Association between Gross National Income per capita and COVID-19 vaccination coverage: a global ecological study

BACKGROUND

Coronavirus 2019 (COVID-19) pandemic has claimed over six million lives and infected more than 650 million people globally. Public health agencies have deployed several strategies, including rolling out vaccination campaigns to curb the pandemic, yet a significant proportion of the global population has not received the COVID-19 vaccine. We assessed differences in COVID-19 vaccination coverage by Gross National Income (GNI) per capita of WHO members (i.e., countries, areas, and territories, n = 192) and by WHO member regions (n = 6).

METHODS

Using an ecological study design, we analyzed publicly available data from the WHO website merged with the World Bank's GNI per capita data. We included a total of 192 WHO members and six WHO regions in the analysis. We utilized negative binomial regression to assess the associations between the GNI per capita and COVID-19 vaccination coverage (cumulative number of persons fully vaccinated and/or received at least one dose of the vaccine per 100 population), and ANOVA test to assess the differences in vaccination coverage per WHO regions.

RESULTS

Low GNI per capita WHO members had significantly lower full vaccination coverage (aRR 0.30, 95% CI 0.22-0.40) compared to high GNI per capita WHO members. These members were also 66% less likely to receive at least one dose of the vaccine (aRR 0.34, 0.26-0.44) relative to high GNI per capita WHO members. Africa region had a significantly lower fully vaccination coverage (aRR 0.71, 95% CI 0.36-0.54) and received at least one dose of the COVID-19 vaccine (aRR 0.78, 95% CI 0.62-0.99) than Europe region. Conversely, the Western Pacific region had significantly higher fully vaccination coverage (aRR 1.40 95% CI 1.12-1.74) and received at least one dose of COVID-19 vaccines (aRR 1.40 95% CI 1.14-1.73) relative to European region.

CONCLUSION

WHO members with low GNI per capita and the African region reported significantly lower COVID-19 vaccination coverage than those with high GNI per capita or other regions. Efforts to strengthen and promote COVID-19 vaccination in low-income WHO countries and African region should be scaled up.

Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis

BACKGROUND

Despite the key role of social vulnerability such as economic disadvantage in health outcomes, research is limited on the impact of social vulnerabilities on COVID-19-related deaths, especially at the state and county level in the USA.

METHODS

We conducted a cross-sectional ecologic analysis of COVID-19 mortality by the county-level Minority Health Social Vulnerability Index (MH SVI) and each of its components in Texas. Negative binomial regression (NBR) analyses were used to estimate the association between the composite MH SVI (and its components) and COVID-19 mortality.

RESULTS

A 0.1-unit increase in the overall MH SVI (IRR, 1.27; 95% CI, 1.04-1.55; p = 0.017) was associated with a 27% increase in the COVID-19 mortality rate. Among the MH SVI component measures, only low socioeconomic status (IRR, 1.55; 95% CI, 1.28-1.89; p = 0.001) and higher household composition (e.g., proportion of older population per county) and disability scores (IRR, 1.47; 95% CI, 1.29-1.68; p < 0.001) were positively associated with COVID-19 mortality rates.

CONCLUSIONS

This study provides further evidence of disparities in COVID-19 mortality by social vulnerability and can inform decisions on the allocation of social resources and services as a strategy for reducing COVID-19 mortality rates and similar pandemics in the future.

Development and refinement of a corner-based injury prevention programme for Latino day labourers

Objective

Latino day labourers (LDLs) in the USA are at increased risk for non-fatal and fatal occupational injuries, which are compounded by stressors that include wage theft, job insecurity and discrimination. This paper describes the development and refinement of Vales+Tú (You are Worthy of More), an injury prevention programme currently being evaluated as part of a cluster randomised trial in which health promotion is taken directly to the 'corners' (e.g. street corners, home improvement store parking lots, and public parks) where workers gather to seek employment.

Design

Vales+Tú comprises two corner-based intervention approaches, group problem-solving (small group discussions) and brief motivational interviewing (one-on-one dialogue), that aim to activate LDL agency to control their safety and that of their peers.

Setting

Corners in Houston, Texas, where LDLs seek employment.

Method

Intervention Mapping informed the refinement of Vales+Tú for the current trial. We provide a narrative review of the development process based on needs assessment and formative development activities (surveys, focus group discussions and pilot tests).

Results

In addition to documenting the need for LDL injury prevention, with 20.2%-41.6% of Houston-based LDLs surveyed between 2013-2014 and 2019 reporting a severe work-related injury in the past year, we describe key facets of the Vales+Tú corner-based intervention approaches - including their theoretical basis and LDL-centred activities, as well as enhancements made informed by formative evaluation.

Conclusion

The community-engaged development process of Vales+Tú resulted in two practical intervention approaches that can be adopted by worker centres and other organisations to promote LDL worker safety.

Remote Versus In-Person Learning During COVID-19: Comparison of E-Cigarette Susceptibility and Ever Use Among a Diverse Cohort of 6th-Grade Students in Texas

BACKGROUND

In response to SARS-CoV2 (COVID-19), school districts incorporated remote learning as a mitigation strategy. This study examines the association between classroom setting (ie, on-campus versus remote) and e-cigarette susceptibility or ever use among a sample of Texas public middle school students.

METHODS

Data from n = 985 students enrolled in the CATCH My Breath E-Cigarette Prevention Program trial were collected in Spring 2021. Participants were 6th-grade students in urban Texas. E-cigarette use was examined using the "at-risk" definition described by FDA, indicating either: (1) susceptible never user; or (2) experimental ever use. A multilevel, logistic regression model examined the association between classroom setting and e-cigarette susceptibility/ever use. Covariates included sex, race/ethnicity, academic achievement, household e-cigarette use, perceived school connectedness, and school-level economic status. Models account for nesting within school district. Analyses stratified by race/ethnicity were also conducted.

RESULTS

Overall, 36.3% of the sample were susceptible never users or ever e-cigarette users. The sample was comprised of 55.0% on-campus and 45.0% remote learners. On-campus learners had greater odds of reporting e-cigarette susceptibility or ever use (aOR: 1.45; p = .014). These findings were observed among Latino (aOR: 1.77; p = .026) and White (aOR: 2.10; p = .099) but not African American/Black (aOR: 0.86; p = .728) youth.

CONCLUSIONS

On-campus learning during the Spring 2021 semester was associated with greater risk for e-cigarette susceptibility or ever use among a diverse sample of 6th-grade students. E-cigarette susceptibility and ever use is a risk factor for progression to long-term e-cigarette use in later adolescence.

IMPLICATIONS

As school districts prepare to return to on-campus learning in 2022, a focused approach to e-cigarette prevention may be needed to prevent widespread e-cigarette initiation and continued use. Further, study findings demonstrate a need for further research on the school environment as a determinant of e-cigarette use.

School Connectedness and E-cigarette Susceptibility/ Ever Use in Texas 6th-Grade Students

Objectives: We examined the association between school connectedness (SC) and e-cigarette susceptibility/ ever use in a diverse sample of Texas 6^th graders, with a secondary aim to explore the association stratified by gender and classroom setting (in-person vs remote). Methods: A cross-sectional analysis was conducted of CATCH My Breath baseline data, representing 985 6^th -graders from 21 public schools. SC was based on National Longitudinal Study of Adolescent Health measures; e-cigarette susceptibility/ever use was based on the FDA's definition of "at-risk" for long-term use. We conducted multi-level logistic regression analyses.Results: Over half the sample was Hispanic (57.6%), with 36.2% reporting susceptibility/ever use. Lower SC was associated with increased odds of e-cigarette susceptibility/ever use (low SC: aOR: 5.17, 95% CI: 3.54, 7.55; medium SC: aOR: 2.15, 95% CI: 1.44, 2.91; high SC= referent). The association held across gender groups, with low SC girls reporting the highest odds of susceptibility/ever use (aOR: 7.83, 95% CI: 4.51, 13.61). Low SC in- person and remote students were 6 and 4 times, respectively, more likely to report susceptibility/ever use as high SC students (p<.05). Conclusion: SC protected against e-cigarette susceptibility/ever use in this sample.

Exploring Models for Youth Engagement in Community Health Planning: The Youth-led Community Health Learning Initiative

BACKGROUND

Community health assessment and improvement planning processes (CHA/CHIP) are often challenged with developing health actions that reach across a large community, city or county and that incorporate locally informed issues and place-specific strategies. In co-learning about approaches for enhancing CHA/CHIP processes through youth stakeholder input, a partnership of academic and community leaders came together to create The Youth-Led Community Health Learning Initiative (YLCHLI), a 1-year pilot initiative aimed at identifying health needs and assets in partnership with youth leaders and two central Texas communities.

OBJECTIVE

To describe our approach, key findings, and lessons learned in implementing the YLCHLI in two different organizational settings: a high school-based setting and a community-based organization setting.

METHODS

Guided by a community advisory board and the Mobilizing for Action through Planning and Partnerships framework, the YLCHLI incorporated a mixed methods design consisting of quantitative community health indicator analysis for topics identified in the Austin/Travis County CHA followed by a youth-led qualitative assessment of selected health issues via methods that included participatory mapping, data walks, and photovoice.

RESULTS

Youth-informed findings provided rich insights and context for understanding disparities in selected health issues, including identification of social and environmental barriers to physical activity, healthy eating, health services, and mental health, and locally informed recommendations for community health improvement.

CONCLUSION

High school health science tracks and community- based organizations represent promising settings for fostering community partnerships and youth engagement in identifying local health needs and opportunities that can enhance community health improvement planning and contribute to positive youth development.

Interweaving Adult Fitness Classes Into Community Settings Via Stronger Austin's Community Partnership Model: Increasing Access to Physical Activity and Positive Social Connectedness in Underserved Communities

The lack of environmental supports for healthy lifestyles is a potent factor in the high prevalence of noncommunicable diseases among communities experiencing economic disadvantage. Stronger Austin aimed to increase access to free physical activity (PA) and fitness programming (eg, Zumba) in underserved communities in Austin, Texas, via a partnership and interweaving into context approach in which classes are interwoven into settings with widespread access for residents, including clinics, city-supported housing, parks, recreation centers, and schools. We aimed to better understand the PA-related benefits and opportunities for improvement when adult fitness classes are interwoven into community settings. A mixed-methods design guided the study, which included SOFIT (Structured Observation of Fitness Instruction Time) assessments of class PA (n = 160 participants) and qualitative assessment of highlights and recommendations for class improvement via participant focus groups (n = 24), open-ended questionnaires (n = 258), and instructor interviews (n = 6). Findings indicated high levels of class PA (76.9%-86.9% of 1-hour class spent in moderate-to-vigorous PA; mean of 18 participants per class), with positive social connectedness cited as a key benefit. Challenges and best practices of community-based fitness classes are explored. Stronger Austin's partnership and interweaving into context approach represents a promising model for increasing access to fitness classes in underserved communities.

Using Community-Academic Partnerships and a Creative Expression Contest to Engage Youth in the Development of Communication Materials for Promoting Behaviors That Prevent COVID-19

Youth can transmit COVID-19 to adults, but few communication materials exist for engaging youth in COVID-19 prevention behaviors. We describe the process of leveraging a community-academic partnership in a rapid response initiative to engage youth in a contest (i.e., Youth-Led Creative Expression Contest to Prevent COVID-19 across Texas) to develop creative public health messaging centered on the prevention of COVID-19 transmission and infection for their peers. Core activities included developing a request for applications that solicited submission of creative expression materials promoting the use of COVID-19 prevention behaviors (mask-wearing, social distancing, handwashing, not touching the face) from Texas youth in elementary, middle, and/or high school; sending the request for applications to 48 organizations in Austin, Brownsville, Dallas, El Paso, Houston, and San Antonio in summer 2020; and recruiting a youth advisory board to score submissions and award prizes. We report on youth engagement in the COVID communication contest across Texas and use statistics (chi-square and t-tests) to characterize and compare youth participants and their creative expression artwork. The contest resulted in 3,003 website views and 34 submissions eligible for scoring. Each submission averaged >2 prevention behaviors. On average, winning submissions included a higher number of prevention behaviors than nonwinning submissions. The prevention behavior "not touching the face" was included more often in winning submissions than nonwinning submissions. Elementary school children were less likely to include a mask in their submission compared with older youth. Existing community-academic networks can engage youth in the development of geographically and age-tailored communication materials.

Perceived Parental Knowledge Reduces Risk for Initiation of Nicotine and Cannabis Vaping: A Longitudinal Study of Adolescents

PURPOSE

This study examines the role of perceived parental knowledge on initiation of nicotine and cannabis vaping among youth.

DESIGN

Longitudinal study from a self-administered online survey. Three waves of data collected in 6-month intervals.

SETTING

79 public and private schools in Texas.

PARTICIPANTS

Adolescents who self-reported never using e-cigarette to vape nicotine (n=1907; weighted sample [N] = 304371) or vape cannabis (n=2212; N=351955) at baseline. Participants were in 8^th, 10^th, and 12^th grade at baseline.

MEASURES

Self-reported measures of nicotine and cannabis vaping.

ANALYSES

Weighted multivariate logistic regression models examined role of perceived parental knowledge at baseline (Spring 2016) as a predictor of nicotine and cannabis vaping initiation at 6-month (Fall 2016) and 12 month (Spring 2017) follow-up. Covariates were age, sex, race/ethnicity, and other tobacco use.

RESULTS

Initiation rates were 5.9% for nicotine vaping and 8.6% for cannabis vaping, at 12-month follow-up overall. Higher perceived parental knowledge was associated with lower odds of nicotine vaping initiation at 6 months (adj OR: .69; 95% CI: .50-.93) and 12 months (adj OR: .68; 95% CI: .50-.92). Similarly, higher perceived parental knowledge was associated with lower odds of cannabis vaping initiation at 6 months (adj OR: .58; 95% CI: .38-.87) and 12 months (adj OR: .53; 95% CI: .38-.74).

CONCLUSION

E-cigarette prevention efforts directed at adolescents should incorporate parent engagement strategies as a method of increasing actual and perceived parental knowledge of their child's location, activities and peer groups.

Use frequency and symptoms of nicotine dependence among adolescent E-cigarette users: Comparison of JUUL and Non-JUUL users

OBJECTIVE

Nicotine exposure among adolescent e-cigarette users remains a public health concern. JUUL, a popular e-cigarette brand among youth, is particularly alarming given the high nicotine delivery (59 mg/mL). This study compares e-cigarette use frequency and symptoms of nicotine dependence among adolescent JUUL and non-JUUL users.

METHODS

We analyzed data from the 2020 National Youth Tobacco Survey. Participants were n = 1713 U.S. middle and high school students who reported past 30-day e-cigarette use. We compared adolescent e-cigarette users who reported JUUL use to those who did not. Outcomes were: (1) symptoms of nicotine dependence (i.e. nicotine cravings; use within 30 min of waking); (2) past 30-day e-cigarette use frequency, categorized as 1-5 days, 6-19 days, and 20-30 days. Covariates were sex, race/ethnicity, other tobacco product use, primary e-cigarette device type (i.e., disposable; pod; mod/tank).

RESULTS

Overall, 49.5% of adolescent e-cigarette users reported using JUUL in the past 30 days, 40.1% reported symptoms of nicotine dependence, and 36.2% reported using an e-cigarette on 20-30 days. JUUL users were 1.77 (95% CI: 1.36-2.31) times as likely to report symptoms of nicotine dependence and 1.43 (95% CI: 1.02-2.01) time as likely to report using e-cigarettes on 20-30 days, compared to 1-5 days, relative to non-JUUL users, controlling for covariates.

CONCLUSION

JUUL use was associated with greater odds of nicotine dependence and more frequent e-cigarette use among adolescents. Greater prevention and regulatory efforts should be made to prevent adolescent use of high dose nicotine devices such as JUUL.

Association between observing peers vaping on campus and E-cigarette use and susceptibility in middle and high school students

BACKGROUND

This study examines the association between exposure to e-cigarette use on school campus and e-cigarette use behaviors among adolescents in the United States.

METHODS

Data were obtained from the 2019 National Youth Tobacco Survey. First, two multivariate logistic regression models examined the association between in-school exposure to e-cigarette use and ever and past 30-day (i.e., current) e-cigarette use. Next, a multivariate logistic regression model to examine the relationship between in-school exposure to e-cigarette use and susceptibility to use was conducted among a subsample (n = 11,958) of never e-cigarette users. Covariates included grade, race/ethnicity, marketing exposure, and ever use of other tobacco products.

RESULTS

Approximately 64.3 % of adolescents reported seeing someone use an e-cigarette on school campus; the most common locations being in the bathroom/locker room (34.4 %) and parking lot (34.0 %). In-school exposure to e-cigarette use was associated with greater odds of ever (Adj OR: 2.06; 95 % CI: 1.82-2.33) and current (Adj OR: 1.70; 95 % CI: 1.46-1.98) e-cigarette use among adolescents as well as greater odds of susceptibility to use (Adj OR: 2.00; 95 % CI: 1.82-2.20) among never e-cigarette users.

CONCLUSIONS

Observing e-cigarette use on school campus was associated with greater odds of e-cigarette use and susceptibility. It is plausible that observing e-cigarette use on campus reinforces the social acceptability of adolescent e-cigarette use. Findings inform on the prevalence of e-cigarettes use on-campus as well as how this phenomenon may influence e-cigarette use/susceptibility among youth. The observed relationship highlights the role of schools in the efforts to reduce adolescent e-cigarette use.

Dissemination of CATCH My Breath, a middle school E-Cigarette prevention program

OBJECTIVES

In 2016, the US Surgeon General issued a Call to Action to address adolescent e-cigarette use and school-based prevention interventions are an effective component of comprehensive tobacco control. This study describes the development and dissemination of CATCH My Breath, an e-cigarette prevention program for middle and high school students.

METHODS

Starting in 2014, a university and nonprofit collaboration designed, formatively evaluated, pilot tested, and disseminated the CATCH My Breath Program (CMB). The team used Social Cognitive Theory to develop the program and Diffusion of Innovations Theory to disseminate the program. Dissemination strategies were applied beginning in 2016. This paper describes the application of both theories and the resulting reach of CMB.

RESULTS

Since dissemination began, CMB has been rapidly adopted, following the typical diffusion normal curve. As of June 2020, approximately 4,000 schools in the United States have adopted the program, 70,000 teachers have taught the program, and 1,400,000 students have been exposed to program materials.

CONCLUSION

The application of Social Cognitive Theory and Diffusion of Innovation Theory resulted in effective prevention results and rapid, widespread adoption of the CMB. This level of adoption and implementation represents 25% of the school marketplace. CMB should be considered as the school component of the recommended combustible and e-cigarette prevention and control toolkit, alongside mass media, marketing restrictions, retail access, taxation, flavor ban, and FDA premarket approval. Other public health interventions seeking rapid adoption should consider applying principles of Diffusion of Innovation as a guide for development and dissemination.

Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences

OBJECTIVE

Efficiently addressing patient priorities and concerns remains a challenge in oncology. Systematic operationalization of patient-centered care (PCC) can support improved assessment and practice of PCC in this unique care setting. This review aimed to synthesize the qualitative empirical literature exploring the National Academy of Medicine (NAM)'s PCC constructs of values, needs, and preferences among patients' during their cancer treatment experiences.

METHODS

A systematic review of qualitative studies published between 2002 and 2018 addressing adult patient values, needs, and preferences during cancer treatment was conducted. Medline, EMBASE, PsycINFO, and SCOPUS databases were searched on September 10, 2018. Methodological rigor was assessed using a modified version of the Evaluation Tool for Qualitative Studies. Included study findings were analyzed using line-by-line coding; and the emergent themes were compared to the National Academy of Medicine (NAM)'s PCC dimensions.

RESULTS

Twenty-nine primary studies were included in the synthesis. Descriptive themes for values (autonomy, being involved, family, hope, normality, and sincerity), needs (care coordination, information, privacy, support of physical well-being, emotional support (family/friends, peer, provider), and self-support), and preferences (care coordination, decision-making, information delivery, source of social support, and treatment) were identified. "Cancer care context" emerged as an important domain in which these constructs are operationalized. This thematic framework outlines PCC attributes that oncology care stakeholders can evaluate to improve patient experiences.

CONCLUSIONS

These findings build on previous PCC research and may contribute to the systematic assessment of patient priorities and the improvement of oncology care quality from the patient perspective.

¡Activate Ya! Co-learning about school-based tobacco prevention and physical activity promotion in secondary school students in Uruguay

PURPOSE

¡Activate Ya! was a group-randomized controlled intervention trial aimed at developing and evaluating the impact of a school-based intervention on preventing cigarette smoking and promoting physical activity (PA) in secondary school students in Uruguay. Secondary aims were to evaluate the program's impact on students' smoking- and PA-related psychosocial risk and protective factors.

METHODS

Sixteen schools and n = 654 students participated in the study. The one-year intervention included a classroom-based curriculum, an afterschool program, activity breaks, and final showcase event. A self-administered questionnaire measured outcomes at three time points. Fixed effects regression models tested for differences in outcomes by study condition.

RESULTS

While positive intervention effects were found for selected psychosocial-related smoking outcomes, no impact on past-year smoking or smoking susceptibility was detected. Past 7-day PA, measured by the PAQ-C, was significantly higher among intervention school students overall (p = .048) and for girls (p = .03) at posttest, and intervention girls reported significantly higher athletic identity PA competence, friend and teacher PA support at posttest, and PA enjoyment at follow-up (p < .05).

CONCLUSION

The positive short-term effects of ¡Activate Ya! on PA and related outcomes for girls support the utility of school-based health promotion in Uruguay. Additional research is needed to determine the most effective strategies to prevent tobacco use among students and promote PA among boys in this setting.

A qualitative analysis of the social and cultural contexts that shape screen time use in Latino families living on the U.S.-Mexico border

Purpose: The purpose of this study was to understand how first generation Latino parents, whose primary language is Spanish and live in a colonia on the U.S.-Mexico border, use screen time in their homes.

Methods: A purposeful sampling approach was used to recruit eligible parents of pre-adolescents (ages 9–14) who were native Spanish speakers, and living on the U.S.-Mexico border. Three focus groups in Spanish (two with mothers and one with fathers) were conducted. Data were codified using a general inductive approach based on grounded theory. A consensus process was repeated until a final codebook was developed.

Results: Screen time allowed parents to foster familismo (family cohesiveness and bonding) and respeto (respect). Parents knew that a healthy balance of media use is important, but broader social contexts (marital discord and economics) challenged the enforcement of familial screen time rules and parents were often permissive.

Conclusions: Our study addressed research gaps by examining the understudied social and cultural contexts (practices, routines, rules, and beliefs) that shape children’s screen time use among a sample of Latino immigrants living on the U.S.-Mexico border. This sample of parents indicated that familismo and respeto (i.e., cohesiveness and bonding) influence familial decision-making including screen time.

Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences

OBJECTIVE

To increase the understanding of patient-centered care (PCC) and address the need for cross-cutting quality cancer care measures that are relevant to both patients and providers.

METHODS

An exploratory factor analysis (EFA) was performed on a short version of the Patients and the Cancer Care Experience Survey, a patient-reported measure of perceived importance of social, emotional, physical, and informational aspects of care, administered to adult patients (n = 104) at a National Cancer Institute-designated comprehensive cancer center. Relationships between PCC dimensions and patient characteristics were also assessed. Principal axis factoring was applied and bivariate analyses were performed using Wilcoxon rank-sum tests.

RESULTS

Most of our sample was over 60 years old (63.4%), female (57.4%), and white (74.2%), with either breast (41.2%) or prostate cancer (27.5%). A 5-factor model was identified: (1) quality of life (α = .91), (2) provider social support (α = .83), (3) psychosocial needs (α = .91), (4) nonprovider social support (α = .79), and (5) health information and decision-making support (α = .88). No statistically significant associations were found between these factors and patients' characteristics.

CONCLUSIONS

A preliminary factor structure for a cancer PCC measure was identified. Our findings reinforce the interrelated nature of PCC dimensions. The lessons learned from this study may be used to develop a single PCC measure that identifies patient priorities across the cancer care continuum. Data collected from such a measure can be used to support patient engagement in treatment planning and decision-making.

A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of "CATCH My Breath"

OBJECTIVES

From 2017 to 2018, electronic cigarette (e-cigarette) use increased 78% among high school students and 48% among middle school students in the United States. However, few e-cigarette prevention interventions have been evaluated. We determined the feasibility and initial effectiveness of "CATCH My Breath," an e-cigarette prevention program, among a sample of middle schools in central Texas.

METHODS

Twelve middle schools in Texas (6 intervention schools and 6 control schools) participated in the CATCH My Breath pilot program during 2016-2017. CATCH My Breath is rooted in social cognitive theory, consists of 4 interactive in-class modules, and is collaboratively administered via classroom and physical education teachers, student-peer leaders, and social messaging (eg, school posters). We collected 3 waves of data: baseline (January 2017), 4-month follow-up (May 2017), and 16-month follow-up (May 2018). Using school as the unit of analysis, we tested a repeated cross-sectional, condition-by-time interaction on e-cigarette ever use, psychosocial determinants of use, and other tobacco use behaviors. Analyses controlled for school-level sociodemographic characteristics (eg, sex, race/ethnicity, and percentage of students eligible for free or reduced-price lunch).

RESULTS

From baseline to 16-month follow-up, increases in ever e-cigarette use prevalence were significantly lower among intervention schools (2.8%-4.9%) than among control schools (2.7%-8.9%), controlling for covariates (P = .01). Intervention schools also had significantly greater improvements in e-cigarette knowledge (β = 0.71; 95% confidence interval [CI], 0.21-1.21; P = .008) and perceived positive outcomes (β = -0.12; 95% CI, -0.23 to -0.02; P = .02) than control schools, controlling for covariates from baseline to 16-month follow-up.

CONCLUSION

Ever e-cigarette use was lower among middle schools that implemented the CATCH My Breath program than among those that did not. Replication of findings among a larger sample of schools, using a group-randomized, longitudinal study design and a longer follow-up period, is needed.

School socioeconomic disparities in e-cigarette susceptibility and use among central Texas middle school students

Social-ecological theory posits that health-related behavior is shaped by the environments and settings that surround us. We examined e-cigarette susceptibility and ever use prevalence among central Texas middle school students by the level of economic disadvantage (ED) of their school. As a secondary aim, we explored gender and ethnic differences (Hispanic vs. White) in e-cigarette susceptibility across school ED levels. A cross-sectional analysis was conducted of baseline data collected in 2017 as part of the CATCH My Breath study. Participants (n = 5278) were 6th grade students from 23 central Texas public middle schools. E-cigarette susceptibility/use and demographics were self-reported; school ED was determined by Texas Education Agency. Analyses included chi-square tests and multi-level logistic regression. E-cigarette susceptibility and use varied by school ED for total sample (p < .0001) and by ethnicity (p ≤ .003). While e-cigarette susceptibility was higher in boys (p < .001), no gender differences were found for e-cigarette use. Students in the highest school ED quartile (Q4) (lowest SES) had significantly higher odds of e-cigarette susceptibility (AOR = 2.01; 95% CI: 1.49–2.71) and use (AOR = 8.12, 95% CI: 2.58–26.30) compared with Q1 students. Significant gender differences in e-cigarette susceptibility persisted within school ED quartiles 1–3 (p ≤ .001); no gender differences were found for Q4 (p = .537). Despite overall higher e-cigarette susceptibility for Hispanic students, they had similar prevalence as White students within three school ED quartiles. Findings underscore a higher risk for e-cigarette susceptibility/use among central Texas sixth graders attending high ED schools and provide foundation for further exploration of the school socioeconomic context in adolescent e-cigarette use.

Exploring physical activity engagement in secondary school students in Montevideo, Uruguay: A qualitative study

Physical activity provides multiple health and educational benefits to children and youth, yet the majority of young people across the globe, including adolescents in Uruguay, do not participate in sufficient physical activity. This study aims to further inform intervention efforts for promoting adolescent physical activity in Uruguay by exploring physical activity perceptions and practices as well as physical activity barriers and opportunities in a sample of public and private secondary school students living in and around Montevideo, Uruguay. A total of n=65 secondary school students, ranging in age from 11 to 15 years, participated in 12 focus groups. Despite generally favorable attitudes expressed by participants toward physical activity and identification of common physical activities, findings indicated several barriers for physical activity engagement in this sample of Uruguayan secondary school students -- which often vary by gender and SES, including: lack of access and availability of physical activity opportunities both within and outside of school time, lack of places as well as equipment and infrastructure for engagement in physical activity, and lack of time and competing activities such as video games. Key themes related to the importance of the social context for physical activity- especially for girls, as well as opportunities for physical activity, including the need for more afterschool programming, were also documented. These findings provide further context for understanding adolescent physical activity in Uruguay as well as direction for future intervention efforts.

The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents

INTRODUCTION

Sensation seeking is strongly associated with cigarette use in adolescents. However, few studies have investigated its relationship with adolescent e-cigarette use. This study examined cross-sectional and longitudinal associations between sensation seeking and a variety of e-cigarette use behaviors among Texas adolescents.

METHODS

This study utilized two waves of data collected 6months apart through the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in 2014-2015 (n=2,488/N=461,069). TATAMS employs a complex probability-sampling design and is representative of students in 6th, 8th and 10th grades from five counties surrounding the four largest cities in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Weighted multivariable logistic regression was used to examine the cross-sectional and longitudinal associations between sensation seeking and susceptibility to e-cigarette use, ever e-cigarette use, and current (past 30day) e-cigarette use.

RESULTS

In the cross-sectional analyses, higher mean sensation seeking scores were associated with higher odds of both susceptibility to e-cigarette use and ever e-cigarette use (AOR=1.25, 95% CI=1.07, 1.47; AOR=1.24, 95% CI=1.08, 1.43, respectively). For the longitudinal analyses, only the association between higher mean sensation seeking scores and transition to ever e-cigarette use remained statistically significant (AOR=1.45, 95% CI=1.01, 2.08). There were no significant associations between sensation seeking and current e-cigarette use in either the cross-sectional or longitudinal analyses.

CONCLUSIONS

Higher sensation seeking scores were consistently and significantly related to experimentation with e-cigarette use among Texas adolescents. Future interventions (e.g., communication campaigns) should target high sensation seeking adolescents to reduce initiation of e-cigarette use among this population.

Health by Design: Interweaving Health Promotion into Environments and Settings

The important influence of the environmental context on health and health behavior—which includes place, settings, and the multiple environments within place and settings—has directed health promotion planners from a focus solely on changing individuals, toward a focus on harnessing and changing context for individual and community health promotion. Health promotion planning frameworks such as Intervention Mapping provide helpful guidance in addressing various facets of the environmental context in health intervention design, including the environmental factors that influence a given health condition or behavior, environmental agents that can influence a population’s health, and environmental change methods. In further exploring how to harness the environmental context for health promotion, we examine in this paper the concept of interweaving of health promotion into context, defined as weaving or blending together health promotion strategies, practices, programs, and policies to fit within, complement, and build from existing settings and environments. Health promotion interweaving stems from current perspectives in health intervention planning, improvement science and complex systems thinking by guiding practitioners from a conceptualization of context as a backdrop to intervention, to one that recognizes context as integral to the intervention design and to the potential to directly influence health outcomes. In exploring the general approach of health promotion interweaving, we examine selected theoretical and practice-based interweaving concepts in relation to four key environments (the policy environment, the information environment, the social/cultural/organizational environment, and the physical environment), followed by evidence-based and practice-based examples of health promotion interweaving from the literature. Interweaving of health promotion into context is a common practice for health planners in designing health promotion interventions, yet one which merits further intentionality as a specific health promotion planning design approach.

Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners

Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.

Bullied Status and Physical Activity in Texas Adolescents

This study examined the association between having been bullied at school during the past 6 months (“bullied status”) and not meeting physical activity (PA) recommendations of 60 minutes of daily PA during the past week among 8th- and 11th-grade Texas adolescents. Multiple logistic regression analysis was conducted to examine this association, adjusted for weight status, grade, race/ethnicity, and stratified by gender; furthermore, a significant interaction was found between bullied status and weight status. Results are presented by interaction status. Results indicated that overweight girls who reported never being bullied, as well as those who reported being bullied more than twice, had higher odds of not meeting PA recommendations than normal weight girls who were never bullied (adjusted odds ratio [AOR] = 2.12, 95% confidence interval [CI: 1.12, 3.99]; AOR = 9.18, 95% CI [2.26, 37.27], respectively). Obese girls who were bullied once or twice had higher odds of not meeting PA recommendations than normal weight girls who were never bullied (AOR = 2.89, 95% CI [1.06, 7.89]). Overweight boys who reported never being bullied had lower odds of not meeting PA recommendations than normal weight boys who were never bullied (AOR = 0.62, 95% CI [0.39, 0.97]). Conversely, obese boys who were bullied once or twice reported higher odds of not meeting PA recommendations than normal weight boys who were never bullied (AOR = 3.61, 95% CI [1.22, 10.67]). Findings from this study indicate that the association between bullied status and meeting PA recommendations is complex and may differ by gender and the interaction between bullied status and weight status.

School-level economic disadvantage and obesity in middle school children in central Texas, USA: a cross-sectional study

BACKGROUND

Although children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students.

METHODS

Multilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender.

RESULTS

Students attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (OR(Adj) =3.4, 95% CI: 1.1-11.4), Hispanic (OR(Adj)=1.8, 95% CI 1.1-3.0) and White (OR(Adj)=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While no obesity differences across school ED categories were found for Hispanic Spanish-speaking students, Hispanic English-speaking students (HES) attending high ED schools were 2.4 times more likely to be obese as HES students at low ED schools (p=.003).

CONCLUSION

Findings support the need to prioritize economically disadvantaged schools for obesity prevention efforts and support further exploration of school SES context in shaping children’s physical activity and dietary behaviors.

School social cohesion, student-school connectedness, and bullying in Colombian adolescents

BACKGROUND

Student-school connectedness is inversely associated with multiple health risk behaviors, yet research is limited on the relative contributions of a student's connectedness with school and an overall context of school social cohesion to peer victimization/bullying.

PURPOSE

We examined associations of perceived school cohesion and student-school connectedness with physical victimization, verbal victimization, and social exclusion in the past six months in adolescents in grades 6-11 (N = 774) attending 11 public and private urban schools in Colombia.

METHODS

Cross-sectional data were collected via a self-administered questionnaire and analyzed using mixed-effects linear regression models.

RESULTS

Higher perceived school cohesion was inversely related with exposure to three bullying types examined (p < 0.05); student-school connectedness was negatively related to verbal victimization among girls only (p < 0.01). In full models, school cohesion maintained inverse associations with three bullying types after controlling for student-school connectedness (p ≤ 0.05).

CONCLUSION

Enhancing school cohesion may hold benefits for bullying prevention beyond a student's individual school connectedness.

Racial and ethnic differences in the home food environment explain disparities in dietary practices of middle school children in Texas

OBJECTIVE

To examine racial and ethnic differences among middle school children in the home food environment (HFE) and the extent to which associations of healthy and unhealthy eating with the HFE differ by race and ethnicity.

DESIGN

Cross-sectional secondary analyses of baseline data from Coordinated Approach to Child Health Middle School, a school-based intervention targeting obesity and obesogenic behaviors among middle school children in Austin, TX.

PARTICIPANTS

A total of 2,502 children (mean age, 13.9 years; 58% Hispanic, 28% white, and 14% black).

VARIABLES MEASURED

Availability and accessibility of healthy foods, and parental support of healthy eating, and family meals. Consumption of both healthy and unhealthy foods was examined.

ANALYSIS

Differences across racial and ethnic groups in aspects of HFE were estimated using linear regression. Models also examined racial and ethnic differences in consumption of healthy and unhealthy foods. If adjusting for HFE, such differences were accounted for.

RESULTS

White children had significantly better HFEs than Hispanic and black children with greater availability and accessibility of healthy foods (P < .001). Adjusting for a healthy HFE reduced disparities in consumption of healthy foods but not in consumption of unhealthy foods.

CONCLUSIONS AND IMPLICATIONS

Improved HFE may increase healthy eating among ethnic minorities but is unlikely to reduce unhealthy eating.

Promoting teacher adoption of physical activity breaks in the classroom: findings of the Central Texas CATCH Middle School Project

BACKGROUND

Research suggests that physical activity breaks (ABs) during class increase students' physical activity levels and provide an academic benefit. This study evaluates a 3-year intervention aimed at encouraging teacher AB use.

METHODS

Thirty central Texas middle schools were assigned to 1 of 3 conditions: training-only (Basic), training plus facilitator support (Basic Plus), and training/facilitator support and a social marketing campaign (Basic Plus SM). Teachers completed surveys at end of years 2 (N = 1039) and 3 (N = 831) to assess exposure to program, self-efficacy, and frequency of AB use.

RESULTS

At end of year 3, teachers in facilitator-supported conditions reported increased exposure, self-efficacy, and use compared to Basic condition. Only 43.2% of teachers in the Basic condition reported receiving training in ABs compared to 84.2% and 90.6% in the Basic Plus and Basic Plus SM conditions, respectively. Additionally, a greater percentage of teachers in the facilitator-support conditions reported conducting ABs weekly (Basic = 23.3%, Basic Plus = 34.4%, Basic Plus SM = 38.7%, at year 3; p < .001).

CONCLUSIONS

Despite perceived barriers, including fear that ABs will detract from instructional time, the intervention was successful in having a core group of teachers implement them weekly. More research is needed to increase the percentage of teachers implementing ABs regularly.

Validated modeling for German white wine varietal authentication based on headspace solid-phase microextraction online coupled with gas chromatography mass spectrometry fingerprinting

An untargeted analytical approach combined with chemometrics using the volatiles of German white wine was investigated regarding the usefulness for verifying botanical origin. A total of 198 wine samples of Riesling, Müller-Thurgau, Silvaner, Pinot Gris, and Pinot Blanc were examined applying headspace solid-phase microextraction online coupled with gas chromatography mass spectrometry. The resultant three-dimensional raw data were processed by available metabolomics software. After data treatment, a partial least-squares discriminant analysis (PLS-DA) model was validated. External samples were correctly classified for 97% Silvaner, 93% Riesling, 91% Pinot Gris/Blanc, and 80% Müller-Thurgau. This model was related to monoterpenoids, C13-norisoprenoids, and esters. Further, 100% prediction for a two-class model of Riesling versus Pinot Gris/Blanc was confirmed by 74 additional samples measured independently. Hence, the strategy applied was, in particular, reliable and relevant for white wine varietal classification. In addition, the superior classification performance of the Riesling class was revealed.

Is frequency of family meals associated with parental encouragement of healthy eating among ethnically diverse eighth graders?

OBJECTIVE

The purpose of the present study was to explore the relationship between family meals and parental encouragement of healthy eating overall and by ethnicity.

DESIGN

Family meal frequency was measured with one item asking how many times in the past 7 d all or most of the family ate a meal together, which was then categorized to represent three levels of family meals (≤2 times, 3-6 times and ≥7 times). Parental encouragement of healthy eating assessed how often parents encouraged the student to eat fruits and vegetables, drink water, eat wholegrain bread, eat breakfast and drink low-fat milk (never to always). An overall scale of parental encouragement of healthy eating was created. Mixed-effect regression analyses were run controlling for gender, ethnicity, age and socio-economic status. Moderation by ethnicity was explored.

SETTING

Middle schools.

SUBJECTS

Participants included 2895 US eighth grade students participating in the Central Texas CATCH (Coordinated Approach To Child Health) Middle School Project (mean age 13·9 years; 24·5 % White, 52·7 % Hispanic, 13·0 % African-American, 9·8 % Other; 51·6 % female).

RESULTS

Eating more family meals was significantly associated with having parents who encouraged healthy eating behaviours (P for trend <0·001). The number of family meals was positively associated with encouragement of each of the healthy eating behaviours (P for trend <0·0001). There were no differences in the relationships by ethnicity of the students.

CONCLUSIONS

Families who eat together are more likely to encourage healthy eating in general. Interventions which promote family meals may include tips for parents to increase discussions about healthy eating.

Physical activity during recess in low-income third-grade Texas students

OBJECTIVES

To estimate the prevalence of recess-based moderate and vigorous physical activity (MVPA) and vigorous physical activity (VPA) among third-grade students attending low-income, urban schools in Texas.

METHODS

Structured observations (N = 77 class and 616 student observations) using SOFIT were conducted over 3 months in 8 elementary schools with majority Hispanic students.

RESULTS

Students engaged in 66.4% and 19.2% of their ∼20-minute recess time in MVPA and VPA, respectively. Boys engaged in more MVPA and VPA (p < .007). Contextual differences in activity (setting and activity type) were identified.

CONCLUSIONS

Findings underscore the importance of scheduled recess time for children's physical activity.

Promoting energy-balance behaviors among ethnically diverse adolescents: overview and baseline findings of The Central Texas CATCH Middle School Project

The Central Texas Coordinated Approach To Child Health (CATCH) Middle School Project is a 3.5-year school-based project aimed at promoting physical activity (PA), healthy eating, and obesity prevention among public middle school students in Texas. This article describes the CATCH intervention model and presents baseline findings from spring 2009. CATCH comprises six core components: CATCH Team, CATCH PE, CATCH Classroom, CATCH Eat Smart Cafeteria, CATCH Family, and CATCH Social Marketing. A group randomized serial cross-sectional design is being employed to test the effect of three program support conditions (n = 10 schools each) on energy-balance behaviors: Basic (training and curriculum only), Basic Plus (training and curriculum plus CATCH facilitator support), and Basic Plus Social Marketing (all inputs plus social marketing component). The study sample is composed of a cross-sectional sample of eighth-grade students (primary outcome evaluation sample) and sixth- and seventh-grade students (PE process evaluation sample) who are selected and measured each year. At baseline, 37.9% of eight-grade students (n = 2,841; 13.9 years) were overweight/obese and 19.2% were obese. Eighth-grade students reported, on average, consuming sugar-sweetened beverages more than two times on the previous day and fruits and vegetables roughly three times on the previous day; only two of five school districts surpassed the recommended 50% cut-point for class time spent in moderate-and-vigorous PA as measured in classes of sixth- and seventh-grade students. Additional behavioral findings are reported. Body mass index and behaviors were comparable across conditions. Baseline findings underscore the need to promote student energy-balance behaviors.

Experimenting with cigarettes and physical activity among Mexican origin youth: a cross sectional analysis of the interdependent associations among sensation seeking, acculturation, and gender

BACKGROUND

Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation.

METHODS

In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson's χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student's t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation.

RESULTS

Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active.

CONCLUSIONS

Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.

Environmental characteristics and student physical activity in PE class: findings from two large urban areas of Texas

BACKGROUND

Physical education (PE) classes provide opportunities for children to be active. This study examined the associations between specific environmental characteristics (teacher characteristics; class size, duration and location; and lesson context) and elementary school-aged children's moderate-to-vigorous activity (MVPA) during PE.

METHODS

Environmental characteristics and student activity levels were measured in 211 third-, fourth-, and fifth-grade PE classes in 74 Texas public schools using SOFIT direct observation.

RESULTS

Students engaged in less than half their PE class time in MVPA (38%), while approximately 25% of class time was spent in classroom management. Percent time in MVPA was significantly higher in outdoor classes compared with indoors (41.4% vs. 36.1%, P = .037). Larger (P = .044) and longer (P = .001) classes were negatively associated with percentage of MVPA and positively correlated with time spent in management (P < .001).

CONCLUSIONS

Findings suggest that children's activity may be influenced by environmental factors such as class size, location, and lesson contexts. These findings hold important policy implications for PE class organization and the need for strategies that maximize children's MVPA. Further research is needed to test the causal association of these factors with student MVPA.

Do trends in physical activity, sedentary, and dietary behaviors support trends in obesity prevalence in 2 border regions in Texas?

OBJECTIVE

The aim of the study was to compare the change in energy balance-related behaviors from 2000-2002 to 2004-2005 between 2 Texas regions with distinct patterns in obesity prevalence (decrease in the El Paso region [EP] and leveling off in the Rio Grande Valley region [RGV]) and to determine the role of the behaviors in the difference in obesity prevalence between the regions.

DESIGN

Cross-sectional measurements of the School Physical Activity and Nutrition Study.

SETTING

Elementary schools.

PARTICIPANTS

3,949 children (9-10 years).

VARIABLES MEASURED

Body mass index (objectively measured) and behaviors (self-assessed).

ANALYSIS

Probability and post-stratification weighting procedures and mediation analysis.

RESULTS

Compared to students in the RGV, students in the EP experienced a smaller decrease in sports team participation, an increase in regular meal consumption, and an increase in the frequency of milk/yogurt, cereal, sweet snacks, and frozen dessert consumption between measurement periods. Prevalence of frequent television viewing was lower in the EP. The lower body mass index in the EP was associated with regular meal consumption, and higher milk/yogurt and sweet snack consumption.

CONCLUSIONS AND IMPLICATIONS

Improvement of physical activity, sedentary behaviors, and healthful diet, but not unhealthful diet like sweet snack consumption, seem to be related to the decrease in obesity in the EP.

Physical activity, watching television, and the risk of obesity in students, Texas, 2004-2005

INTRODUCTION

The epidemic of childhood obesity has been well-documented. Prevalence of obesity among students in Texas is higher than the US prevalence. Our objective was to understand the combined influence of physical activity and television viewing on weight status of students in Texas.

METHODS

Students in grades 4, 8, and 11 participated in the School Physical Activity and Nutrition survey during the 2004-2005 academic year. Multinomial logistic regression tested the associations between both being overweight and obese (vs underweight/normal weight) and the combined influence of physical activity and watching television, adjusting for age, grade, race/ethnicity, language spoken at home, and percentage of economically disadvantaged students in the school. We used 5 physical activity indicators to describe students' physical activity.

RESULTS

Girls who participated in less than 3 days of exercise per week to strengthen or tone muscles and watched 2 hours or less per day of television had increased odds of being obese (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0) compared with girls who participated in 3 or more days per week of exercise to strengthen or tone muscles and watched 2 hours or less per day of television. Boys in our study who watched 3 or more hours per day of television and did not meet physical activity recommendations had increased odds of being obese in all of our 5 physical activity indicators.

CONCLUSION

Although results varied by physical activity indicator and sex, our findings provide further evidence for the combined effect of high television watching and low physical activity engagement on the risk for obesity in children and adolescents.

Associations among dietary supplement use and dietary and activity behaviors by sex and race/ethnicity in a representative multiethnic sample of 11th-grade students in Texas

BACKGROUND AND OBJECTIVE

The purpose of this study was to examine associations among dietary supplement use and dietary/activity patterns in a representative sample of adolescents by sex and race/ethnicity, a research area where extant data is limited.

DESIGN/PARTICIPANTS

Cross-sectional, multistage, probability-based sample of 11th graders in Texas during 2004-2005 (n=6,422; 48.8% white/other, 37% Hispanic, and 14.2% African American; 50.6% boys; mean age 16.7 years).

SETTING

Classrooms. MAIN VARIABLES ASSESSED: Dietary supplement use, dietary/activity patterns, and anthropometrics.

STATISTICAL ANALYSES PERFORMED

Multiple logistic regression models (odds ratios [ORs] and 95% confidence intervals [CIs]).

RESULTS

Dietary supplement users reported healthy dietary and physical activity behaviors overall, yet sex- and race/ethnicity-specific differences were seen in associations among specific diet/activity behaviors and supplement use. In whites/others and Hispanics, but not African Americans, supplement use was associated with higher diet quality scores (OR 2.93, 95% CI 1.74 to 4.95 for whites/others; OR 3.93, 95% CI 2.26 to 6.83 for Hispanics), and regular consumption of breakfast (OR 2.27, 95% CI 1.40 to 3.66 for whites/others; OR 1.96, 95% CI 1.11 to 3.46 for Hispanics) and low-fat foods (OR 3.02, 95% CI 1.53 to 5.98 for whites/others; OR 3.59, 95% CI 1.11 to 11.6 for Hispanics). Supplement use was not associated with body mass index or with sedentary behaviors overall, but was associated with less television viewing only in whites/others (OR 0.53, 95% CI 0.33 to 0.84). For physical activity, boys and whites/others showed positive associations between supplement use and all indicators examined, but girls, Hispanics and African Americans showed mixed patterns of associations. Supplement use was associated with higher weight preference only in boys (OR 2.47, 95% CI 1.24 to 4.90), and vegetarian diets only in girls (OR 2.96, 95% CI 1.35 to 6.47).

CONCLUSIONS

Dietary and activity patterns associated with dietary supplement use may vary by sex- and racial/ethnic subpopulation, especially amongst African American youth. These findings together with further research on psychosocial and attitudinal characteristics associated with adolescent supplement use can enhance the development of targeted and tailored health communications about supplement use in adolescent subpopulations.

Parental influences on television watching among children living on the Texas-Mexico border

PURPOSE

We examined the association of parental television (TV) rules and compliance with the American Academy of Pediatrics' (AAP) recommendations of <or=2 h of television per day in a primarily Hispanic sample of elementary school children (n=734) living on the U.S. side of the Texas-Mexico border. The potential modifying effects of children's home environment (parental TV watching, parent at home after school, and TV in bedroom) were also examined.

METHODS

A cross-sectional analysis was performed on baseline survey data merged from two waves (2006 and 2007) of a CDC-funded TV reduction intervention with 4th grade children (mean age: 9.5 years). Logistic regression analyses were conducted to examine associations.

RESULTS

Children who had TV rules were 1.4 (95% CI: 1.04, 1.94) and 1.7 (95% CI: 1.22, 2.32) times more likely to meet the AAP recommendation for weekend and weekday TV watching, respectively. Parental TV watching and TV in bedroom modified the effect of TV rules on children's TV watching, with null associations found for children whose parents watch TV frequently and for children with no TV in bedroom. No interaction effect was found for children's afterschool context.

CONCLUSIONS

Parental TV limits is one strategy for reducing children's television watching that merits further investigation.

Reductions in child obesity among disadvantaged school children with community involvement: the Travis County CATCH Trial

The objective of this study was to compare the impact of two intervention approaches on the prevalence of child overweight and obesity: (i) Coordinated Approach To Child Health BasicPlus (CATCH BP), in which schools were provided evidence-based coordinated school health program training, materials, and facilitator support visits, and (ii) CATCH BP and Community (BPC), in which BP schools received additional promotion of community partnerships with the aim of integrating community members and organizations into schools, local decision making and action, and best practices workshops. Schools (n = 97) in four central Texas districts were recruited to participate in the 4-year project. Of the low-income schools (n = 58), 15 schools were selected to receive the BPC intervention and matched with 15 schools in the BP condition. A serial cross-sectional design was used, in which 4th grade student BMI, physical activity, and diet were assessed in the 30 schools in spring 2007 and 2008. Measurements in spring 2007 included 1,107 students, with 53% female; 61% Hispanic, and 14% African American; and mean age of 9.9 years. Adjusted prevalence of overweight/obesity (>or=85th percentile) was 42.0 and 47.4% in spring 2007 for the BP and BPC students, respectively. From spring 2007 to spring 2008, the percent of students classified as overweight/obese decreased by 1.3 percentage points (P = 0.33) in BP schools, compared to a decrease of 8.3 percentage points (P < 0.005) in students from BPC schools; the difference between conditions was significant (P = 0.05). CATCH BPC students also reported more positive trends in related behaviors. Implementation of a community-enhanced school program can be effective in reducing the prevalence of child overweight in low-income student populations.

Senate Bill 42: implementation and impact on physical activity in middle schools

PURPOSE

In 2005, the Texas State Legislature passed Senate Bill 42 (SB42), which required public middle school students (grades 6-8) to participate in 30 minutes of daily structured physical activity. The purpose of this study was to assess awareness of and adherence to SB42 in Texas middle schools, and to assess the impact of SB42 on the frequency and quality of structured physical activity.

METHODS

Key informant (school principals, physical education [PE] instructors, nurses, or designated personnel) telephone interviews on the implementation of SB42 were conducted from a statewide representative sample of public middle schools (n=112). Direct observation, key informant, and student report of physical activity in PE classes at 17 Texas-Mexico border middle schools assessed the frequency and quality of structured physical activity.

RESULTS

State level (94% +/- 4.5%) and border district (94% +/- 13.5%) key informants reported a high level of overall awareness of SB42. Postimplementation of SB42 border districts reported a minimum of 4 days per week of PE instruction and more than 58 minutes per PE class, exceeding the 30-minute minimum of structured physical activity per day or 135 minutes per week as required by SB42 (range: 58.2-61.4 minutes). A significant increase in the number of days of PE class was observed in the border sample between 2004 and 2005 and 2006 and 2008, with eighth grade students reporting an average of 2.0 days and 3.7 days of PE per week, respectively (p < .001). Additionally, border districts met the Healthy People 2010 objective of 50% time in moderate-to-vigorous physical activity (mean 54.9% +/- 5.1%) during PE class.

CONCLUSIONS

Implementation of SB42 appears to have impacted the frequency of school PE in Texas and the prevalence of child self-reported physical activity behaviors along the Texas-Mexico border. General awareness of and adherence to SB42 was high in both statewide and among the border districts. Our mixed findings on adherence to specific components of the legislation suggest the need for further investigation of the factors that both facilitate and inhibit local leadership around school policy and the mechanisms to ensure the school policy is being implemented.

Prevalence of physical activity and sedentary behaviors by metropolitan status in 4th-, 8th-, and 11th-grade students in Texas, 2004-2005

INTRODUCTION

Research on geographic differences in children's physical activity (PA) engagement is limited. This study examined the prevalence of PA and sedentary behaviors in a probability sample of children in the 4th (mean age, 9.7 years; n = 7,907), 8th (mean age, 13.7 years; n = 8,827), and 11th (mean age 16.9 years; n = 6,456) grades by urban, suburban, and rural location in Texas.

METHODS

Using data from the 2004-2005 School Physical Activity and Nutrition (SPAN) study, we conducted logistic regression analyses stratified by sex to assess associations of 6 PA indicators and 2 sedentary behavior indicators with metropolitan status.

RESULTS

Urban 8th- and 11th-grade students reported the lowest prevalence of PA. Suburban or rural schools were significantly more likely than their urban counterparts to report higher school-based sports team participation in 8th graders (P = .001); higher vigorous PA (P = .01) and strengthening exercise (P = .01) in 11th-grade boys; and higher physical education attendance in 4th (P < .01) and 11th graders (P = .05). Sports team (P = .04) and other organized PA participation (P = .04) in urban 4th-grade girls and vigorous PA in urban 8th-grade boys (P = .04) were the only behaviors for which a significantly higher prevalence was reported compared with nonurban counterparts. We observed few significant geographic differences in prevalence of television watching and video game playing.

CONCLUSION

Several significant differences in PA behaviors were found by metropolitan status in this sample of public school students in Texas. Research is needed on availability of PA opportunities and PA barriers by metropolitan status to better understand the lower prevalence estimates reported in older urban children.

Methamphetamine use and sexual risk behaviors in U.S. high school students: findings from a national risk behavior survey

BACKGROUND

Methamphetamine use is associated with numerous adverse physical and mental health outcomes. This study investigated the prevalence and distribution of lifetime methamphetamine use (MU) as well as the association between methamphetamine use and engagement in sexual risk behaviors among a nationally representative sample of U.S. high school students.

METHODS

A secondary analysis of the 2003 Youth Risk Behavior Survey (n = 15,240) was carried out. Weighted descriptive and logistic regression analyses were conducted to determine the prevalence of MU by socio-demographic characteristics and the association between drug use and sexual risk behaviors.

RESULTS

Prevalence of having used methamphetamine > or =1 times (lifetime methamphetamine use) (7.6%; 95%CI +/- 1.0) was comparable to lifetime cocaine use but over double the rate of lifetime heroin use. Males reported slightly higher MU than females (8.3%+/-1.4 vs. 6.8%+/-1.0). MU was more than twice as high for white (8.1%+/-1.1) and Hispanic (8.2%+/-2.2) students compared to black students (3.1%+/-1.0). MU was associated with approximately 2 to 11 times the likelihood of engaging in one of the six sexual risk behaviors examined. Heavy methamphetamine users were >4 times more likely to report having had sexual intercourse before age 13, sex with multiple partners, and having been/gotten someone pregnant compared to those who used methamphetamine 1-2 times.

CONCLUSION

Findings indicate that a substantial number of U.S. youth have used methamphetamine, that white and Hispanic high school students may be at higher risk for methamphetamine use, and that methamphetamine users may be at higher risk for engaging in sexual risk behaviors.

Perceived parental monitoring and health risk behavior among public secondary school students in El Salvador

Although parental monitoring has received considerable attention in studies of U.S. adolescents, few published studies have examined how parents' knowledge of their children's whereabouts may influence health risk behaviors in adolescents living in Latin America. We investigated the association between perceived parental monitoring and substance use, fighting, and sexual behaviors in rural and urban Salvadoran adolescents (n = 982). After adjusting for several sociodemographic covariates, multilevel regression analyses indicated that students reporting low parental monitoring were between 2 to 3.5 times more likely to report risk behaviors examined. The promotion of specific parenting practices such as parental monitoring may hold promise for reducing adolescent risk behaviors in El Salvador.

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador

Background

Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains–aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors–among public secondary school students in central El Salvador.

Methods

We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12–20 years participated in the study.

Results

Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).

Conclusion

A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.

Social support, physical activity and sedentary behavior among 6th-grade girls: a cross-sectional study

BACKGROUND

Despite the importance of social support in promoting physical activity, little is known about the relative influence of the type or source of social support on adolescent girls' physical activity and sedentary behaviors. This study examined the associations of two types of social support (social participation in and social encouragement for physical activity) and two social support sources (family and friends) with self-reported daily minutes of physical activity and sedentary behavior among sixth-grade girls in Texas.

METHODS

A secondary analysis of 718 sixth-grade girls between the ages of 10 to 14 was performed using cross-sectional baseline data from an osteoporosis prevention intervention study. Physical activity and sedentary behaviors (television-video viewing and computer-video game playing) were assessed using 3 administrations of the Self-Administered Physical Activity Checklist; social support indicators were assessed with Likert-type items from a psychosocial questionnaire.

RESULTS

In multiple linear regression analyses, friend physical activity participation (partial correlation coefficient (r) = 0.10, p = .009) and friend (r = 0.12) and family encouragement (r = 0.11) (p < .01, respectively) were positively related to moderate-to-vigorous physical activity in the full model with other support variables, BMI and ethnicity; friend encouragement was the only variable positively related to vigorous physical activity (r = 0.11, p = .005). Family participation in physical activity had the strongest negative correlation with total minutes of television-video viewing and computer-video playing (r = -0.08, p < .05).

CONCLUSION

Findings lend support to the importance of social support for physical activity among adolescent girls but suggest that the source and type of social support may differ for physical activity and sedentary behaviors. Further research is needed to assess the causal or reciprocal relation between the roles of friends and family in promoting physical activity and of family physical activity in decreasing sedentary behaviors among early adolescent girls.

Prevalence of overweight misperception and weight control behaviors among normal weight adolescents in the United States

Weight perceptions and weight control behaviors have been documented with underweight and overweight adolescents, yet limited information is available on normal weight adolescents. This study investigates the prevalence of overweight misperceptions and weight control behaviors among normal weight adolescents in the U.S. by sociodemographic and geographic characteristics. We examined data from the 2003 Youth Risk Behavior Survey (YRBS). A total of 9,714 normal weight U.S. high school students were included in this study. Outcome measures included self-reported height and weight measurements, overweight misperceptions, and weight control behaviors. Weighted prevalence estimates and odds ratios were computed. There were 16.2% of normal weight students who perceived themselves as overweight. Females (25.3%) were more likely to perceive themselves as overweight than males (6.7%) (p < 0.05). Misperceptions of overweight were highest among white (18.3%) and Hispanic students (15.2%) and lowest among black students (5.8%). Females (16.8%) outnumbered males (6.8%) in practicing at least one unhealthy weight control behavior (use of diet pills, laxatives, and fasting) in the past 30 days. The percentage of students who practiced at least one weight control behavior was similar by ethnicity. There were no significant differences in overweight misperception and weight control behaviors by grade level, geographic region, or metropolitan status. A significant portion of normal weight adolescents misperceive themselves as overweight and are engaging in unhealthy weight control behaviors. These data suggest that obesity prevention programs should address weight misperceptions and the harmful effects of unhealthy weight control methods even among normal weight adolescents.

The Relationship Between Perceived Exposure to Promotional Smoking Messages and Smoking Status among High School Students

Data on self-reported perceived exposure to pro-smoking messages were collected from 1,608 high school students surveyed through the ASPIRE (A Smoking Prevention Interactive Experience) Program in Houston, Texas, in 2003. Results indicated that high school smoking quitters had approximately twice the odds of perceived exposure to pro-smoking messages as nonsmokers through billboard advertisements (Adjusted Odds Ratio [AOR] = 2.04, 95% CI: 1.09, 3.81), newspapers & magazines (AOR: 1.97, 95% CI: 1.09, 3.56), and movies (AOR: 1.94, 95% CI: 1.03, 3.65). Smoking experimenters marginally perceived more exposure to pro-smoking radio messages (AOR = 1.31, 95% CI: 1.04, 1.67) and billboard advertisements (AOR = 1.28, 95% CI: 1.02, 1.61) compared to nonsmokers. Lastly, current smokers were 1.82 times as likely to report exposure to pro-smoking poster advertisements as nonsmokers (95% CI: 1.19, 2.79, p < or = .05). These findings suggest that experimenters and quitters may pay more attention to smoking advertisements than nonsmokers and current smokers.