Dietary intakes of Native American children: findings from the pathways feasibility study.
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Child↗
Biomedical subjects
Mary Story
Publications and source records attributed to Mary Story.
School food policies and practices: a state-wide survey of secondary school principals.
OBJECTIVE: To describe food-related policies and practices in secondary schools in Minnesota. DESIGN: Mailed anonymous survey including questions about the secondary school food environment and food-related practices and policies. SUBJECTS/SETTING: Members of a statewide professional organization for secondary school principals (n = 610; response rate: 463/610 = 75%). Of the 463 surveys returned, 336 met the eligibility criteria (current position was either principal or assistant principal and school included at least one of the grades of 9 through 12). STATISTICAL ANALYSIS: Descriptive statistics examined the prevalence of specific policies and practices. Chi2 analysis examined associations between policies and practices and school variables. RESULTS: Among principals, 65% believed it was important to have a nutrition policy for the high school; however, only 32% reported a policy at their school. Principals reported positive attitudes about providing a healthful school food environment, but 98% of the schools had soft drink vending machines and 77% had contracts with soft drink companies. Food sold at school fundraisers was most often candy, fruit, and cookies. APPLICATIONS: Dietetics professionals who work in secondary school settings should collaborate with other key school staff members and parents to develop and implement a comprehensive school nutrition policy. Such a policy could foster a school food environment that is supportive of healthful food choices among youth.
Administrative Personnel↗
Individual and environmental influences on adolescent eating behaviors.
Food choices of adolescents are not consistent with the Dietary Guidelines for Americans. Food intakes tend to be low in fruits, vegetables, and calcium-rich foods and high in fat. Skipping meals is also a concern among adolescents, especially girls. Factors influencing eating behaviors of adolescents need to be better understood to develop effective nutrition interventions to change eating behaviors. This article presents a conceptual model based on social cognitive theory and an ecological perspective for understanding factors that influence adolescent eating behaviors and food choices. In this model, adolescent eating behavior is conceptualized as a function of individual and environmental influences. Four levels of influence are described: individual or intrapersonal influences (eg, psychosocial, biological); social environmental or interpersonal (eg, family and peers); physical environmental or community settings (eg, schools, fast food outlets, convenience stores); and macrosystem or societal (eg, mass media, marketing and advertising, social and cultural norms).
Adolescent↗
Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: findings from Project EAT.
OBJECTIVE: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls. METHODS: The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating). RESULTS: In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys. CONCLUSIONS: Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.
Adolescent↗
Parental correlates of physical activity in a racially/ethnically diverse adolescent sample.
PURPOSE: To evaluate relationships between parents' and adolescents' physical activity and television usage and whether these relationships differed among adolescents from different racial/ethnic backgrounds. METHODS: Adolescents and their parents were separately asked to report information about their eating, exercising, and weight-related behaviors. Among the 900 adolescents, 477 were girls and 423 were boys; 60% were in high school; 29% were white, 23% were black, 21% were Asian, 14% were Hispanic, and 13% were considered mixed or other race/ethnicity. RESULTS: Parents' reported encouragement was positively related to physical activity in white (r = 0.39; p <.001) and black boys (r = 0.26; p =.007), and girls (all race/ethnic groups combined: r = 0.15; p <.001). Parents' television time was positively related to television time in Hispanic boys (r = 0.40; p =.009) but negatively related to television time in black boys (r = -0.23; p =.036). Parents' concern about their own fitness was negatively related to television time in white girls (r = -0.19; p =.029) but positively related in black girls (r = 0.23; p =.030). CONCLUSION: This study found significant, although modest, relationships between parents' and adolescents' physical activity attitudes and behaviors. Many of these relationships differed by race/ethnicity. Results from the present and previous studies suggest that factors other than parents' behavior and support explain adolescents' physical activity behaviors.
Adolescent↗
Unhealthy behaviors and psychosocial difficulties among overweight adolescents: the potential impact of familial factors.
PURPOSE: To compare overweight and non-overweight youth on a selection of self-reported eating, physical activity, dieting, educational, and emotional variables and identify familial factors that serve as protective forces against unhealthy behaviors and psychosocial difficulties among overweight adolescents. METHODS: Data were taken from a 1996 cross-sectional school-based survey of 9957 adolescents in grades 7, 9, and 11. Based on self-reported heights and weights, respondents were categorized as "overweight" (body mass index) > or =85th percentile or "non-overweight." Student's t-tests were used to compare the non-overweight and overweight sample on the self-reported health-related behaviors and psychosocial variables. Logistic and linear regressions were used to identify familial factors associated with a reduced risk of engaging in unhealthy behaviors and experiencing psychosocial distress. RESULTS: Overweight adolescents reported engaging in significantly more unhealthy behaviors and experiencing more psychosocial distress than their non-overweight peers. Among the overweight youth, higher levels of reported family connectedness and parental expectations and moderate levels of parental monitoring were associated with the lowest levels of unhealthy behaviors and psychosocial distress. CONCLUSIONS: Satisfying and developmentally appropriate parent-adolescent relationships are associated with reduced behavioral and psychosocial risk factors associated with overweight during adolescence.
Adolescent↗
Steroid use among adolescents: findings from Project EAT.
PURPOSE: To explore the prevalence and correlates of using steroids for the purpose of gaining muscle among adolescent males and females. More specifically, the study objectives were to: (a) assess the prevalence of anabolic steroid use in a large population-based sample of adolescent males and females; and (b) identify personal, socio-environmental, and behavioral factors related to the health of adolescents that use anabolic steroids. METHODS: The study population included 4746 middle and high school students from St. Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of a population-based study of eating patterns and weight concerns among teenagers (Project EAT: Eating Among Teens). Steroid use and a range of socio-environmental, personal, and behavioral factors hypothesized to be correlates of steroid use were assessed. Associations were examined separately among males and females through comparisons of means (unadjusted and adjusted for grade-level and race) for continuous variables, and percentages, and odds ratios for dichotomized variables. RESULTS: Steroid use was more common in males (5.4%, vs. 2.9% of females), non-Caucasians (especially Hmong, a subset of the Asian-American population), and in middle school students (as compared to high school). In males, steroid use was associated with poorer self-esteem and higher rates of depressed mood and attempted suicide, poorer knowledge and attitudes about health, greater participation in sports that emphasize weight and shape, greater parental concern about weight, and higher rates of disordered eating and substance use. Among females, steroid use was less consistent in its associations with other variables, although overall, a similar pattern of results emerged. CONCLUSIONS: Anabolic steroid use in adolescence is associated with poorer health-related attitudes and behaviors and exposure to socio-environmental influences encouraging weight preoccupation. Attention needs to be directed toward youth who may be at increased risk for steroid use within clinical and community-based settings
Adolescent↗
Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity.
PURPOSE: To examine the current prevalence of disordered eating behaviors in a large sample of adolescents, by gender and ethnicity, and to identify gender and ethnic-specific risk and protective factors. METHODS: The study population included 81,247 9th- and 12th-graders who completed the 1998 Minnesota Student Survey, a self-report, school-based survey which included questions about disordered eating behaviors and a variety of psychosocial characteristics. RESULTS: Fifty-six percent of 9th-grade females and 28% of 9th-grade males report disordered eating behaviors (i.e. one or more of the following to lose or control weight: fasting or skipping meals, diet pills, vomiting, laxatives or smoking cigarettes; and binge-eating), with slightly higher rates among 12th-grade females and males, 57% and 31%, respectively. Among both genders, Hispanic and American Indian youth reported the highest prevalence of disordered eating. Risk factors for disordered eating among both males and females included cigarette smoking, appearance concerns, and alcohol use. Protective factors for both males and females were positive self-esteem, emotional well-being, school achievement, and family connectedness. While risk and protective factors were similar across gender, they differed across ethnicity particularly among females. CONCLUSIONS: Health professionals working with youth need to be aware of the high prevalence of these subclinical disordered eating behaviors, ask appropriate screening questions, and provide resources and referral, if necessary, for youth reporting these behaviors. Knowledge of risk and protective factors can serve to guide intervention and prevention efforts, particularly as they apply across ethnicity.
Adolescent↗
Prevalence and correlates of weight-control behaviors among Caribbean adolescent students.
Adolescent students from nine English-speaking Caribbean countries completed a survey that assessed weight-control behaviors. Weight-control behaviors were prevalent and similar across gender. Extreme weight-control behaviors were related to several psychosocial factors and compromising health behaviors. Future interventions should target adolescents who are using weight-controlling behaviors to prevent future eating disturbances and psychosocial and health morbidities.
Adolescent↗
Weight control behaviors among obese, overweight, and nonoverweight adolescents.
OBJECTIVE: To evaluate weight control behaviors, eating, and physical activity behaviors among obese, overweight, and nonoverweight female and male adolescents. METHODS: A representative sample of 8,330 7th, 9th, and 11th grade public school students in Connecticut participated in the study. Adolescents responded to questions about weight control behaviors (dieting, exercise, vomiting, diet pills, and laxatives), healthy eating behaviors, breakfast consumption, and vigorous physical activity. RESULTS: In comparison to nonoverweight youths, overweight adolescents were less likely to eat breakfast and less likely to engage in vigorous physical activity than nonoverweight youths. Higher prevalences of unhealthy weight control behaviors were evident among overweight youths. CONCLUSIONS: Overweight adolescents use more unhealthy weight management strategies and are not engaging in healthier strategies, such as increased physical activity or healthier eating. These findings suggest the need to provide consistent messages about healthy weight loss methods to adolescents.
Adolescent↗
Peer-led, school-based nutrition education for young adolescents: feasibility and process evaluation of the TEENS study.
Peer education has become a popular strategy for health promotion interventions with adolescents, but it has not been used widely in school-based nutrition education. This paper describes and reports on the feasibility of the peer leader component of a school-based nutrition intervention for young adolescents designed to increase fruit and vegetable intakes and lower fat foods. About 1,000 seventh-grade students in eight schools received the nutrition intervention. Of these, 272 were trained as peer leaders to assist the teacher in implementing the activities. Results from a multicomponent process evaluation based on peer leader and classroom student feedback, direct classroom observation, and teacher ratings and interviews are presented. Results show that peer-led nutrition education approaches in schools are feasible and have high acceptability among peer leaders, classroom students, and teachers.
Adolescent↗
Factors in the school cafeteria influencing food choices by high school students.
This study set three objectives: 1) to examine the perceived influence of health concerns, labeling and nutrition information, taste, cost, availability, and peers on adolescents' food choices, particularly in the school cafeteria; 2) to determine whether these factors vary by gender, grade level, or adolescents' health and weight concerns; and 3) to provide recommendations regarding promotion of low-fat foods in the school cafeteria based on factors associated with food choices. Data were collected from a school survey that assessed key influences on adolescents' food choices, including low-fat foods. Some 289 students in grades 10-12 from a senior high school in a metropolitan area served as subjects. Descriptive statistics, chi-square, and general linear models were used for analysis. Results indicated that, when choosing foods from the school cafeteria, taste and getting a lot for their money were important to most students (93.7% and 71.7%, respectively). Females, and students who thought about their health and weight more frequently when deciding what to eat, were more likely to report greater interest in labeling and nutrition information and availability of low-fat foods in the school cafeteria. Findings suggest that efforts to promote low-fat foods to adolescents need to address the taste of low-fat foods, availability of low-fat options, and point-of-purchase labeling of low-fat foods. Focusing on the value and cost of low-fat foods may offer a key strategy for promoting low-fat foods to males.
Adolescent↗
Food-related beliefs, eating behavior, and classroom food practices of middle school teachers.
This study examined classroom food practices and eating behavior of middle school teachers from 16 schools in a metropolitan area, located in the upper Midwest. In winter 1999-2000, teachers in sixth, seventh, and eighth grade were surveyed (response rate = 70%; n = 490/701). Questions addressed teachers' classroom food practices, eating behavior while at school, personal health, and attitudes about the school food environment. Use of food as an incentive/reward for students was a common classroom practice in middle schools, and most foods did not support development of health eating patterns by young adolescents. Candy was the most frequently used food item, reported by 73% of teachers, followed by cookies/doughnuts (37%), sweetened drinks (35%), and pizza (28%). Many middle school teachers did not role model healthy eating behavior at school. Prevalent use of vending was a particular concern, with beverage and snack vending use reported by 62% and 35% of teachers, respectively. Most vending items purchased were sweetened drinks (57%) and high-fat or high-sugar snacks (85%). Low perceived personal health, high-fat scores, and low support for the school food environment were some of the significant correlates of teachers' eating behavior. School and health professionals should continue to advocate for schoolwide policies and programs that support students and teachers if the goal of an integrated healthy school food environment is to be realized.
Adolescent↗
Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents?
Multicomponent interventions are recommended for health behavior change among adolescents. However, it is difficult to disentangle the effects of multiple intervention components. This article reports outcomes associated with varying levels of exposure to a school-based nutrition intervention. Teens Eating for Energy and Nutrition at School (TEENS). Four incremental exposures were possible: (1) control group, (2) school environment interventions only, (3) classroom plus environment interventions, and (4) peer leaders plus classroom plus environment interventions. Pattems suggesting dose response were observed, with peer leaders reporting the largest increases in fruit, vegetable, and lower fat food consumption. Students exposed to classroom plus environment interventions also improved, whereas students exposed only to school environment interventions showed trends toward choosing lower fat foods and declining fruit intake and no change in vegetable intake. Control students' choices remained stable. Future studies may investigate mechanisms for peer leaders' changes, maximizing curriculum effectiveness, and improving environmental interventions.
Adolescent↗
Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives?
OBJECTIVES: This study determined the prevalence of Minnesota urban youths reaching the Healthy People 2010 objectives for obesity and intake of fat, calcium, fruits, vegetables, and grains and compared prevalence rates across sociodemographic characteristics. METHODS: The study sample included 4746 adolescents (aged 11-18 years) from the Minneapolis/St. Paul area who completed dietary surveys and participated in anthropometric measurements as part of a school-based population study. RESULTS: Considerable gaps were seen between the existing prevalence rates for obesity and nutrient and food patterns and the targeted Healthy People 2010 prevalence rates. For example, 12.5% of the girls and 16.6% of the boys had body mass index values at or greater than the 95th percentile (target = 5%). Only 29.5% of the girls and 42.5% of the boys were meeting the daily recommended intakes for calcium (target = 75%). Similarly, percentages of youths consuming the recommended amounts of fat, fruits, vegetables, and grains were lower than the targeted percentages. There were large sociodemographic disparities in obesity and eating patterns, particularly across race/ethnicity and socioeconomic status. CONCLUSIONS: Concerted public health efforts are needed to achieve the Healthy People 2010 objectives for obesity and nutrition and to reduce racial/ethnic and socioeconomic disparities.
Adolescent↗
Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: associations with sociodemographics, weight concerns, familial factors, and metabolic outcomes.
OBJECTIVE: This study examines the prevalence of specific weight control practices/disordered eating behaviors and associations with sociodemographic characteristics, BMI and weight perceptions, family functioning, and metabolic control among adolescent females and males with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study population included 70 adolescent females and 73 adolescent males with type 1 diabetes who completed the AHEAD (Assessing Health and Eating among Adolescents with Diabetes) survey. Data on BMI and glycosylated hemoglobin (HbA(1c)) were drawn from medical records. RESULTS: Unhealthy weight control practices were reported by 37.9% of the females and by 15.9% of the males. Among the females, 10.3% reported skipping insulin and 7.4% reported taking less insulin to control their weight. Only one male reported doing either of these behaviors. Weight control/disordered eating behaviors were not associated with age, parental level of education, family structure, or race/ethnicity. Higher levels of weight dissatisfaction tended to be associated with unhealthy weight control/disordered eating; associations with BMI were inconsistent. Family cohesion was negatively associated with disordered eating among females (r = -0.52; P < 0.001) and males (r = -0.41; P < 0.001), but correlations with other measures of family environment (control, independence, and responsibility for diabetes management) were not significant. Correlations between disordered eating and HbA(1c) levels were significant among females (r = 0.33; P < 0.01) and males (r = 0.26; P < 0.05). CONCLUSIONS: Special attention is needed for youth with weight concerns and those from less cohesive families to assist in the development of healthy diabetes management behaviors.
Adolescent↗
Observations of parent-child co-shoppers in supermarkets: children's involvement in food selections, parental yielding, and refusal strategies.
The study aimed to collect descriptive information on the decision-making processes of adult shoppers around food purchases when young children are present. Anthropological field observations were conducted on adult-child grocery shoppers. Eleven supermarkets in the Minneapolis-St. Paul metropolitan region. A convenience sample (n = 142) of adult-child shoppers at 8 budget and 3 deluxe supermarkets located in diverse urban and suburban areas. Observations registered adult-child interactions over food selections, including parental yielding or refusal strategies and child engagement in shopping. Means and frequencies were calculated for food items considered. In 67 (50.4%) of the total 133 observations, a child initiated a request. Half (55.2%) of the requests were for sweets or snacks. Nearly half (47.8%) of adults yielded to the child's request. Brands and marketing techniques appeared to be a factor in 28.6% of selections. The most frequent adult refusals either provided an explanation or ignored the request. Adults yield to children's requests for sweets and snacks nearly as often as they refuse them. However, effective refusal strategies are used by many adults. Opportunities exist in the grocery store for adults to reinforce young children's interest in food and nutrition.
Adult↗
Associations between perceived family meal environment and parent intake of fruit, vegetables, and fat.
OBJECTIVE: To describe the family mealtime environment and assess associations with adult fruit, vegetable, and fat intake. DESIGN: Telephone survey. PARTICIPANTS: A convenience sample of 277 adults in the Minneapolis/St. Paul area were recruited through 4 schools. The sample was 85% female and 70% married. The mean number of children in the household was 2.6 (range 1 to 9). VARIABLES MEASURED: Adult fruit and vegetable intake, fat intake, and perceptions of the mealtime environment. ANALYSIS: Descriptive and mixed-model linear regression. RESULTS: Participants reported that the television was frequently on during dinner meals and almost one third felt that their family was too busy to eat dinner together. A higher frequency of television viewing during dinner was associated with lower fruit and vegetable consumption and higher fat consumption. Planning meals in advance was associated with higher fruit and vegetable consumption; however, 46% of the adults did not plan meals in advance. Arguments concerning eating behavior during dinner were associated with higher fat consumption. CONCLUSIONS AND IMPLICATIONS: The family meal environment is associated with adult eating patterns and should be considered when designing nutrition messages for families.
Adult↗