and general linear models to evaluate associations between family typologies and body mass index (BMI) of youth and parents.Three typologies described most families with 18.8% "Unenriched/Obesogenic," 16.9% "Risky Consumer," and 64.3% "Healthy Consumer/Salutogenic." After adjustment for demographic and socioeconomic factors, parent BMI and youth BMI Z-scores were higher in unenriched/obesogenic families (BMI difference = 2.7, p 0.01 and BMI Z-score difference = 0.51, p 0.01, respectively) relative to the healthy consumer/salutogenic typology. In contrast, parent BMI and youth BMI Z-scores were similar in the risky consumer families relative to those in healthy consumer/salutogenic type.We can identify family types differing in obesity risks with implications for public health interventions.

BACKGROUND: The purpose of this study was to describe the extent to which vending offerings in 106 schools in the St. Paul-Minneapolis, Minnesota metropolitan area, met criteria for types of beverages, fat, and calories based on selected criteria offered by the Institute of Medicine. METHODS: Schools where youth participants were attending for the 2006–2007 school year were identified and invited to participate in the study (n = 143); 81% of schools (n = 116) agreed to participate. RESULTS: Of the 116 schools, 106 had vending machines. Across schools with vending machines (n = 106), 5085 food and 8442 beverage items were offered. Overall, only 18% of beverage items met criteria for calories and type of beverage; significantly more items in public schools met the criteria as compared to private schools (19% vs 12%; p < .01). This difference was also significant for high schools as compared to middle schools (18% vs 22%; p < .01). For food items, 41% met calorie criteria, 45% met fat criteria, and 22% met both fat and calorie criteria. Significantly more food items met both criteria in public than private schools (22% vs 18%; p = .01), while high schools (22%) and middle schools (21%) were similar. A very small proportion of foods (

The objective of this study was to determine whether obesity prevalence and weight-related behaviors (e.g., diet, physical activity) differ among students enrolled in two-year community/technical colleges and those attending four-year colleges/universities. This information could inform the development of intervention strategies. Through an existing surveillance system of Minnesota post-secondary education institutions, survey data were collected from 16,539 students from 27 campuses (14 two-year college campuses, 13 four-year college/university campuses; 2007-2008), including self-reported physical activity, media use, dietary patterns, weight control behaviors, height and weight. Unadjusted analyses indicated that students enrolled in two-year colleges, particularly females, had a higher prevalence of overweight/obesity, lower levels of physical activity, more television viewing, higher intakes of soda, fast food, and diet pills compared to students attending four-year colleges (p

Research is limited on how the social environment of the home is related to childhood obesity.The purpose of this research was to examine the relationships between positive family meal practices, family stressors, and the weight of youth and to examine parental weight status as a moderator of these relationships.The study enrolled 368 parent/child dyads from a Minnesota sample. We used mediation analysis to examine the associationsFamilies represented by an overweight parent reported fewer positive family meal practices (p 0.001), higher levels of depression (p = 0.01), and fewer family rules (p = 0.02) as compared to families represented by a healthy weight parent. For overweight parents, positive family meal practices mediated the relationship between some family stressors and child weight.This research suggests that the home environment may affect the weight of children in the family, and the effect is more pronounced in families with at least one overweight parent.

ObjectiveTo examine neighbourhood food environments, adolescent nutrition and weight status.DesignCross-sectional, observational study.SettingMinneapolis/St. Paul metropolitan region, Minnesota, USA.SubjectsA total of 349 adolescents were recruited to the study. Participants completed 24 h dietary recalls and had their weight and height measured. They also reported demographic information and other diet-related behaviours. Geographic Information Systems were used to examine the availability and proximity of food outlets, particularly those captured within the 800, 1600 and/or 3000 m network buffers around participants’ homes and schools.ResultsAdjusting for gender, age and socio-economic status, adolescents’ sugar-sweetened beverage intake was associated with residential proximity to restaurants (including fast food), convenience stores, grocery stores and other retail facilities within the 800 and/or 1600 m residential buffers (P≤ 0·01). BMIZ-score and percentage body fat were positively associated with the presence of a convenience store within a 1600 m buffer. Other individual-level factors, such as energy, fruit and vegetable intake, as well as convenience store and fast food purchasing, were not significantly associated with features of the residential neighbourhood food environment in adjusted models. In addition, school neighbourhood environments yielded few associations with adolescent outcomes.ConclusionsMany factors are likely to have an important role in influencing adolescent dietary intake and weight status. Interventions aimed at increasing neighbourhood access to healthy foods, as well as other approaches, are needed.

We examined changes in adolescent self-reported parent-child communication using growth curve models conditional on family meal frequency over a 3.5-year period among a population of racially diverse, low-income adolescents from an urban environment (n = 4,750). Results indicated that although both family dinner frequency and adolescent perceptions of parent-child communication scores were characterized by negative linear growth over time (both p < .001), family dinner frequency was positively associated with adolescent perceptions of parent-child communication scores over time (p < .001). Study findings suggest that families with teenagers may enhance parent-child communication and ultimately promote healthy adolescent development by making family dinner a priority. In addition, the communication benefits of family dinner at the beginning of sixth grade may be protective through eighth grade.

Objective To determine if weight status affects the relationship between weight-related beliefs and consumption of sugar-sweetened beverages (SSB) and fast and convenience store food purchases (FCFP). Design Observational, cross-sectional. Setting Twin Cities Metropolitan area, Minnesota, USA. Methods Body composition and psychosocial survey were obtained for 345 adolescents. General Linear Models tested adjusted (age and sex) associations between weight-related beliefs and consumption of SSB and FCFP. Significant associations were tested for moderation by weight status. Results SSB was positively related to perceptions that people worry too much about their weight (β = 0.103, p = 0.016), with no moderation present. FCFP were positively associated to perceived barriers to maintaining a healthy weight (β = 0.042, p = 0.004) with a subsequent significant interaction by weight status. Stratified models showed a significant association between perceived barriers to a healthy weight and FCFP for overweight adolescents (β = 0.345, p = 0.022). Conclusions Addressing perceived barriers to a healthy diet may lead to important risk reduction.

While the epidemic of childhood obesity is well documented, the etiology of the disease is poorly understood.1,2 One venue that has been investigated for its contribution to the epidemic and called upon to help reduce the risk is the school environment.3,4 Beyond food served as part of the United States Department of Agriculture’s (USDA) National School Lunch Program (NSLP) and School Breakfast Program (SBP), it is well recognized that youth have many other options for eating and drinking during the school day. An important source of this additional food that is largely unregulated is the competitive foods or foods that “compete” with the regular meal pattern lunch such as foods offered as fund-raisers or incentives, foods available in vending and in schools stores or foods available on the a la carte line.5,6 A la carte foods are foods and beverages available in the cafeteria that are not part of the regular reimbursable meal pattern. Foods available through a la carte are of particular interest because of their availability in large numbers, the majority of which are high in fat and sugar.4,5 The presence of an a la carte line in schools has been shown to impact the dietary intake of youth across the entire day.7,8 Interest in understanding the role and extent of competitive foods in schools and attempting to encourage schools to offer more healthful options in a la carte and vending has been growing in the past 2 decades. In 1996, the Centers for Disease Control and Prevention published the Guidelines for School Health Programs to promote lifelong healthy eating, one of the first government documents to draw attention to other sources of food in schools and its potential to impact the health of school children.9 In 2004, USDA passed the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act10 that required the development of a wellness policy that included, among other things, guidelines for competitive foods in schools. Most recently, the Institute of Medicine (IOM) published specific criteria to be applied to evaluate the healthfulness of foods offered outside of the NSLP.11 With this interest, a variety of stakeholders, including school staff, community interest groups, public health nutrition advocacy groups, and researchers, have attempted to assess and evaluate what schools are offering through their a la carte programs and the healthfulness of those choices. Current reports of a la carte foods tend to be descriptive in nature, for example, reporting the proportion of schools that offer salty snacks or soft drinks. While this information has been important in drawing attention to the types of foods that are offered in schools, more work needs to be done to increase our understanding of how the food environment of schools may be related to health.5 The intent of measuring the healthfulness of an environment is actually to assess an attribute of the environment that may affect health; for example an environment that offers more healthful options as compared to fewer healthful options. This characterization is most useful if it results in a measure that has construct validity (eg, being able to show that schools with more healthful foods in the environment have students who eat more healthful foods) or a measure that can rank order schools along a continuum that assesses the degree of obesogenic potential or conditions leading to obesity.12 We know very little about how tools compare with regard to their ability to rank order schools along some continuum of “healthfulness” or “obesogeneity.” A number of methods have been used to identify and quantify foods offered on school a la carte lines including the use of cash register data,13 inventories,7 and checklists.5 However, each method has its limitations with regard to expense, amount of data reduction required, validity, and reliability. There is a great need for tools that are efficient, reliable, and valid indicators of the “healthfulness” of the school food environment, both for school stakeholders and for researchers attempting to characterize school food environments along some continuum of healthfulness or obesogeneity. The purpose of this study is to compare 2 approaches for ranking schools with regard to healthfulness of foods available on the a la carte lines: a detailed inventory approach, and a checklist approach. The hypothesis is that a checklist approach is a valid method for assessing the healthfulness of the a la carte food environment of schools, particularly when resources for data collection may be limited.

The objectives of this study were to determine: (1) if the number of outdoor alcohol advertisements around schools varied by ethnicity of students in the school; and (2) how the content of alcohol advertising around schools varied by the ethnicity of students in the school.All outdoor alcohol advertisements within 1500 feet of 63 Chicago schools were documented and coded for content and theme. On average, the ethnic make-up of schools was 54.9% African American, 24.4% Hispanic, and 16.2% White; 79.7% of students were low SES. To compare the mean number and type of ads by ethnicity of the school, schools were coded by ethnicity (i.e., 20% or more Hispanic students compared with less than 20% Hispanic students).Youth attending schools with 20% or more Hispanic students were exposed to 6.5 times more alcohol advertising than students attending schools with less than 20% Hispanic students. Schools with 20% or more Hispanic students were also surrounded by more beer advertising and alcohol advertisements on bars and liquor stores.Alcohol advertising is more prevalent around schools with 20% or more Hispanic students. Policies should be considered to reduce the amount of alcohol advertising around schools.

Despite the need for effective obesity prevention strategies, little research is currently available to assess adolescents’ knowledge around basic concepts of energy intake, expenditure and balance. Using data from 349 adolescent-caregiver pairs (recruited from Minneapolis/St. Paul metro region, MN, 2006-2007), cross-sectional linear regression was used to assess adolescent and parental knowledge related to energy intake and expenditure as a predictor of adolescent weight-related behaviors and outcomes. Findings indicated that knowledge related to energy intake and expenditure was highly variable, with a substantial proportion of participants (particularly adolescents) lacking knowledge on a range of concepts. Adolescent knowledge was positively associated with moderate physical activity and negatively associated with television viewing (P< 0.05), but it was not associated with sweetened beverage consumption, fast food intake, weight status, and/or body composition. While overall parental knowledge was a significant predictor of adolescent knowledge (p

To examine cross-sectional and longitudinal associations between weight status and measures of risk and protective factors in youth.Participants included 3010 students (72.1% white, 27.9% nonwhite), with a baseline mean age of 12.7 years from the Teens Eating for Energy and Nutrition at School (TEENS) study. Surveys were administered in grades 7 and 8. Cross-sectional and longitudinal mixed-effects regression analyses were conducted to determine the association between body mass index z-score percentiles (BMI) and risk and protective factors (including substance use, depression, fighting, optimism, and spirituality).Only depression was associated with BMI at the beginning of grade 7. However, by the end of grade 8, binge drinking, alcohol, tobacco, and other drug (ATOD) use, fighting, and depression were all cross-sectionally associated with BMI. Longitudinally, BMI in grade 7 did not predict risk and protective factors in grade 8. However, ATOD use, fighting, depression, and optimism in grade 7 predicted BMI in grade 8.This study suggests there is a notable co-occurrence of unhealthy factors (including weight status, ATOD use, depression) which appears to develop during the critical transition period through early adolescence. Specifically, earlier ATOD use, depression, increased fighting, and decreased optimism may lead to unhealthy increases in weight status, whereas early indicators of increased weight status do not appear to predict increases in these factors. This work yields important insights into the causal mechanisms underlying adolescent behavior patterning and the progression with which these unhealthy risk factor profiles are adopted during this critical age.

Young adolescent alcohol users drink at higher rates than their peers throughout adolescence and appear to be less amenable to intervention. This study compares those who reported alcohol use in the past year to those who reported no use in a multiethnic, urban sample of sixth graders in 61 schools in Chicago in 2002 ( N = 4,150). Demographic, behavioral, intrapersonal, and socioenvironmental factors were identified based on behavioral theories and potential mediators of the Project Northland Chicago intervention. Single and multiple regression models were created for users and nonusers to determine associations between these factors and alcohol use behavior and intentions. The multiple regression models explained 35% and 56% of the variance in alcohol use behavior and intentions between students for nonusers and users, respectively. Results suggest that primary prevention programs for alcohol use should occur prior to sixth grade, particularly for the substantial group at high risk for early use.

PURPOSE: To investigate the temporal relation between energy drink and alcohol use among adolescents. METHODS: Data were collected from adolescents attending public high schools in two waves (n=894). RESULTS: Path analysis indicated that energy drink use at baseline was positively associated with the number of drinking days but not binge drinking or average drinks per drinking day over the past 30 days at follow-up. This relation remained while controlling for race, age, gender, previous alcohol use, and impulsivity. CONCLUSIONS: Alcohol use prevention efforts should consider energy drink use as risk factors for adolescent alcohol use. Language: en

Few studies of the food environment have collected primary data, and even fewer have reported reliability of the tool used. This study focused on the development of an innovative electronic data collection tool used to document outdoor food and beverage (FB) advertising and establishments near 43 middle and high schools in the Outdoor MEDIA Study. Tool development used GIS based mapping, an electronic data collection form on handheld devices, and an easily adaptable interface to efficiently collect primary data within the food environment. For the reliability study, two teams of data collectors documented all FB advertising and establishments within one half-mile of six middle schools. Inter-rater reliability was calculated overall and by advertisement or establishment category using percent agreement. A total of 824 advertisements (n=233), establishment advertisements (n=499), and establishments (n=92) were documented (range=8–229 per school). Overall inter-rater reliability of the developed tool ranged from 69–89% for advertisements and establishments. Results suggest that the developed tool is highly reliable and effective for documenting the outdoor FB environment.

Objective To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers. Method One hundred ninety‐eight youths aged 12‐19 years were recruited from outpatient mental health clinics and completed self‐reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad‐band (externalizing, internalizing) and narrow‐band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self‐Report and Child Behavior Checklist. Results Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at ≥14 or >14 years of age. Conclusions Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social‐personal framework for understanding sexual risk‐taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut. J. Am. Acad. Child Adolesc. Psychiatry , 2003, 42(5):594‐608.

Many young adolescents are dissatisfied with their body due to a discrepancy between their ideal and actual body size, which can lead to weight cycling, eating disorders, depression, and obesity. The current study examined the associations of parental and peer factors with fifth-graders' body image discrepancy, physical self-worth as a mediator between parental and peer factors and body image discrepancy, and how these associations vary by child's sex. Body image discrepancy was defined as the difference between young adolescents' self-perceived body size and the size they believe a person their age should be. Data for this study came from Healthy Passages, which surveyed 5,147 fifth graders (51 % females; 34 % African American, 35 % Latino, 24 % White, and 6 % other) and their primary caregivers from the United States. Path analyses were conducted separately for boys and girls. The findings for boys suggest father nurturance and getting along with peers are related negatively to body image discrepancy; however, for girls, fear of negative evaluation by peers is related positively to body image discrepancy. For both boys and girls, getting along with peers and fear of negative evaluation by peers are related directly to physical self-worth. In addition, mother nurturance is related positively to physical self-worth for girls, and father nurturance is related positively to physical self-worth for boys. In turn, physical self-worth, for both boys and girls, is related negatively to body image discrepancy. The findings highlight the potential of parental and peer factors to reduce fifth graders' body image discrepancy. © 2013 Springer Science+Business Media New York (outside the USA).

Objective. This study aimed to determine the relationship between parent time demands and presence and enforcement of family rules and parent/child dyad weight status. Method. In dyads of one child/parent per family ( N = 681 dyads) in Twin Cities, Minnesota, 2007-2008, height and weight were measured, and a survey of demographics, time demands, and family rules–related questions was taken. Parent/child dyads were classified into four healthy weight/overweight categories. Multivariate linear associations were analyzed with SAS, testing for interaction by work status and family composition ( p < .10). Results. In adjusted models, lack of family rules and difficulty with rule enforcement were statistically lower in dyads in which the parent or child was healthy weight compared with dyads in which the parent and child were both overweight (difference in family rules scores = 0.49, p = .03; difference in rule enforcement scores = 1.09, p ≤ .01). Of parents who worked full-time, healthy weight dyads reported lower time demands than other dyads (difference in time demands scores = 1.44, p = .01). Conclusions. Family experiences of time demands and use of family rules are related to the weight status of parents and children within families.

Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietetics practitioners. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and takeout foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006-2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly vs none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z score, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, triglycerides, fasting glucose, insulin, and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency, and demographic characteristics. The odds of overweight/obesity were considerably greater when families reported at least one away-from-home dinner purchase in the past week (odds ratio=1.2 to 2.6). Mean percent body fat, metabolic risk cluster z scores, and insulin levels were significantly greater with weekly purchases of family dinner from fast-food restaurants (P

Objectives—To examine associations between weight misperception and youth health risk and protective factors. Methods—Three thousand ten US seventh-graders (72.1% white, mean age: 12.7 years) selfreported height, weight, risk, and projective factors. Analyses were conducted to determine crosssectional and longitudinal associations between weight overestimation and health risk and protective factors. Results—Risk and protective factors had significant cross-sectional associations with weight overestimation. However, only depressive symptoms and reduced optimism predicted weight overestimation in eighth grade. Weight overestimation did not predict engagement in risky behaviors. Conclusions—Weight overestimation and risk factors appear to co-occur, suggesting a constellation of risk that warrants further research.

ObjectiveTo assess the relationship between adolescent perception of time to walk to neighbourhood food retail outlets and purchasing of sugar-sweetened beverages (SSB), fast and convenience food items, and to test for differences by urban v. suburban environment.DesignCross-sectional observational study.SettingTwin Cities Metropolitan Area, Minnesota, USA.SubjectsAdolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure, and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted.ResultsThere were 634 adolescents, approximately half male, predominantly white, with a middle-class background. Greater perceived time to food outlets was associated with less frequent purchasing of SSB, convenience store foods and fast-food items. Multivariate models showed that a perceived shorter walking time (i.e. 1−5 v. 31+ min) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10 min walk (B = 0·05, P = 0·02).ConclusionsA reduction in consumption of SSB and other energy-dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.

OBJECTIVES To assess the correlates of parental classification of adolescent weight status. METHODS Measured adolescent weight status was compared to parent self-report perception data (n = 374 dyads) using multivariate analyses with interactions to identify characteristics associated with inaccurate parent classification of adolescent weight status. RESULTS Adolescent weight status was underestimated by 31% of parents. College-educated parents were more likely to underestimate the weight of their male adolescents (OR = 1.95) and overweight adolescents (OR = 4.0). Non-college-educated parents were 8.92 times as likely to misclassify overweight adolescents, regardless of the sex of the child. CONCLUSIONS Parental perception may play a role in supporting adolescent's healthy weight-related behaviors.

PURPOSE: The purpose of this study was to explore how behavioral, intrapersonal, and socio-environmental factors were associated with the likelihood of having at least one older friend. METHODS: Participants included 3,709 ethnically diverse eighth grade students in the Project Northland Chicago intervention trial. Socio-demographic characteristics included gender, family composition, language spoken at home, race/ethnicity, and age. Behavioral factors included cigarette, alcohol, and marijuana use, depressed feelings, willingness to wear alcohol-branded merchandise, and violent and delinquent behavior. Intrapersonal factors included low refusal self-efficacy, and outcome expectations and expectancies. Socio-environmental factors included alcohol offers and access, normative estimates and expectations, and peer alcohol use. Having an older friend was defined as having at least one friend aged 16 years or older (students' mean age = 14.2). Logistic mixed-effects regression models were used and controlled for gender, race/ethnicity, treatment status, and age. RESULTS: Adolescent girls and older eighth graders were significantly more likely to have at least one older friend. Students who scored higher on all the behavioral, intrapersonal, and socio-environmental risk factors were significantly more likely to have at least one older friend. Significant gender interactions were found for several of the relationships. CONCLUSION: Overall, this study showed that multiple risk-related factors are associated with having older friends in eighth grade. Particularly important factors appear to be cigarette, marijuana and alcohol use, having friends who use alcohol, having increased alcohol offers, and being willing to wear or use alcohol-branded merchandise. Language: en

Background:This article describes policies, practices, and facilities that form the physical activity climate in Minneapolis/St. Paul, Minnesota metro area middle and high schools and examines how the physical activity climate varies by school characteristics, including public/private, school location and grade level.Methods:Surveys examining school physical activity practices, policies and environment were administered to principals and physical education department heads from 115 middle and high schools participating in the Transdisciplinary Research on Energetics and Cancer-Identifying Determinants of Eating and Activity (TREC-IDEA) study.Results:While some supportive practices were highly prevalent in the schools studied (such as prohibiting substitution of other classes for physical education); other practices were less common (such as providing opportunity for intramural (noncompetitive) sports). Public schools vs. private schools and schools with a larger school enrollment were more likely to have a school climate supportive of physical activity.Conclusions:Although schools reported elements of positive physical activity climates, discrepancies exist by school characteristics. Of note, public schools were more than twice as likely as private schools to have supportive physical activity environments. Establishing more consistent physical activity expectations and funding at the state and national level is necessary to increase regular school physical activity.

Research to date in young children and adults shows a strong, inverse relationship between sleep duration and risk for overweight and obesity. Fewer studies examining this relationship have been conducted in adolescents. The purpose of the article is to describe the relationship between sleep and weight in a population of adolescents, controlling for demographics, energy intake, energy expenditure, and depression. This is a cross-sectional study of 723 adolescents participating in population-based studies of the etiologic factors related to obesity. We examined the relationship between three weight-related dependent variables obtained through a clinical assessment and three sleep variables obtained through self-report. Average caloric intake from dietary recalls, average activity counts based on accelerometers, and depression were included as covariates and the analysis was stratified by gender and grade level. Our results show that the relationship between sleep duration and BMI is evident in middle-school boys (β = −0.32, s.e. = 0.06: P < 0.001) and girls (β = −0.18, s.e. = 0.08: P = 0.02) but largely absent in high-school students. Differences in sleep patterns have little association with weight in males, but in high-school girls, waking up late on weekends as compared to weekdays is associated with lower body fat (β = −0.80, s.e. = 0.40: P = 0.05) and a healthy weight status (β = −0.28, s.e. = 0.14: P = 0.05). This study adds to the evidence that, particularly for middle-school boys and girls, inadequate sleep is a risk factor for early adolescent obesity. Future research needs to examine the relationship longitudinally and to study potential mediators of the relationship.