Project EAT Publications

What have we learned about food choices among adolescents and young adults?

1.Neumark-Sztainer D, Story M, Perry C, Casey MA. Factors influencing food choices of adolescents: Findings from focus-group discussions with adolescents. Journal of the American Dietetic Association. 1999;99(8):929-37.

Abstract:
OBJECTIVE: To assess adolescents’ perceptions about factors influencing their food choices and eating behaviors.
DESIGN: Data were collected in focus-group discussions.
SUBJECTS/SETTING: The study population included 141 adolescents in 7th and 10th grade from 2 urban schools in St Paul, Minn, who participated in 21 focus groups.
ANALYSIS: Data were analyzed using qualitative research methodology, specifically, the constant comparative method.
RESULTS: Factors perceived as influencing food choices included hunger and food cravings, appeal of food, time considerations of adolescents and parents, convenience of food, food availability, parental influence on eating behaviors (including the culture or religion of the family), benefits of foods (including health), situation-specific factors, mood, body image, habit, cost, media, and vegetarian beliefs. Major barriers to eating more fruits, vegetables, and dairy products and eating fewer high-fat foods included a lack of sense of urgency about personal health in relation to other concerns, and taste preferences for other foods. Suggestions for helping adolescents eat a more healthful diet include making healthful food taste and look better, limiting the availability of unhealthful options, making healthful food more available and convenient, teaching children good eating habits at an early age, and changing social norms to make it “cool” to eat healthfully.
APPLICATIONS/CONCLUSIONS: The findings suggest that if programs to improve adolescent nutrition are to be effective, they need to address a broad range of factors, in particular environmental factors (e.g., the increased availability and promotion of appealing, convenient foods within homes schools, and restaurants).

2.Neumark-Sztainer D, Story M, Hannan PJ, Croll J. Overweight status and eating patterns among adolescents: Where do youth stand in comparison to the Healthy People 2010 Objectives? American Journal of Public Health. 2002;92(5):844-51. PMCID: PMC1447172.

Abstract:
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.

3.Neumark-Sztainer D, Wall MM, Hannan PJ, Story M, Croll J, Perry C. Correlates of fruit and vegetable intake among adolescents: Findings from Project EAT. Preventive Medicine. 2003;37(3):198-208.

Abstract:
BACKGROUND: This study aims to identify correlates of fruits and vegetables from within the domains of personal factors (taste preferences, health/nutrition attitudes, weight/body concerns, and self-efficacy), behavioral factors (meal frequency, fast food intake, and weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). This study further aims to identify correlates of home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between availability and taste preferences.
METHODS: The population included 3957 adolescents from 31 public middle and high schools in Minnesota. Structural equation modeling was used for model testing.
RESULTS: The strongest correlates of fruit/vegetable intake were home availability of fruits/vegetables and taste preferences of fruits/vegetables. The final model explained 13% of the variance in fruit/vegetable intake, 45% of the variance in home availability, and 28% of the variance in taste preferences. Correlates of home availability included social support for healthy eating, family meal patterns, family food security, and socio-economic status. Correlates of taste preferences included health/nutrition attitudes and home availability of fruits/vegetables. A test of interaction effects indicated that when home availability of fruits/vegetables was low, intake patterns did not differ, regardless of taste preferences. In contrast, even when taste preferences for fruits/vegetables were low, if fruits/vegetables were available, intake increased.
CONCLUSIONS: Interventions to increase fruit/vegetable intake in adolescents need to target socio-environmental factors such as greater availability of fruits/vegetables.

4.Larson NI, Perry CL, Story M, Neumark-Sztainer D. Food preparation by young adults is associated with better diet quality. Journal of the American Dietetic Association. 2006;106:2001-7.

Abstract:
OBJECTIVE: To describe food-preparation behaviors, cooking skills, resources for preparing food, and associations with diet quality among young adults.
DESIGN: Cross-sectional analyses were performed in a sample of young adults who responded to the second wave of a population-based longitudinal study. Measures pertaining to food preparation were self-reported and dietary intake was assessed by a food frequency questionnaire, both by a mailed survey.
SUBJECTS/SETTING: Males (n = 764) and females (n = 946) ages 18 to 23 years.
STATISTICAL ANALYSES PERFORMED: Cross-tabulations and chi2 tests were used to examine associations between food preparation, skills/resources for preparing foods, and characteristics of young adults. Mixed regression models were used to generate expected probabilities of meeting the Healthy People 2010 dietary objectives according to reported behaviors and skills/resources.
RESULTS: Food-preparation behaviors were not performed by the majority of young adults even weekly. Sex (male), race (African American), and living situation (campus housing) were significantly related to less frequent food preparation. Lower perceived adequacy of skills and resources for food preparation was related to reported race (African American or Hispanic) and student status (part-time or not in school). The most common barrier to food preparation was lack of time, reported by 36% of young adults. Young adults who reported frequent food preparation reported less frequent fast-food use and were more likely to meet dietary objectives for fat (P < 0.001), calcium (P < 0.001), fruit (P < 0.001), vegetable (P < 0.001), and whole-grain (P = 0.003) consumption.
CONCLUSIONS: To improve dietary intake, interventions among young adults should teach skills for preparing quick and healthful meals.

5.Larson NI, Story M, Eisenberg ME, Neumark-Sztainer D. Food preparation and purchasing roles among adolescents: Associations with sociodemographic characteristics and diet quality. Journal of the American Dietetic Association. 2006;106:211-8.

Abstract:
OBJECTIVE: To describe adolescent involvement in preparing and shopping for food and examine if extent of involvement is related to diet quality.
DESIGN: Cross-sectional study design. Past week frequency of involvement in preparing and shopping for food was self-reported on the Project EAT (Eating Among Teens) survey. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire.
SUBJECTS/SETTING: Middle school and high school students from Minneapolis/St Paul, MN, public schools.
STATISTICAL ANALYSES PERFORMED: Associations between involvement and sociodemographic characteristics were examined using cross tabulations. General linear modeling was used to compare dietary intakes of adolescents across different levels of involvement in preparing and shopping for food.
RESULTS: The majority of adolescents reported helping prepare dinner (68.6%) and nearly half reported shopping for groceries (49.8%) at least once during the past week. Greater involvement in these food tasks was related to sex (female), grade level (middle school), race (Asian American), socioeconomic status (low), family meal frequency (high), and weight status (overweight). Frequency of preparing food was related to lower intakes of fat (P<0.01) and higher intakes of fruits and vegetables, fiber, folate, and vitamin A. Preparing was related to lower intakes of carbonated beverages among female adolescents (P<0.01) and lower intakes of fried foods among male adolescents (P<0.01). In contrast, food shopping frequency was related to greater consumption of fried foods among female adolescents (P<0.01).
CONCLUSIONS: Adolescents should be encouraged to help with meal preparation and may benefit from interventions and programs that teach skills for cooking and making healthful purchasing decisions.

6.Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Trends in adolescent fruit and vegetable consumption, 1999-2004: Project EAT. American Journal of Preventive Medicine. 2007;32:147-50.

Abstract:
BACKGROUND: Diets abundant in fruits and vegetables are associated with reduced risk for chronic disease, but intakes of adolescents are often inadequate. To design effective interventions it is important to understand how dietary intake changes longitudinally during adolescence and to monitor progress in the population toward fruit and vegetable consumption recommendations. The objective of this study was to examine longitudinal and secular trends in fruit and vegetable intake among two cohorts of Minnesota adolescents over the period 1999-2004.
METHODS: Measures of fruit and vegetable intake and demographics were completed by 944 boys and 1161 girls who were Project EAT participants in 1999 and 2004. In 2005, mixed linear regression models were used to estimate (1) longitudinal trends among two cohorts of young people during developmental transitions and (2) age-matched secular trends between the two cohorts of young people at middle adolescence.
RESULTS: Longitudinal trends indicated that adolescents decreased their daily intake of fruit and vegetables by an average of 0.7 servings during the transition from early to middle adolescence and by 0.6 servings from middle to late adolescence. Analyses of age-matched secular trends at middle adolescence showed a mean daily decrease of 0.7 servings among girls and 0.4 servings among boys between 1999 and 2004.
CONCLUSIONS: The large longitudinal and secular declines in fruit and vegetable intakes of adolescents indicate a strong need for further research to understand why consumption is decreasing among adolescents and to develop more effective interventions for increasing fruit and vegetable consumption during this critical developmental period.

7.Larson NI, Story M, Perry CL, Neumark-Sztainer D, Hannan PJ. Are diet and physical activity patterns related to cigarette smoking in adolescents? Preventing Chronic Disease. 2007;4(3). PMCID: PMC1955390.

Abstract:
INTRODUCTION: An inadequate diet and physical inactivity may compound the many deleterious effects of smoking on health. Some research indicates that smoking behavior is related to other health behaviors, but little research has examined how smoking may be related to dietary intake of key nutrients, consumption of fast food, sedentary lifestyle, or weight status. The purpose of this study was to describe smoking frequency among adolescents and its relationship to physical activity and dietary patterns.
METHODS: The research study employed a cross-sectional, population-based design. Adolescents self-reported cigarette smoking, physical activity, and eating behaviors on the Project EAT (Eating Among Teens) survey and reported dietary intake on a food frequency questionnaire completed in school classrooms. The sample included 4746 middle school and high school students from Minneapolis-St. Paul public schools. Mixed-model regression, which was controlled for sex, race and ethnicity, socioeconomic status, grade level (middle school or high school), and school, was used to examine the association of smoking with diet and physical activity patterns.
RESULTS: Overall, reported smoking frequency was inversely related to participating in team sports, eating regular meals, and consuming healthful foods and nutrients. Smoking frequency was directly related to frequency of fast-food and soft drink consumption.
CONCLUSION: Adolescents who smoke cigarettes may be less likely to engage in health-promoting lifestyle behaviors. Interventions are needed to prevent smoking and the unhealthy dietary practices and physical activity behaviors that may be associated with it.

8.Stang J, Kong A, Story M, Eisenberg M, Neumark-Sztainer D. Food and weight related patterns and behaviors of Hmong adolescents. Journal of the American Dietetic Association. 2007;107:936-41.

Abstract:
OBJECTIVE: Little is known about the food and weight-related behaviors of Hmong adolescents. This study assessed these behaviors in Hmong adolescents and determined if they differed between Hmong and white teens or by country of birth.
DESIGN: School-based cross-sectional study.
SUBJECTS/SETTING: Hmong (n=649) and white (n=2,260) adolescents from 31 public middle and high schools in the Minneapolis/St Paul, MN, metropolitan area who participated in Project EAT (Eating Among Teens).
MAIN OUTCOME MEASURES: Family meals, grocery shopping, and meal preparation; consumption of breakfast, snacks, and fast foods, physical activity and inactivity; body satisfaction, weight concern, body mass index, and weight-control behaviors.
STATISTICAL ANALYSES PERFORMED: Variables were compared across race/ethnicity and by country of birth using chi(2) tests and general linear model regression.
RESULTS: Hmong students reported greater participation in family meals and more involvement with food purchasing and preparation. Fast-food consumption was similar among groups. Hmong teens reported less frequent breakfast consumption. The prevalence of overweight was higher in Hmong male adolescents than white male adolescents, but similar among female adolescents. Hmong students reported higher levels of weight concern, body dissatisfaction, dieting, unhealthful weight-control behaviors, less physical activity, and more inactivity than white students. Hmong male adolescents participated in extreme unhealthful weight-control behaviors four times more often than white male adolescents.
CONCLUSIONS: Hmong adolescents appear to be at increased risk for obesity, body dissatisfaction, and unhealthful weight-control behaviors compared to white adolescents. There is a need for culturally tailored interventions to address these nutrition and weight issues among Hmong adolescents.

9.Larson NI, Neumark-Sztainer D, Harnack L, Wall M, Story M, Eisenberg ME. Fruit and vegetable intake correlates during the transition to young adulthood. American Journal of Preventive Medicine. 2008;35(1):33-7.

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

10.Barr-Anderson DJ, Larson NI, Nelson MC, Neumark-Sztainer D, Story M. Does television viewing predict dietary intake five years later in high school students and young adults? International Journal of Behavioral Nutrition and Physical Activity. 2009;6(1):7. PMCID: PMC2643350.

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

11.Cutler GJ, Flood A, Hannan P, Neumark-Sztainer D. Major patterns of dietary intake and their stability over time. Journal of Nutrition. 2009;139(2):323-8.

Abstract:
A diet-patterns approach has often been used to describe eating patterns in adults but has rarely been used in adolescents. We used principal components factor analysis to: 1) describe the dietary patterns of a cohort of ethnically diverse youth during early and middle adolescence; 2) examine if the patterns persisted 5 y later; and 3) study secular trends. Project EAT-I (Time 1) collected data on 4746 middle school (younger cohort) and high school (older cohort) students in 31 Minnesota schools in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n = 2516) of the original cohort in 2003-2004. Dietary intake was assessed at Time 1 and 2 using the Youth/Adolescent FFQ. We identified dietary patterns separately by cohort (older/younger) and gender (boys/girls). At Time 1, we identified 4 patterns in early and middle adolescents that were relatively consistent between boys and girls that we labeled vegetable, fruit, sweet/salty snack food, and starchy food. Longitudinal analyses indicated that patterns were relatively stable over 5 y, with the exception of a new fast food pattern. Examination of age-matched secular trends in middle adolescents (older cohort at Time 1, younger cohort at Time 2) showed similar patterns, with the exception of the fast food pattern that emerged at Time 2 among middle adolescent boys. We identified dietary patterns in this adolescent population that differed from those usually found in adults. Patterns were similar across gender and age cohorts and were relatively similar over time, with the exception a new fast food pattern.

12.Larson NI, Nelson MC, Neumark-Sztainer D, Story M, Hannan P. Making time for meals: Meal structure and association with dietary intake in young adults. Journal of the American Dietetic Association. 2009;109:72-9.

Abstract:
BACKGROUND: Prior studies have found that family meals and other aspects of meal structure are associated with dietary intake during adolescence, but little research has characterized meals in young adulthood.
OBJECTIVE: This study was designed to describe attitudes regarding the social nature of meals, time constraints on meals, and meal regularity in young adults. In addition, this study aimed to describe the sociodemographic characteristics of young adults who report eating dinner with others and “eating on the run,” and examine associations of these behaviors with meal attitudes and dietary intake.
DESIGN: Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a Minnesota population-based study.
SUBJECTS/SETTING: Mailed surveys and food frequency questionnaires were completed in 2003-2004 by 1,687 young adult (mean age=20.5 years; 44% male) participants.
MAIN OUTCOMES MEASURED AND STATISTICAL ANALYSES PERFORMED: chi(2) tests were calculated to examine differences in meal attitudes and behaviors according to sociodemographic characteristics. Relationships between meal attitudes and behaviors were explored using Spearman’s correlation coefficients. Linear regression models adjusted for demographic characteristics were used to examine associations between meal behaviors and dietary intake variables.
RESULTS: The majority of young adults reported they enjoy and value eating with others, but 35% of males and 42% of females reported lacking time to sit down and eat a meal. Eating dinner with others was significantly associated (P</=0.01) with several markers of better dietary intake, including higher intakes of fruit, vegetables, and dark-green and orange vegetables. Eating on the run was significantly associated (P<0.01) with higher intakes of soft drinks, fast food, total fat and saturated fat, and lower intake of several healthful foods.
CONCLUSIONS: Findings suggest that health services and programs for young adults should encourage taking the time to sit down for meals and to share meals with others.

13.Larson NI, Neumark-Sztainer D, Harnack L, Wall M, Story M, Eisenberg ME. Calcium and dairy intake: Longitudinal trends during the transition to young adulthood and correlates of calcium intakes. Journal of Nutrition Education and Behavior. 2009;41(4):254-60.

Abstract:
OBJECTIVE: To describe changes in calcium and dairy intake during the transition from middle adolescence to young adulthood and to identify baseline correlates of calcium intake in young adulthood.
DESIGN: Population-based, 5-year follow-up study (Project EAT: Eating Among Teens).
SETTING: Baseline surveys were completed in Minneapolis/St. Paul, MN schools and by mail at follow-up.
PARTICIPANTS: Males and females (N = 1521) attending high school at baseline (mean age = 15.9 years) and with a mean age of 20.5 years at follow-up.
MAIN OUTCOME MEASURES: Calcium intake.
ANALYSIS: Mixed and linear regression methods were used to respectively examine trends and correlates of intake.
RESULTS: During the transition to young adulthood, mean daily calcium intakes of females and males decreased by an average of 153 mg and 194 mg respectively. Mealtime milk availability, health/nutrition attitudes, taste preference for milk, healthful weight control behaviors, and peer support for healthful eating at baseline were associated with better follow-up calcium intake. Time spent watching television and lactose intolerance were associated with lower intake at follow-up.
CONCLUSIONS AND IMPLICATIONS: Nutrition interventions are needed to counter longitudinal decreases in calcium intake. Interventions targeted to adolescents should address the availability of milk at meals and other identified supports for healthful eating.
14.Nelson MC, Larson NI, Barr-Anderson D, Neumark-Sztainer D, Story M. Disparities in dietary intake, meal patterning and home food environments among young adult nonstudents and 2- and 4-year college students. American Journal of Public Health. 2009;99(7):1216-9. PMCID: PMC2696671.

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

15.Nelson MC, Neumark-Sztainer D, Hannan PJ, Story M. Five-year longitudinal and secular shifts in adolescent beverage intake: Findings from Project EAT-II. Journal of the American Dietetic Association. 2009;109(2):308-12.

Abstract:
Detailed research examining concurrent longitudinal and secular changes in adolescent beverage intake is not currently available, particularly since the year 2000. This study’s objective was to evaluate these trends in beverage intake in a large, diverse adolescent cohort. Project EAT (Eating Among Teens)-II is a 5-year longitudinal study (n=2,516) including two cohorts, which allows for the observation of longitudinal changes from early to mid-adolescence (junior high to high school) and from mid- to late adolescence (high school to post high school). Project EAT-II also examined secular trends in adolescent health behavior from 1999-2004 in mid-adolescence. Daily beverage servings were assessed using the Youth and Adolescent Food Frequency Questionnaire. Longitudinal findings indicate that intake of soda and sugar-sweetened beverages (including soda, sweetened iced teas, and fruit drinks) increased significantly among younger males, and alcohol increased across all groups (P<0.01). Consumption of certain beverages decreased with age: fruit juice (among all males and older females, P< or =0.02), milk (older adolescents, P<0.01), other milk beverages (all females and older males, P<0.01), diet soda (younger adolescents, P<0.01), and coffee/tea (all males and younger females, P<0.01). Significant secular decreases were observed in fruit juice and coffee/tea for males and females (P< or =0.05). Overall, these findings reflect recent secular and longitudinal shifts in adolescent beverage consumption during the critical transition period from early to mid-adolescence and mid- to late adolescence. Although additional research is needed to better understand nuances in adolescent consumption patterns, registered dietitians and other health care practitioners working with adolescents should address the importance of limiting sugar-sweetened beverages with low nutrient density.

16.Robinson-O’Brien R, Larson NI, Neumark-Sztainer D, Hannan P, Story M. Characteristics and dietary patterns of adolescents who value eating locally grown, organic, nongenetically engineered, and nonprocessed foods. Journal of Nutrition Education and Behavior. 2009;41(1):11-8.

Abstract:
OBJECTIVE: To examine characteristics of adolescents who value eating locally grown, organic, nongenetically engineered, and/or nonprocessed food and whether they are more likely than their peers to meet Healthy People 2010 dietary objectives.
DESIGN: Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT: Eating Among Teens).
SETTING: Participants completed a mailed survey and food frequency questionnaire in 2004.
PARTICIPANTS: Males and females (N = 2516), ages 15-23 years.
MAIN OUTCOME MEASURES: Dietary intake of fruit, vegetables, fat, grains, calcium, and fast food.
ANALYSIS: Chi-square tests, logistic regression models adjusting for race/ethnicity, socioeconomic status, and vegetarian status.
RESULTS: Percentages of adolescents who reported that it was somewhat or very important that their food be locally grown, organic, nongenetically engineered, and nonprocessed were 20.9%, 23.2%, 34.1%, and 29.8%, respectively. Those who valued each practice were more likely than their peers to be nonwhite (P < .001) and have a low socioeconomic status (P < .001). Adolescents who valued >/= 2 practices were more likely than their peers to have a dietary pattern consistent with the Healthy People 2010 objectives (P < .001) for fruit, vegetable, and fat intake.
CONCLUSIONS AND IMPLICATIONS: It may beneficial to discuss alternative food production practices as part of nutrition education programs for adolescents.
17.Burgess-Champoux TL, Larson NI, Neumark-Sztainer DR, Hannan PJ, Story MT. Longitudinal and secular trends in adolescent whole-grain consumption, 1999-2004. American Journal of Clinical Nutrition. 2010;91(1):154-9.

Abstract:
BACKGROUND: The replacement of refined grains in the diet with whole grains may help prevent chronic disease and excess weight gain, but intakes in adolescents are often lower than recommended.
OBJECTIVES: This study aimed to examine demographic disparities and 5-y longitudinal and secular trends (1999-2004) in whole-grain intake among 2 cohorts of Minnesota adolescents.
DESIGN: Whole-grain intake was examined among 996 adolescent males and 1222 adolescent females who were Project EAT (Eating Among Teens) participants in 1999 and 2004. Multinomial logistic regression models were used to examine demographic differences in whole-grain intake. Mixed linear regression models were used to estimate 1) longitudinal trends among 2 cohorts of adolescents during developmental transitions and 2) age-matched secular trends between the cohorts at middle adolescence.
RESULTS: In 1999, 11% of adolescent males and 13% of adolescent females reported that they consumed more than one daily serving of whole grains. Whole-grain intake was lowest among youth of the Native American and white races and among youth of high socioeconomic status. During the transition from middle to late adolescence, whole-grain intake increased by a mean of 0.14 daily servings among adolescent males and 0.09 daily servings among adolescent females. No significant changes in whole-grain intake were shown among either sex during the transition from early to middle adolescence. Yeast breads, popcorn, and ready-to-eat breakfast cereals were major sources of whole grains in 1999 and 2004.
CONCLUSION: Findings suggest the need to advance efforts that target improvements in the amount of whole-grain foods selected by adolescents.

18.Larson NI, Neumark-Sztainer D, Story M, Burgess-Champoux T. Whole-grain intake correlates among adolescents and young adults: findings from Project EAT. Journal of the American Dietetic Association. 2010;110(2):230-7.

Abstract:
BACKGROUND: National survey data indicate few adolescents or young adults consume whole grains in the amount recommended to prevent chronic disease and maintain a healthful weight. Interventions are needed to address this gap; however, little is known about what modifiable factors influence whole-grain intake among youth.
OBJECTIVE: This study aimed to identify socioenvironmental, personal, and behavioral correlates of whole-grain intake among adolescents and young adults.
DESIGN: Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a population-based study in Minnesota. Mailed surveys and food frequency questionnaires were completed by male (44.8%) and female (55.2%) participants in 2003-2004, including 792 adolescents (mean age=17.2 years) and 1,686 young adults (mean age=20.5 years). Linear regression models adjusted for demographic characteristics were used to identify factors associated with energy-adjusted daily intake of whole grains.
RESULTS: Mean daily intake of whole grains was lower than recommended among adolescents (males: 0.59+/-0.04 servings, females: 0.61+/-0.04 servings) and young adults (males: 0.68+/-0.03 servings, females: 0.58+/-0.03 servings). Home availability of whole-grain bread, self-efficacy to consume > or =3 daily servings of whole grains, and preference for the taste of whole-grain bread were positively associated with whole-grain intake during adolescence and young adulthood across sex. Conversely, fast-food intake was associated with lower intake of whole grains among adolescents and young adults of both sexes. The factors examined in this study explained 28% to 34% of variance in whole-grain intake across sex and the two age groups.
CONCLUSIONS: The findings suggest nutrition interventions should address the availability of whole-grain foods in homes and restaurants. In addition, young people should be provided with opportunities to taste a variety of whole-grain foods to enhance taste preferences and self-efficacy to consume whole-grain products.

19.Bruening M, Larson N, Story M, Neumark-Sztainer D, Hannan P. Predictors of adolescent breakfast consumption: longitudinal findings from Project EAT. Journal of Nutrition Education and Behavior. 2011;43(5):390-5.

Abstract:
OBJECTIVE: To identify predictors of breakfast consumption among adolescents.
METHODS: Five-year longitudinal study Project EAT (Eating Among Teens). Baseline surveys were completed in Minneapolis-St. Paul schools and by mail at follow-up by youth (n = 800) transitioning from middle to high school. Linear regression models examined associations between baseline predictors and follow-up breakfast consumption.
RESULTS: Frequency of breakfast consumption at follow-up was positively associated with baseline breakfast consumption and inversely associated with baseline weight concerns (P < .01). Perceptions of being too rushed in the morning to eat a healthful breakfast were associated with lower breakfast frequency 5 years later among girls (P < .01). After adjusting for baseline breakfast consumption, none of the associations with predictor variables remained statistically significant.
CONCLUSIONS AND IMPLICATIONS: Early adolescence is an important time to establish regular breakfast consumption. Interventions aimed at increasing breakfast consumption should include messages about healthful weight management and ideas for quick, healthful breakfasts.

20.Cutler GJ, Flood A, Hannan PJ, Slavin JL, Neumark-Sztainer D. Association between major patterns of dietary intake and weight status in adolescents. British Journal of Nutrition. 2012:1-8.

Abstract:
The relationship between dietary intake and obesity is complex, and dietary pattern analysis may offer new insight. We examined associations between dietary patterns identified in a diverse cohort of adolescents and weight status cross-sectionally and over a 5-year period. Project EAT (Eating Among Teens) (Time 1) collected data on 4746 middle (younger cohort) and high school (older cohort) students in 1998-9. EAT-II (Time 2) resurveyed 2516 of the original cohort in 2003-4. All analyses were run separately by age cohort and sex. The relationship between dietary patterns identified previously (vegetable, fruit, vegetable & fruit, starchy food, sweet & salty snack food, and fast food) and weight status was examined using logistic regression. All analyses were adjusted for socioeconomic status, race/ethnicity and activity level (longitudinal analyses were also adjusted for baseline weight status). In cross-sectional analyses, higher adherence to dietary patterns loading heavily on vegetables was associated with lower risk of overweight/obese weight status in older and younger girls, whereas higher adherence to a ‘sweet & salty snack food’ pattern was associated with lower risk in older and younger boys. These associations were found prospectively in older boys and girls, but were no longer significant in analyses adjusting for baseline weight status. We did not find consistent or intuitive associations between dietary patterns and weight status. Identified patterns may not capture the elements of diet that are truly important in determining adolescent weight, or diet may not be the primary driver in determining weight status at this age. Methodological difficulties in assessing diet must also be taken into consideration.

21.Larson N, Laska M, Story M, Neumark-Sztainer D. Predictors of fruit and vegetable intake in young adulthood. Journal of the Academy of Nutrition and Dietetics. 2012;112(8):1216-22. PMCID: PMC3402589.

Abstract:
Few young adults meet national recommendations to consume at least 2 c fruit and 2 to 3 c vegetables daily. Effective strategies and messaging are needed to address this disparity, but research examining influences on fruit and vegetable (F/V) intake during young adulthood has been limited and primarily cross-sectional. This study was conducted to identify 5-year and 10-year longitudinal predictors of F/V intake in young adulthood. The sample included 476 male and 654 female participants enrolled in a population-based cohort study (Projects EAT-I, II, and III [Eating and Activity in Teens and Young Adults]). Participants completed surveys and food frequency questionnaires in Minneapolis/St Paul, MN, high school classrooms in 1998-1999 (mean age=15.8 years, adolescence) and follow-up measures in 2003-2004 (mean age=20.4 years, emerging adulthood) and 2008-2009 (mean age=26.2 years, young adulthood). In young adulthood, average daily intake was 0.9 servings of fruit (excluding juice) and 1.8 servings of vegetables (excluding potatoes). Factors examined in adolescence and in emerging adulthood that were predictive of F/V intake in young adulthood included favorable taste preferences, fewer perceived time barriers to healthy eating, higher home availability of F/V, and limited home availability of unhealthy foods. Analyses also identified additional factors that were specifically relevant to fruit (eg, breakfast patterns) or vegetable intake (eg, home food preparation) and of particular relevance during emerging adulthood (eg, significant other’s healthy eating attitudes). Findings suggest individual and socioenvironmental factors, particularly food preferences and home food availability, during adolescence and emerging adulthood may influence F/V intake in young adulthood.

22.Laska MN, Larson NI, Neumark-Sztainer D, Story M. Does involvement in food preparation track from adolescence to young adulthood and is it associated with better dietary quality? Findings from a 10-year longitudinal study. Public Health Nutrition. 2012;15(7):1150-8. PMCID: PMC3472035.

Abstract:
OBJECTIVES: To examine whether involvement in food preparation tracks over time, between adolescence (15-18 years), emerging adulthood (19-23 years) and the mid-to-late twenties (24-28 years), as well as 10-year longitudinal associations between home food preparation, dietary quality and meal patterning.
DESIGN: Population-based, longitudinal cohort study.
SETTING: Participants were originally sampled from Minnesota public secondary schools (USA).
SUBJECTS: Participants enrolled in Project EAT (Eating Among Teens and Young Adults)-I, EAT-II and EAT-III (n 1321).
RESULTS: Most participants in their mid-to-late twenties reported an enjoyment of cooking (73 % of males, 80 % of females); however, few prepared meals including vegetables most days of the week (24 % of males, 41 % of females). Participants in their mid-to-late twenties who enjoyed cooking were more likely to have engaged in food preparation as adolescents and emerging adults (P < 0.01); those who frequently prepared meals including vegetables were more likely to have engaged in food preparation as emerging adults (P < 0.001), but not as adolescents. Emerging adult food preparation predicted better dietary quality five years later in the mid-to-late twenties, including higher intakes of fruit, vegetables and dark green/orange vegetables, and less sugar-sweetened beverage and fast-food consumption. Associations between adolescent food preparation and later dietary quality yielded few significant results.
CONCLUSIONS: Food preparation behaviours appeared to track over time and engagement in food preparation during emerging adulthood, but not adolescence, was associated with healthier dietary intake during the mid-to-late twenties. Intervention studies are needed to understand whether promoting healthy food preparation results in improvements in eating patterns during the transition to adulthood.

23.Arcan C, Larson N, Bauer K, Berge J, Story M, Neumark-Sztainer D. Dietary and weight-related behaviors and body mass index among Hispanic, Hmong, Somali, and white adolescents. Journal of the Academy of Nutrition and Dietetics. 2014;114(3):375-83. PMCID: PMC4016713.

Abstract:
BACKGROUND: The population of the United States is becoming increasingly ethnically and racially diverse, much of it due to immigration patterns. However, little is known about dietary intake and weight-related concerns and behaviors of youth from some ethnic-minority groups, especially Hispanic, Hmong, and Somali adolescents.
OBJECTIVE: Our aim was to describe dietary intake and weight-related concerns and behaviors among Hispanic, Hmong, and Somali adolescents and compare them with white adolescents.
DESIGN: We performed a cross-sectional analysis of data from Eating and Activity in Teens 2010, a population-based study in the Minneapolis/St Paul metropolitan area.
PARTICIPANTS/SETTING: Current analysis includes 1,672 adolescents (Hispanic: n=562 [33.6%]; Hmong: n=477 [28.5%]; Somali: n=113 [6.8%]; white: n=520 [31.1%]; mean age=15.0 years). Adolescents completed classroom surveys and had their height/weight measured during the 2009-2010 academic year.
STATISTICAL ANALYSIS: Multivariable regression models, adjusted for socioeconomic status, age, and school as a random effect were used to examine racial/ethnic differences for each outcome variable for boys and girls.
RESULTS: There were numerous differences in the behaviors of Hispanic, Hmong, and Somali adolescents as compared with whites. Hispanic and Somali youth consumed fruit and fast food more frequently. Hmong adolescents consumed sugar-sweetened beverages less frequently, and Somali boys consumed energy and sport drinks more frequently than whites. Compared with white boys, overweight/obesity was higher among Hispanic and Hmong. A higher percentage of Hmong and Somali adolescents engaged in unhealthy weight control behaviors. Body satisfaction was lower for all Hmong adolescents compared with whites.
CONCLUSIONS: There were varying areas of concern in dietary intake, weight, and weight-related concerns and behaviors among adolescents in all ethnic groups. Future nutrition and physical activity interventions that include adolescents from these ethnic and cultural groups can benefit from, for example, modifying intervention strategies to the specific priority behaviors within the target population.

24.Bruening M, MacLehose R, Eisenberg ME, Nanney MS, Story M, Neumark-Sztainer D. Associations between sugar-sweetened beverage consumption and fast-food restaurant frequency among adolescents and their friends. Journal of Nutrition Education and Behavior. 2014;46(4):277-85.

Abstract:
OBJECTIVE: To assess associations between adolescents and their friends with regard to sugar-sweetened beverage (SSB)/diet soda intake and fast-food (FF) restaurant visits.
DESIGN: Population-based, cross-sectional survey study with direct measures from friends.
SETTING: Twenty Minneapolis/St Paul schools during 2009-2010.
PARTICIPANTS: Adolescents (n = 2,043; mean age, 14.2 +/- 1.9 years; 46.2% female; 80% non-white).
MAIN OUTCOME MEASURES: Adolescent SSB/diet soda intake and FF visits.
ANALYSIS: Generalized estimating equation logistic models were used to examine associations between adolescents’ SSB/diet soda intake and FF visits and similar behaviors in nominated friends (friend groups and best friends). School-level (middle vs high school) interactions were assessed.
RESULTS: Significant associations were found between adolescents and friends behaviors for each of the beverages assessed (P < .05), but they varied by friendship type and school level. Five of 6 models of FF visits (including all FF visits) were significantly associated (P < .05) among adolescents and their friends. Significant interactions by school level were present among adolescents’ and friends’ FF visits, with associations generally for high school participants compared with middle school participants (P < .05).
CONCLUSIONS AND IMPLICATIONS: Findings suggest that for many beverages and FF restaurant types, friends’ behaviors are associated, especially FF visits for older adolescents. Nutrition education efforts may benefit by integrating knowledge of the impact of adolescents’ friends on FF visits.
25.Larson N, Dewolfe J, Story M, Neumark-Sztainer D. Adolescent consumption of sports and energy drinks: linkages to higher physical activity, unhealthy beverage patterns, cigarette smoking, and screen media use. Journal of Nutrition Education and Behavior. 2014;46(3):181-7. PMCID: PMC4023868.

Abstract:
OBJECTIVE: To examine patterns of adolescent sports and energy drink (SED) consumption and identify behavioral correlates.
DESIGN: Data were drawn from Eating and Activity in Teens, a population-based study.
SETTING: Adolescents from 20 middle and high schools in Minneapolis/St Paul, MN completed classroom-administered surveys.
PARTICIPANTS: A total of 2,793 adolescents (53.2% girls) in grades 6-12.
VARIABLES MEASURED: Beverage patterns; breakfast frequency; moderate to vigorous physical activity (MVPA); media use; sleep; and cigarette smoking.
ANALYSIS: Linear and logistic regression models were used to estimate associations between health behaviors and SED consumption, adjusting for demographics.
RESULTS: Over a third of adolescents consumed sports drinks and 14.7% consumed energy drinks at least once a week. Among boys and girls, both sports and energy drink consumption were related to higher video game use; sugar-sweetened beverage and fruit juice intake; and smoking (P < .05). Sports drink consumption was also significantly related to higher MVPA and organized sport participation for both genders (P < .01).
CONCLUSIONS AND IMPLICATIONS: Although sports drink consumption was associated with higher MVPA, adolescents should be reminded of recommendations to consume these beverages only after vigorous, prolonged activity. There is also a need for future interventions designed to reduce SED consumption, to address the clustering of unhealthy behaviors.

How is the home environment associated with dietary intake in adolescents and young adults?

1.Hanson NI, Neumark-Sztainer D, Eisenberg ME, Story M, Wall M. Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables, and dairy foods. Public Health Nutrition. 2005;8:77-85.

Abstract:
OBJECTIVE: This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.
DESIGN: Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.
SUBJECTS/SETTING: The study sample included 902 adolescents and their parent or guardian.
RESULTS: Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P<0.01) and soft drink availability was inversely associated with dairy intake (ttrend=2.08, P=0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend=3.65, P<0.01). Parental intakes were positively associated with dairy intake for boys (ttrend=2.04, P=0.04), and with dairy (ttrend=2.43, P=0.01), vegetable (ttrend=3.72, P<0.01) and fruit (ttrend=3.17, P<0.01) intakes for girls.
CONCLUSIONS/APPLICATIONS: Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents’ intake of healthful food choices.

2.Larson NI, Story M, Wall M, Neumark-Sztainer D. Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns. Journal of the American Dietetic Association. 2006;106:1816-24.

Abstract:
OBJECTIVE: To identify correlates of calcium, dairy, and milk intakes among male and female adolescents.
DESIGN: Cross-sectional study design. Adolescents self-reported measures pertaining to correlates on the Project EAT (Eating Among Teens) survey and completed a food frequency questionnaire at school.
SUBJECTS/SETTING: Subjects were a total of 4,079 middle and high school students from Minneapolis/St Paul, MN, public schools.
STATISTICAL ANALYSES PERFORMED: Multiple linear regression models based on social cognitive theory were examined by sex.
RESULTS: Male adolescents reported higher daily intakes of calcium (male: 1,217+/-663 mg; female: 1,035+/-588 mg; P<0.001), dairy servings (male: 2.9+/-1.9; female: 2.4+/-1.7; P<0.001), and milk servings (male: 2.0+/-1.5; female: 1.5+/-1.4; P<0.001) than female adolescents. Calcium intakes of male adolescents were significantly and positively related to availability of milk at meals, taste preference for milk, eating breakfast, higher socioeconomic status, and social support for healthful eating; intakes were significantly and inversely related to consumption of soft drinks and fast food. Among female adolescents, availability of milk at meals, taste preference for milk, eating breakfast, higher socioeconomic status, personal health/nutrition attitudes, and self-efficacy to make healthful food choices were significantly and positively related to intakes; intakes were significantly and inversely related to fast-food consumption. Models of calcium intake explained 71% of the variance in male adolescents and 72% of the variance in female adolescents.
CONCLUSIONS: Multicomponent interventions with a focus on the family environment are likely to be most effective in increasing calcium intakes among adolescents.

3.Arcan C, Neumark-Sztainer D, Hannan P, van den Berg P, Story M, Larson NI. Parental eating behaviors, home food environment and adolescent intakes of fruits, vegetables and dairy foods: Longitudinal findings from Project EAT. Public Health Nutrition. 2007;10(1257-1265).

Abstract:
OBJECTIVE: To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes.
DESIGN: Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts.
SUBJECTS/SETTING: The sample included 509 pairs of parents/guardians and adolescents.
RESULTS: Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02).
CONCLUSIONS: The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.

4.Boutelle KN, Birkeland RW, Hannan PJ, Story M, Neumark-Sztainer D. Associations between maternal concern for healthy eating and maternal eating behaviors, home food availability, and adolescent eating behaviors. Journal of Nutrition Education and Behavior. 2007;39:248-56.

Abstract:
OBJECTIVE: Evaluate the relationship between maternal concern for healthful eating and maternal and adolescent dietary intake, eating behavior, and home food environment.
DESIGN: Mothers of a subsample of adolescents who participated in a school-based survey (Project Eating Among Teens [EAT]) completed telephone interviews.
PARTICIPANTS: Seven hundred fourteen mother-adolescent pairs.
VARIABLES MEASURED: Mothers responded to a question regarding how much they are personally concerned with eating healthfully, and adolescents responded to a question regarding perceptions of their mothers’ concern about eating healthfully. Dependent variables included adolescent and parent food intake and home food environment.
ANALYSIS: Multinomial cumulative logistic regression models, adjusted for maternal race/ethnicity, socioeconomic status (SES), and adolescent grade level.
RESULTS: A positive association was found between maternal concern for healthful eating and maternal fruit and vegetable intake, maternal breakfast and lunch consumption, and serving fruits and vegetables in the home. Maternal concern for healthful eating (as reported by mothers) was not associated with adolescent behavior. Adolescent perception of maternal concern for healthful eating was positively associated with adolescent fruit and vegetable intake.
CONCLUSIONS AND IMPLICATIONS: Mother’s concern for healthful eating is associated with maternal eating behavior and the home food environment. Adolescent perceptions of maternal attitudes are a stronger predictor than actual maternal attitudes of adolescent behavior. Parents should be encouraged to share their beliefs regarding the importance of healthful eating with their adolescents.

5.Widome R, Neumark-Sztainer D, Hannan PJ, Haines JI, Story M. Eating when there is not enough to eat: Eating behaviors and perceptions of food among food-insecure youths. American Journal of Public Health. 2009;99(5):822-8. PMCID: PMC2667833.

Abstract:
OBJECTIVES: We explored differences in adolescents’ eating habits, perceptions, and dietary intakes by food security status.
METHODS: As part of Project EAT (Eating Among Teens), we surveyed 4746 multiethnic middle and high school students in 31 primarily urban schools in the Minneapolis-St. Paul, Minnesota, area during the 1998-1999 academic year. Participants completed in-class surveys. We used multiple regression analysis to characterize associations between behaviors, perceptions, nutritional intake, and food security status.
RESULTS: Compared with food-secure youths, food-insecure youths were more likely to perceive that eating healthfully was inconvenient and that healthy food did not taste good. Additionally, food-insecure youths reported eating more fast food but fewer family meals and breakfasts per week than did youths who were food secure. Food-insecure and food-secure youths perceived similar benefits from eating healthfully (P = .75). Compared with those who were food secure, food-insecure youths had higher fat intakes (P < .01). Food-insecure youths were more likely to have a body mass index above the 95th percentile.
CONCLUSIONS: The eating patterns of food-insecure adolescents differ in important ways from the eating patterns of those who are food secure. Policies and interventions focusing on improving the foods that these youths eat deserve further examination.

6.Laska MN, Larson NI, Neumark-Sztainer D, Story M. Dietary patterns and home food availability during emerging adulthood: Do they differ by living situation? Public Health Nutrition. 2010;13:222-8. PMCID: PMC2931267.

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

7.Bauer KW, Laska MN, Fulkerson JA, Neumark-Sztainer D. Longitudinal and secular trends in parental encouragement for healthy eating, physical activity, and dieting throughout the adolescent years. Journal of Adolescent Health. 2011;49(3):306-11. PMCID: PMC3401949.

Abstract:
PURPOSE: Parental encouragement for healthy eating and physical activity has been found to be associated with the long-term healthy habits of adolescents, whereas parental encouragement to diet has been associated with disordered eating behaviors among adolescents. However, little is known about how parental encouragement changes as adolescents grow older (longitudinal trends), or how parental encouragement has changed over time (secular trends). This study examined 5-year longitudinal and secular trends in adolescents’ report of their parents’ encouragement to eat healthily, be physically active, and diet.
METHODS: Project Eating Among Teens surveyed a cohort of Minnesota adolescents (n = 2,516) in the years 1999 and 2004. Mixed-model regressions were used to assess changes in adolescents’ reports of parental encouragement from early to middle adolescence (middle school to high school) and from middle to late adolescence (high school to post-high school), and secular changes in parental encouragement among middle adolescents between the years 1999 and 2004.
RESULTS: Longitudinally, there were significant decreases in parental encouragement to eat healthy food, be active, and diet between early and middle adolescence. Between middle and late adolescence, among males parental encouragement for all behaviors decreased, whereas among females parental encouragement to diet increased. Few secular changes in parental encouragement were observed between 1999 and 2004.
CONCLUSION: Given the importance of parental support for healthy eating and physical activity, efforts should be made to help parents maintain a high level of encouragement for their children’s healthy behavior throughout adolescence. Parents of late adolescent females should aim to decrease the pressure on their daughters to diet during these critical developmental years.

8.Cutler GJ, Flood A, Hannan P, Neumark-Sztainer D. Multiple sociodemographic and socioenvironmental characteristics are correlated with major patterns of dietary intake in adolescents. Journal of the American Dietetic Association. 2011;111(2):230-40.

Abstract:
BACKGROUND: Few studies have used dietary pattern analysis, a useful method to summarize dietary intake, in adolescents.
OBJECTIVE: Examine sociodemographic and socioenvironmental correlates of habitual dietary patterns.
DESIGN: Data for this cross-sectional/prospective analysis were drawn from Project EAT (Eating Among Teens), a population-based study.
SUBJECTS/SETTING: Project EAT-I (Time 1), collected data on 4,746 adolescents in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n=2,516) of the original cohort 5 years later in 2003-2004. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire.
MAIN OUTCOME MEASURES/STATISTICAL ANALYSIS PERFORMED: Factor analysis identified four dietary patterns at Time 1 (vegetable, fruit, starchy food, and snack food) and Time 2 (vegetable and fruit, fast food, starchy food, and snack food). Linear regression was used to examine the relationship of Time 1 socioeconomic status and race (mutually adjusted) on factor scores for each dietary pattern, and then of Time 1 socioenvironmental characteristics (adjusted for socioeconomic status and race) on these factor scores.
RESULTS: In prospective analyses, socioeconomic status, family meal frequency, and home availability of healthy food were positively associated with the vegetable and fruit and starchy food patterns and inversely associated with the fast food pattern. Home availability of unhealthy food was inversely associated with the vegetable and fruit and starchy food patterns and positively associated with the fast food and snack food patterns. Maternal, paternal, and peer support for healthy eating were positively associated with the vegetable and fruit pattern and inversely associated with the fast food pattern. Similar associations were seen in cross-sectional analyses.
CONCLUSIONS: Multiple correlates of dietary patterns were identified. Health professionals should target these factors to improve the dietary quality of habitual eating practices in adolescents by encouraging parents to decrease home availability of unhealthy food while increasing availability of healthy food, family meal frequency, and parental support for healthy eating.
9.Bauer K, Hearst MO, Escoto KH, Berge JM, Neumark-Sztainer D. Parental employment and work-family stress: Associations with family food environment. Social Science and Medicine. 2012;50:651-3. PMCID: PMC3586574.

Abstract:
Parental employment provides many benefits to children’s health. However, an increasing number of studies have observed associations between mothers’ full-time employment and less healthful family food environments. Few studies have examined other ways in which parental employment may be associated with the family food environment, including the role of fathers’ employment and parents’ stress balancing work and home obligations. This study utilized data from Project F-EAT, a population-based study of a socio-demographically diverse sample of 3709 parents of adolescents living in a metropolitan area in the Midwestern United States, to examine cross-sectional associations between mothers’ and fathers’ employment status and parents’ work-life stress with multiple aspects of the family food environment. Among parents participating in Project F-EAT, 64% of fathers and 46% of mothers were full-time employed, while 25% of fathers and 37% of mothers were not employed. Results showed that full-time employed mothers reported fewer family meals, less frequent encouragement of their adolescents’ healthful eating, lower fruit and vegetable intake, and less time spent on food preparation, compared to part-time and not-employed mothers, after adjusting for socio-demographics. Full-time employed fathers reported significantly fewer hours of food preparation; no other associations were seen between fathers’ employment status and characteristics of the family food environment. In contrast, higher work-life stress among both parents was associated with less healthful family food environment characteristics including less frequent family meals and more frequent sugar-sweetened beverage and fast food consumption by parents. Among dual-parent families, taking into account the employment characteristics of the other parent did not substantially alter the relationships between work-life stress and family food environment characteristics. While parental employment is beneficial for many families, identifying policy and programmatic strategies to reduce parents’ work-life stress may have positive implications for the family food environment and for the eating patterns and related health outcomes of children and parents.

10.Bruening M, MacLehose R, Loth K, Story M, Neumark-Sztainer D. Feeding a family in a recession: food insecurity among Minnesota parents. American Journal of Public Health. 2012;102(3):520-6. PMCID: PMC3349989.

Abstract:
OBJECTIVES: We assessed current levels of food insecurity among a large, diverse sample of parents and examined associations between food insecurity and parental weight status, eating patterns, and the home food environment.
METHODS: Project F-EAT (Families and Eating and Activity Among Teens) examined the home food environments of adolescents. Parents and caregivers (n = 2095) living with adolescents from the Minneapolis-St. Paul, Minnesota school districts completed mailed surveys during a 12-month period in 2009-2010. We performed our assessments using multivariate regressions.
RESULTS: Almost 39% of the parents and caregivers experienced household food insecurity, whereas 13% experienced very low food security. Food insecurity was significantly associated with poorer nutrition-related variables such as higher rates of parental overweight and obesity, less healthy foods served at meals, and higher rates of binge eating. Food-insecure parents were 2 to 4 times more likely to report barriers to accessing fruits and vegetables.
CONCLUSIONS: Food insecurity was highly prevalent. Environmental interventions are needed to protect vulnerable families against food insecurity and to improve access to affordable, healthy foods.

11.Escoto KH, Laska MN, Larson N, Neumark-Sztainer D, Hannan PJ. Work hours and perceived time barriers to healthful eating among young adults. American Journal of Health Behavior. 2012;36(6):786-96. PMCID: PMC3464955.

Abstract:
OBJECTIVE: To describe time-related beliefs and behaviors regarding healthful eating, indicators of dietary intake, and their associations with the number of weekly hours of paid work among young adults.
METHODS: Population-based study in a diverse cohort (N=2287).
RESULTS: Working > 40 hours per week was associated with time-related barriers to healthful eating most persistently among young adult men. Associations were found among females working both part-time and > 40 hours per week with both time-related barriers and dietary intake.
CONCLUSIONS: Findings indicate that intervention strategies, ideally those addressing time burden, are needed to promote healthful eating among young, working adults.

12.Loth KA, MacLehose RF, Fulkerson JA, Crow S, Neumark-Sztainer D. Eat this, not that! Parental demographic correlates of food-related parenting practices. Appetite. 2013;60(1):140-7. PMCID: PMC3889702.

Abstract:
To understand how parents of adolescents attempt to regulate their children’s eating behaviors, the prevalence of specific food-related parenting practices (restriction, pressure-to-eat) by sociodemographic characteristics (parent gender, race/ethnicity, education level, employment status, and household income) were examined within a population-based sample of parents (n=3709) of adolescents. Linear regression models were fit to estimate the association between parent sociodemographic characteristics and parental report of food restriction and pressure-to-eat. Overall, findings suggest that use of controlling food-related parenting practices, such as pressuring children to eat and restricting children’s intake, is common among parents of adolescents, particularly among parents in racial/ethnic minority subgroups, parents with less than a high school education, and parents with a low household income. Results indicate that that social or cultural traditions, as well as parental access to economic resources, may contribute to a parent’s decision to utilize specific food-related parenting practices. Given that previous research has found that restriction and pressure-to-eat food-related parenting practices can negatively impact children’s current and future dietary intake, differences in use of these practices by sociodemographic characteristics may contribute, in part, to the disparities that exist in the prevalence of overweight and obesity among adolescents by their race/ethnicity and socioeconomic status.

13.Berge JM, Wall M, Larson N, Forsyth A, Bauer KW, Neumark-Sztainer D. Youth dietary intake and weight status: healthful neighborhood food environments enhance the protective role of supportive family home environments. Health & Place. 2014;26:69-77. PMCID: PMC3942084.

Abstract:
The aim of this study is to investigate individual and joint associations of the home environment and the neighborhood built environment with adolescent dietary patterns and body mass index (BMI) z-score. Racially/ethnically and socioeconomically diverse adolescents (n=2682; 53.2% girls; mean age14.4 years) participating in the EAT 2010 (Eating and Activity in Teens) study completed height and weight measurements and surveys in Minnesota middle and high schools. Neighborhood variables were measured using Geographic Information Systems data. Multiple regressions of BMI z-score, fruit and vegetable intake, and fast food consumption were fit including home and neighborhood environmental variables as predictors and also including their interactions to test for effect modification. Supportive family environments (i.e., higher family functioning, frequent family meals, and parent modeling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Associations between the built environment and adolescent outcomes were fewer. Interaction results, although not all consistent, indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighborhood was supportive of healthful behavior. Public health interventions that simultaneously improve both the home environment and the neighborhood environment of adolescents may have a greater impact on adolescent obesity prevention than interventions that address one of these environments alone.

14.Estima CC, Bruening M, Hannan PJ, Alvarenga MS, Leal GV, Philippi ST, et al. A cross-cultural comparison of eating behaviors and home food environmental factors in adolescents from Sao Paulo (Brazil) and Saint Paul-Minneapolis (US). Journal of Nutrition Education and Behavior. 2014;46(5):370-5.

Abstract:
OBJECTIVE: Describe cross-cultural differences in nutrition-related factors among adolescents from Sao Paulo, Brazil and St Paul-Minneapolis, US.
DESIGN: Two large-population-based studies with cross-cultural comparisons.
SETTING: Twelve Sao Paulo and 10 St Paul-Minneapolis high schools in 2009-2010.
PARTICIPANTS: A total of 1,148 adolescents from Sao Paulo and 1,632 adolescents from St Paul-Minneapolis.
MAIN OUTCOME MEASURE(S): Meal consumption, family meals, fast-food consumption, and home food availability.
ANALYSIS: Binomial regressions, weighted for age distributions and adjusted for gender, were used to compare identical measures from each sample.
RESULTS: Generally, Sao Paulo adolescents reported healthier nutritional outcomes than St Paul-Minneapolis adolescents. Sao Paulo adolescents were 7 times less likely to report high fast-food consumption than St Paul-Minneapolis adolescents (P < .001). Whereas most measures of the home environment indicated healthier home environments in Sao Paulo, more Sao Paulo adolescents reported that sugar-sweetened beverages were usually available at home than did St Paul-Minneapolis adolescents (P < .001).
CONCLUSIONS AND IMPLICATIONS: Sao Paulo youth tended to have healthier eating behaviors and home food environment factors than St Paul-Minneapolis youth. Brazilian eating patterns tend to be healthier and support a connection with food and culture. Interventions are needed to encourage youth and their families to maintain these patterns.

What is the prevalence of overweight? What can be done to support healthy weight management for adolescents and young adults who are overweight?

1.Neumark-Sztainer D, Story M, Hannan PJ, Perry CL, Irving LM. Weight-related concerns and behaviors among overweight and non-overweight adolescents: Implications for preventing weight-related disorders. Archives of Pediatrics and Adolescent Medicine. 2002;156(2):171-8.

Abstract:
OBJECTIVES: To assess weight-related concerns and behaviors in a population-based sample of adolescents and to compare these concerns and behaviors across sex and weight status.
DESIGN: The study population included 4746 adolescents from St Paul or Minneapolis, Minn, public schools 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: Measured weight status, weight-related concerns (perceived weight status, weight disparity, body satisfaction, and care about controlling weight), and weight-related behaviors (general and specific weight control behaviors and binge eating).
RESULTS: Weight-related concerns and behaviors were prevalent among the study population. Although adolescents were most likely to report healthy weight control behaviors (adolescent girls, 85%; and adolescent boys, 70%), also prevalent were weight control behaviors considered to be unhealthy (adolescent girls, 57%; and adolescent boys, 33%) or extreme (adolescent girls, 12%; and adolescent boys, 5%). Most overweight youth perceived themselves as overweight and reported the use of healthy weight control behaviors during the past year. However, the use of unhealthy and extreme weight control behaviors and binge eating were alarmingly high among overweight youth, particularly adolescent girls. Extreme weight control practices (taking diet pills, laxatives, or diuretics or vomiting) were reported by 18% of very overweight adolescent girls, compared with 6% of very overweight adolescent boys (body mass index, > OR = 95th percentile).
CONCLUSION: Prevention interventions that address the broad spectrum of weight-related disorders, enhance skill development for behavioral change, and provide support for dealing with potentially harmful social norms are warranted in light of the high prevalence and co-occurrence of obesity and unhealthy weight-related behaviors.

2.Boutelle K, Fulkerson JA, Neumark-Sztainer D, Story M. Mothers’ perceptions of their adolescents’ weight status: Are they accurate? Obesity Research. 2004;12:1754-7.

Abstract:
OBJECTIVE: To evaluate the accuracy of mothers’ perceptions of adolescents’ weight status.
RESEARCH METHODS AND PROCEDURES: Parent interviews and adolescent surveys (755) were conducted in an ethnically diverse sample from Project EAT (Eating among Teens).
RESULTS: Adolescent weight status was accurately assessed by 60% of mothers, underestimated by 35% of mothers, and overestimated by 5% of mothers. In multivariate analyses, mothers of female adolescents were about half as likely to underestimate their adolescent’s weight status as mothers of male adolescents. Nonoverweight mothers were about half as likely as overweight mothers to underestimate their adolescent’s weight status.
DISCUSSION: Most mothers are able to accurately assess their adolescent’s weight status; however, adolescent gender and mothers’ weight status are related to accuracy. Mothers were more likely to underestimate their sons’ weights than their daughters’ weights, and overweight mothers were more likely to be inaccurate in their assessments than nonoverweight mothers. Findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide support for healthy weight management.

3.Himes JH, Hannan P, Wall M, Neumark-Sztainer D. Factors associated with errors in self-reports of stature, weight, and body mass index in Minnesota adolescents. Annals of Epidemiology. 2005;15:272-8.

Abstract:
PURPOSE: Obtaining stature, weight, and body mass index (BMI) from self-reports rather than by direct measurements is highly attractive economically and logistically, but there are few data available for adolescents that allow evaluation of potential sources of reporting bias. Because self-reports are based on self perceptions, personal characteristics of youth may be related to errors in reporting.
METHODS: Differences between self-reported and measured stature, weight, and BMI were investigated for a sample of 3797 Minnesota youth, 12 to 18 years of age. Gender, age, race/ethnicity, socioeconomic status (SES), and measured body size were examined as potential factors associated with errors in self-reports.
RESULTS: Self-reported stature, weight, and BMI were generally highly correlated with corresponding measured dimensions, although adolescents of both genders systematically overestimated their statures, underestimated their weights, and underestimated BMI. Significant associations of errors in self-reports with age, race/ethnicity, and socioeconomic status suggested that differences in self perceptions or value ascribed to body size varies according to these personal characteristics. Systematic errors in self-reported stature, weight, and BMI were negatively associated with the corresponding measured dimension when adjusted for age, race/ethnicity and SES, such that prevalences of overweight based on BMI from self-reported measures were systematically underestimated relative to measured values.
CONCLUSIONS: Self-reports of stature, weight, and BMI are on the average, valid representations of their measured counterparts; nevertheless, errors in the self-reports are systematically related to characteristics of youth. Consequently, findings from these studies should be interpreted carefully.

4.Neumark-Sztainer D, van den Berg P, Hannan PJ, Story M. Self-weighing in adolescents: Helpful or harmful? Longitudinal associations with body weight changes and disordered eating. Journal of Adolescent Health. 2006;39:811-8.

Abstract:
PURPOSE: This study addresses the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviors over a 5-year period among adolescent females and males?
METHODS: Project EAT is a 5-year population-based longitudinal study. Participants completed surveys exploring factors associated with eating and weight concerns. Participants included 2516 adolescents who were transitioning from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort).
RESULTS: In the older cohort of females and in both cohorts of males, frequent self-weighing at Time 1 was not associated with weight changes at Time 2 (5 years later), after adjusting for Time 1 weight status and sociodemographic characteristics. In the younger cohort of females, Time 1 frequent self-weighing predicted weight increases at Time 2. In both cohorts of females, but not in males, Time 1 frequent self-weighing predicted higher prevalences of Time 2 disordered eating behaviors, including unhealthy weight control behaviors and binge eating, after adjusting for Time 1 behavioral outcomes, weight status, and sociodemographic characteristics.
CONCLUSIONS: Frequent self-weighing was not associated with weight change, with the exception of predicting weight increases in younger females. In females, but not males, self-weighing predicted a higher frequency of binge eating and unhealthy weight control behaviors. Although further research is needed to explore the potential merits and problems associated with regular self-weighing, the findings suggest that population-based obesity prevention strategies targeting adolescents should avoid messages likely to lead to frequent self-weighing.

5.Neumark-Sztainer D, Wall M, Eisenberg ME, Story M, Hannan PJ. Overweight status and weight control behaviors in adolescents: Longitudinal and secular trends from 1999-2004. Preventive Medicine. 2006;43(1):52-9.

Abstract:
BACKGROUND: This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents.
METHODS: Project EAT-II followed 2516 adolescents from Minnesota longitudinally from 1999 to 2004. The population included two cohorts allowing for the observation of transitions from early to middle adolescence (junior high school to high school) and from middle to late adolescence (high school to post-high school).
RESULTS: The prevalence of overweight (females: 28.7%; males: 28.0%) was high in early adolescence and remained high throughout adolescence. In females, between early and middle adolescence, there were steep longitudinal increases in the use of unhealthy weight control behaviors (48.6% to 58.8%, P = 0.001) and extreme weight control behaviors (9.4% to 17.9%, P < 0.001), and between middle and late adolescence, extreme weight control behaviors increased from 14.5% to 23.9% (P < 0.001). In males, extreme weight control behaviors doubled from middle to late adolescence (3.4% to 6.3%, P = 0.023). Use of diet pills doubled from 7.5% to 14.2% from 1999 to 2004 (P = 0.004) in high school females. One fifth (19.9%) of females in late adolescence reported taking diet pills.
CONCLUSIONS: Overweight status and unhealthy weight control behaviors in adolescents are major public health concerns that warrant interventions addressing both problems.

6.Haines J, Neumark-Sztainer D, Wall M, Story M. Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity Research. 2007;15:2748-60.

Abstract:
OBJECTIVE: The objective was to examine a breadth of personal, behavioral, and socio-environmental factors as potential risk and protective factors of overweight among male and female adolescents.
RESEARCH METHODS AND PROCEDURES: A longitudinal study was conducted with an ethnically and socio-economically diverse sample of 2516 adolescents who completed surveys at both Time 1 (1998 to 1999) and Time 2 (2003 to 2004) of the Project Eating Among Teens (EAT) study.
RESULTS: In 1998 to 1999, 335 (25.7%) girls and 282 (26.4%) boys met the age-adjusted criteria for overweight. During the 5-year study period, 236 (70.5%) of the overweight girls and 185 (65.7%) of the overweight boys remained overweight and 115 (12.0%) girls and 77 (9.9%) boys originally not overweight became overweight. Although differences by sex were found, a number of personal, behavioral, and socio-environmental factors were associated with overweight among both male and female adolescents. Body dissatisfaction and weight concerns at Time 1 predicted overweight at Time 2 for both male and female adolescents. Dieting and use of unhealthy weight control behaviors at Time 1 also predicted overweight at Time 2. Greater frequency of breakfast consumption at Time 1 was protective against overweight. Higher levels of weight-related teasing and parental weight-related concerns and behaviors at Time 1 were positively associated with Time 2 overweight.
DISCUSSION: Body dissatisfaction, weight concerns, use of unhealthy weight control behaviors, weight-related stigmatization, and parental concern about the child’s weight may increase risk for adolescent overweight. Interventions that enhance adolescents’ body satisfaction while providing them with skills to avoid dieting and to engage in more effective weight-control behaviors should be developed and tested.

7.Neumark-Sztainer D, Wall M, Haines J, Story M, Sherwood NE, van den Berg P. Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventive Medicine. 2007;33:359-69.

Abstract:
BACKGROUND: Weight-related problems, including obesity, eating disorders, and disordered eating, are major public health problems in adolescents. The identification of shared risk and protective factors for these problems can guide the development of relevant interventions to a broad spectrum of weight-related problems. This paper examines the prevalence and co-occurrence of overweight, binge eating, and extreme weight-control behaviors (vomiting, diet pills, laxatives, and diuretics) in adolescents and identifies shared risk and protective factors from within the socioenvironmental, personal, and behavioral domains for these three adverse weight-related outcomes.
METHODS: Data were collected at Time 1 (1998-1999) and Time 2 (2003-2004) on 2516 adolescents participating in Project EAT (Eating Among Teens). Data were analyzed in 2006-2007.
RESULTS: Weight-related problems were identified in 44% of the female subjects and 29% of the male subjects. About 40% of overweight girls and 20% of overweight boys engaged in at least one of the disordered eating behaviors (binge eating and/or extreme weight control). Weight-teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors strongly and consistently predicted overweight status, binge eating, and extreme weight-control behaviors after 5 years. Family meals, regular meal patterns, and media exposure to messages about weight loss were also associated with weight-related outcomes, although the strength and consistency of associations differed across outcomes and gender.
CONCLUSIONS: Weight-specific socioenvironmental, personal, and behavioral variables are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence. These findings support the need for research to determine if decreasing weight-related social pressures, personal weight concerns, and unhealthy weight-control behaviors can contribute to reductions in obesity in children and adolescents.

8.DeLong AJ, Larson NI, Story M, Neumark-Sztainer D, Weber-Main AM, Ireland M. Factors associated with overweight among urban American Indian Adolescents: Findings from Project EAT. Ethnicity and Disease. 2008;18:317-23.

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

9.Neumark-Sztainer D, Wall M, Story M, van den Berg P. Accurate parental classification of overweight adolescents’ weight status: does it matter? Pediatrics. 2008;121(6):e1495-502.

Abstract:
OBJECTIVE: Our goal was to explore whether parents of overweight adolescents who recognize that their children are overweight engage in behaviors that are likely to help their adolescents with long-term weight management.
METHODS: The study population included overweight adolescents (BMI >/= 85th percentile) who participated in Project EAT (Eating Among Teens) I (1999) and II (2004) and their parents who were interviewed by telephone in Project EAT I. Cross-sectional analyses were conducted with 314 adolescent-parent dyads, and longitudinal analyses were completed with 170 dyads.
RESULTS: Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children’s weight status did not predict child weight status 5 years later.
CONCLUSIONS: Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet. Instead of focusing on weight per se, it may be more helpful to direct efforts toward helping parents provide a home environment that supports healthful eating, physical activity, and well-being.

10.Timlin M, Pereira MA, Story M, Neumark-Sztainer D. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens). Pediatrics. 2008;121(3):e638-45.

Abstract:
OBJECTIVE: Breakfast-eating frequency declines through adolescence and has been inversely associated with body weight in cross-sectional studies, with few prospective studies on this topic. This study was conducted to examine the association between breakfast frequency and 5-year body weight change in 2216 adolescents.
PATIENTS AND METHODS: Project EAT (Eating Among Teens) was a 5-year longitudinal study of eating patterns and weight concerns among adolescents. Surveys were completed in 1998-1999 (time 1) and 2003-2004 (time 2). Multivariable linear regression was used to examine the association between breakfast frequency and change in BMI, with adjustment for age, socioeconomic status, race, physical activity, time 1 BMI and breakfast category, and time 1 dietary and weight-related variables.
RESULTS: At time 1, frequency of breakfast was directly associated with intake of carbohydrate and fiber, socioeconomic status, white race, and physical activity and inversely associated with smoking and alcohol consumption and dieting and weight-control behaviors. In cross-sectional analyses at times 1 and 2, inverse associations between breakfast frequency and BMI remained largely independent of all of the confounding and dietary factors. Weight-related factors (concerns, behaviors, and pressures) explained little of the breakfast-BMI association. In prospective analyses, frequency of breakfast was inversely associated with BMI in a dose-response manner. Further adjustment for confounding and dietary factors did not seem to explain the association, but adjustment for weight-related variables seemed to partly explain this finding.
CONCLUSIONS: Although experimental studies are needed to verify whether the association between breakfast and body weight is of a causal nature, our findings support the importance of promoting regular breakfast consumption among adolescents. Future studies should further examine the role of breakfast habits among youth who are particularly concerned about their weight.

11.Neumark-Sztainer D. Preventing obesity and eating disorders in adolescents: What can health care providers do? Journal of Adolescent Health. 2009;44(3):206-13.

Abstract:
This article describes five research-based recommendations for health care providers to help prevent both obesity and eating disorders among adolescents that they see within clinical, school, or other settings. The recommendations are based primarily upon findings from Project EAT, a large, population-based study of eating and weight-related issues in adolescents. Recommendations include the following: 1) discourage unhealthy dieting; instead encourage and support the use of eating and physical activity behaviors that can be maintained on an ongoing basis; 2) promote a positive body image; 3) encourage more frequent, and more enjoyable, family meals; 4) Encourage families to talk less about weight and do more at home to facilitate healthy eating and physical activity; and 5) assume that overweight teens have experienced weight mistreatment and address this issue with teens and their families. These recommendations stress the importance of helping adolescents and their families focus less on weight and more on sustained behavioral change.

12.Sherwood NE, Wall M, Neumark-Sztainer D, Story M. Effect of socioeconomic status on weight change patterns in adolescents. Preventing Chronic Disease. 2009;6(1). PMCID: PMC2644606.

Abstract:
INTRODUCTION: Although socioeconomic differences in prevalence of obesity are well documented, whether patterns of weight gain during key periods of growth and development differ among youth from different socioeconomic backgrounds is unknown. This study examines socioeconomic disparities in overweight status and 5-year weight gain among adolescents.
METHODS: Project EAT (Eating Among Teens)-II followed a socioeconomically and ethnically diverse sample of 2,516 adolescents from 1999 through 2004. Mixed-model regression analyses examined longitudinal trends in overweight status as a function of socioeconomic status (SES).
RESULTS: Girls and boys in the low-SES category were more likely to be overweight than were those in the high-SES category. Boys in the high-SES category showed a significant decrease (P = .006) in overweight prevalence between 1999 and 2004, whereas boys in the low- and middle-SES categories showed no significant change. Girls in the low-SES category showed a significant 5-year increase (P = .004) in overweight prevalence compared with a stable prevalence of overweight among girls in the middle- and high-SES categories.
CONCLUSION: Our data show continued and, in some cases, increasing socioeconomic disparities in risk for overweight. Youth from low-SES backgrounds are at increased risk for overweight and are more likely to remain overweight (boys) or become overweight (girls). Designing obesity prevention and treatment interventions that reach and address the unique needs of youth and families from less-advantaged socioeconomic backgrounds is a public health priority.

13.Vanselow MS, Pereira MA, Neumark-Sztainer D, Raatz SK. Adolescent beverage habits and changes in weight over time: Findings from Project EAT. American Journal of Clinical Nutrition. 2009;90(6):1489-95.

Abstract:
BACKGROUND: Obesity in adolescence has been increasing in the past several decades. Beverage habits among adolescents include increased consumption of sugar-sweetened beverages and decreased consumption of milk.
OBJECTIVE: This study aimed to examine the association between beverage consumption and 5-y body weight change in 2294 adolescents.
DESIGN: Project EAT (Eating Among Teens) is a 5-y longitudinal study of eating patterns among adolescents. Surveys were completed in 1998-1999 (time 1) and in 2003-2004 (time 2). Multivariable linear regression was used to examine the association between beverage consumption at time 2 and change in body mass index from time 1 to time 2, with adjustments for age, socioeconomic status, race, cohort, physical activity, sedentary behavior, coffee, tea, time 1 body mass index, and beverage variables.
RESULTS: In prospective analyses, consumption of beverages was not associated with weight gain, except for consumption of low-calorie soft drinks (positive association, P = 0.002) and white milk (inverse association, P = 0.03), but these associations did not appear to be a monotonic linear dose-response relation. The positive association with low-calorie soft drinks was no longer present after adjustment for dieting and parental weight-related concerns, which suggests that the use of low-calorie soft drinks is a marker for more general dietary behaviors and weight concerns.
CONCLUSIONS: We showed no association between sugar-sweetened beverage consumption, juice consumption, and adolescent weight gain over a 5-y period. A direct association between diet beverages and weight gain appeared to be explained by dieting practices. Adolescents who consumed little or no white milk gained significantly more weight than their peers who consumed white milk. Future research that examines beverage habits and weight among adolescents should address portion sizes, adolescent maturation, and dieting behaviors.

14.Berge JM, Wall M, Bauer KW, Neumark-Sztainer D. Parenting characteristics in the home environment and adolescent overweight: A latent class analysis. Obesity (Silver Spring). 2010;18(4):818-25. PMCID: PMC2893139.

Abstract:
Parenting style and parental support and modeling of physical activity and healthy dietary intake have been linked to youth weight status, although findings have been inconsistent across studies. Furthermore, little is known about how these factors co-occur, and the influence of the coexistence of these factors on adolescents’ weight. This article examines the relationship between the co-occurrence of various parenting characteristics and adolescents’ weight status. Data are from Project EAT (eating among teens), a population-based study of 4,746 diverse adolescents. Theoretical and latent class groupings of parenting styles and parenting practices were created. Regression analyses examined the relationship between the created variables and adolescents’ BMI. Having an authoritarian mother was associated with higher BMI in sons. The co-occurrence of an authoritarian mother and neglectful father was associated with higher BMI for sons. Daughters’ whose fathers did not model or encourage healthy behaviors reported higher BMIs. The co-occurrence of neither parent modeling healthy behaviors was associated with higher BMIs for sons, and incongruent parental modeling and encouraging of healthy behaviors was associated with higher BMIs in daughters. Although, further research into the complex dynamics of the home environment is needed, findings indicate that authoritarian parenting style is associated with higher adolescent weight status and incongruent parenting styles and practices between mothers and fathers are associated with higher adolescent weight status.

15.Berge JM, Wall M, Loth K, Neumark-Sztainer D. Parenting style as a predictor of adolescent weight and weight-related behaviors. Journal of Adolescent Health. 2010;46(4):331-8. PMCID: PMC2844861.

Abstract:
PURPOSE: Current research indicates that specific parenting styles are associated with adolescent overweight, dietary intake, and physical activity; but most of the research has been cross-sectional, making it difficult to determine the temporal order of these associations. The current study adds to the previous research by examining 5-year longitudinal associations between parenting style and adolescent weight and weight-related behaviors.
METHODS: Data from Project EAT, a population-based study with adolescents from diverse ethnic and socioeconomic backgrounds, were used. Adolescents (N = 2,516) from 31 Minnesota schools completed in-class assessments in 1999 (Time 1) and mailed surveys in 2004 (Time 2). Multiple linear regression models were used to predict mean levels of adolescent outcomes at Time 2 from parenting style at Time 1.
RESULTS: Time 1 maternal authoritative parenting style predicted lower body mass index in adolescent sons and daughters at Time 2. Time 1 paternal permissive parenting style predicted more fruits and vegetables intake in daughters at Time 2. Significant associations were not found between parenting style and adolescent physical activity.
CONCLUSIONS: Findings suggest that authoritative parenting style may play a protective role related to adolescent overweight and that the dimension of warmth and/or caring in the parent-adolescent relationship may be important in relation to female adolescent healthy dietary intake. Further exploration of opposite sex parent-adolescent dyad patterns related to parenting style and adolescent weight and weight-related behaviors is warranted.

16.Berge JM, MacLehose R, Eisenberg M, Neumark-Sztainer D, Laska MN. How significant is the ‘significant other’: Associations between significant others’ health behaviors and young adults’ health outcomes. International Journal of Behavioral Nutrition and Physical Activity. 2012;9(35). PMCID: PMC3410807.

Abstract:
BACKGROUND: Having a significant other has been shown to be protective against physical and psychological health conditions for adults. Less is known about the period of emerging young adulthood and associations between significant others’ weight and weight-related health behaviors (e.g. healthy dietary intake, the frequency of physical activity, weight status). This study examined the association between significant others’ health attitudes and behaviors regarding eating and physical activity and young adults’ weight status, dietary intake, and physical activity.
METHODS: This study uses data from Project EAT-III, a population-based cohort study with emerging young adults from diverse ethnic and socioeconomic backgrounds (n = 1212). Logistic regression models examining cross-sectional associations, adjusted for sociodemographics and health behaviors five years earlier, were used to estimate predicted probabilities and calculate prevalence differences.
RESULTS: Young adult women whose significant others had health promoting attitudes/behaviors were significantly less likely to be overweight/obese and were more likely to eat ≥ 5 fruits/vegetables per day and engage in ≥ 3.5 hours/week of physical activity, compared to women whose significant others did not have health promoting behaviors/attitudes. Young adult men whose significant other had health promoting behaviors/attitudes were more likely to engage in ≥ 3.5 hours/week of physical activity compared to men whose significant others did not have health promoting behaviors/attitudes.
CONCLUSIONS: Findings suggest the protective nature of the significant other with regard to weight-related health behaviors of young adults, particularly for young adult women. Obesity prevention efforts should consider the importance of including the significant other in intervention efforts with young adult women and potentially men.

17.Bruening M, Eisenberg M, MacLehose R, Nanney MS, Story M, Neumark-Sztainer D. Relationship between adolescents’ and their friends’ eating behaviors: breakfast, fruit, vegetable, whole-grain, and dairy intake. Journal of the Academy of Nutrition and Dietetics. 2012;112(10):1608-13. PMCID: PMC3462737.

Abstract:
We examined associations between adolescents’ and their friends’ healthy eating behaviors, specifically breakfast, fruit, vegetable, whole-grain, and dairy food intake as reported by both adolescents and their friends. Data for this study were drawn from EAT-2010 (Eating and Activity among Teens), a population-based study examining multilevel factors of eating, physical activity, and weight-related outcomes among adolescents (80% racial/ethnic minority) in Minneapolis/St Paul, MN, during the 2009-2010 academic year. In-class surveys were completed by 2,043 adolescents in 20 schools. Adolescents identified friends from a class roster; friends’ survey data were then linked to each participant. Generalized estimating equation linear regression models were used to examine associations between adolescents’ healthy eating behaviors and these behaviors from their friends (friend group and best friends), adjusting for sociodemographic characteristics. Significant positive associations were found for breakfast eating between adolescents and their friend groups and best friends (friend groups beta=.26, P<0.001; best friends beta=.19, P=0.004), as well was for whole-grain intake (friend groups beta=.14, P<0.001; best friends beta=.13, P=0.003) and dairy food intake (friend groups beta=.08, P=0.014; best friends beta=.09, P=0.002). Adolescents’ and their best friends’ vegetable intake were also significantly related (beta=.09, P=0.038). No associations were seen among friends for fruit intake. Findings from our study suggest that adolescent friends exhibit similarities in healthy eating patterns. Registered dietitians and health professionals may consider developing strategies to engage friends to promote adolescents’ healthy dietary behaviors.

18.Meyer K, Wall MM, Larson NI, Laska MN, Neumark-Sztainer D. Sleep duration and body mass index in a sample of young adults. Obesity. 2012;220:1279-87. PMCID: PMC3406736.

Abstract:
We examined the association between sleep duration and BMI in young adults, and, specifically, in possible gender differences. The population-based sample included 955 young men and 1051 young women (mean age = 25.3 years, s.d. = 1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults)-III. In 2008-2009, study participants completed a survey, on which they reported their weight, height, and typical bed and awakening times. Gender-specific regression models estimated cross-sectional associations between sleep duration and weight status, adjusting for age, race, SES, family structure, depressive symptoms, physical activity, and sedentary and dietary behaviors. In multivariable-adjusted linear regression models, an hour increase in sleep was associated with a -0.38 (-0.70, -0.048) BMI in men. Men who slept <7 h had a 1.4 unit higher mean BMI (27.9; 95% confidence interval (CI): 26.9, 28.9) than men who slept 7-9 h/day (26.5; 95% CI: 26.1, 27.0). Prevalence estimates of overweight (BMI ≥ 25) and obesity (BMI ≥ 30) were also inversely associated with sleep duration among men. Sleep duration was not associated with BMI, overweight, or obesity in women. Among women, but not men, there was a statistically significant positive association between trouble falling or staying asleep and mean BMI. Sleep may be an important modifiable risk factor for obesity, particularly in young adult men.

19.Neumark-Sztainer D. Integrating messages from the eating disorders field into obesity prevention. Adolescent Medicine: State of the Art Reviews. 2012;23(3):520-43.

Abstract:
Weight-related problems, including unhealthy weight control behaviors, binge eating, overweight and obesity, and eating disorders, are prevalent in youth. Furthermore, many young people exhibit more than one of these problems. Therefore, it is essential to consider how to simultaneously work toward the prevention of a broad range of weight-related problems in youth. Dieting, body dissatisfaction, weight talk, and weight-related teasing are commonly addressed risk factors within eating disorder prevention interventions, whereas low levels of physical activity and high intakes of foods high in fat and sugar are commonly addressed within interventions aimed at obesity prevention. Empirical data to be presented in this article demonstrate why risk factors such as dieting and body dissatisfaction, which are typically addressed within the eating disorder field, need to also be addressed within the obesity field. Although dieting and body dissatisfaction strongly predict weight gain over time, these findings are not always taken into account in the design of obesity interventions for youth. Possible reasons as to why risk factors such as dieting, body dissatisfaction, and weight stigmatization may be not adequately addressed within interventions addressing obesity are discussed. Suggestions for how physicians and other nonphysician clinicians might link messages from the fields of both eating disorders and obesity into their work with youth are provided. Finally, the potential for work on mindfulness and yoga to decrease risk factors for both eating disorders and obesity are explored.

20.Neumark-Sztainer D, Wall MM, Larson N, Story M, Fulkerson JA, Eisenberg ME, et al. Secular trends in weight status and weight-related attitudes and behaviors in adolescents from 1999 to 2010. Preventive Medicine. 2012;54(1):77-81. PMCID: PMC3266744.

Abstract:
OBJECTIVE: To examine secular trends from 1999 to 2010 in weight status and weight-related attitudes and behaviors among adolescents.
METHODS: A repeated cross-sectional design was used. Participants were from Minneapolis/St. Paul middle schools and high schools and included 3072 adolescents in 1999 (mean age 14.6 ± 1.8) and 2793 adolescents in 2010 (mean age 14.4 ± 2.0). Trends in weight-related variables were examined using inverse probability weighting to control for changes in socio-demographics over time.
RESULTS: The prevalence of obesity among boys increased by 7.8% from 1999 to 2010, with large ethnic/racial disparities. In black boys the prevalence of obesity increased from 14.4% to 21.5% and among Hispanic boys, obesity prevalence increased from 19.7% to 33.6%. Trends were more positive among girls: weight status did not significantly increase, perceptions of overweight status were more accurate, the use of healthy weight control behaviors remained high, dieting decreased by 6.7%, unhealthy weight control behaviors decreased by 8.2% and extreme weight control behaviors decreased by 4.5%.
CONCLUSIONS: Trends indicate a need to intensify efforts to prevent obesity and other weight-related problems, particularly for boys from ethnic/racial minorities. The decreases in unhealthy weight control behaviors among girls are encouraging.

21.Larson N, Wall M, Story M, Neumark-Sztainer D. Home/family, peer, school, and neighborhood correlates of obesity in adolescents. Obesity. 2013;21(9):1958-69. PMCID: PMC3776207.

Abstract:
OBJECTIVE: This study was designed to (1) identify the most important home/family, peer, school, and neighborhood environmental characteristics associated with weight status and (2) determine the overall contribution of these contexts to explaining weight status among an ethnically/racially diverse sample of adolescents.
DESIGN AND METHODS: Surveys and anthropometric measures were completed in 2009-2010 by 2,793 adolescents (53.2% girls, mean age = 14.4 ± 2.0, 81.1% non-white) in Minneapolis/St. Paul, Minnesota schools. Data representing characteristics of adolescents’ environments were collected from parents/caregivers, friends, school personnel, and Geographic Information System sources. Multiple regression models controlled for adolescent age, ethnicity/race, and socioeconomic status.
RESULTS: The variance in body mass index (BMI) z-scores explained by 51 multicontextual characteristics was 24% for boys and 22% for girls. Across models, several characteristics of home/family (e.g., infrequent family meals) and peer environments (e.g., higher proportion of male friends who were overweight) were consistently associated with higher BMI z-scores among both boys and girls. Among girls, additional peer (e.g., lower physical activity among female friends) and neighborhood (e.g., perceived lack of safety) characteristics were consistently associated with higher BMI z-scores.
CONCLUSIONS: Results underscore the importance of addressing the home/family and peer environments in future research and intervention efforts designed to reduce adolescent obesity.

22.Loth KA, MacLehose RF, Fulkerson JA, Crow S, Neumark-Sztainer D. Food-related parenting practices and adolescent weight status: a population-based study. Pediatrics. 2013;131(5):e1443-50. PMCID: PMC3639463.

Abstract:
OBJECTIVE: To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs.
METHODS: Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone.
RESULTS: Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status.
CONCLUSIONS: Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children’s ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.

23.Quick V, Wall M, Larson N, Haines J, Neumark-Sztainer D. Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings. International Journal of Behavioral Nutrition and Physical Activity. 2013;10:37. PMCID: PMC3623851.

Abstract:
BACKGROUND: The objective of this study was to identify 10-year longitudinal predictors of overweight incidence during the transition from adolescence to young adulthood.
METHODS: Data were from Project EAT (Eating and Activity in Teens and Young Adults). A diverse, population-based cohort (N = 2,134) completed baseline surveys in 1998-1999 (mean age = 15.0+/-1.6, ‘adolescence’) and follow-up surveys in 2008-2009 (mean age = 25.4+/-1.7, ‘young adulthood’). Surveys assessed personal, behavioral and socio-environmental factors hypothesized to be of relevance to obesity, in addition to height and weight. Multivariable logistic regression was used to estimate the adjusted odds for each personal, behavioral and socio-environmental factor at baseline, and 10-year changes for these factors, among non-overweight adolescents (n = 1,643) being predictive of the incidence of overweight (BMI >/= 25) at 10-year follow-up.
RESULTS: At 10-year follow-up, 51% of young adults were overweight (26% increase from baseline). Among females and males, higher levels of body dissatisfaction, weight concerns, unhealthy weight control behaviors (e.g., fasting, purging), dieting, binge eating, weight-related teasing, and parental weight-related concerns and behaviors during adolescence and/or increases in these factors over the study period predicted the incidence of overweight at 10-year follow-up. Females with higher levels of whole grain intake and breakfast and dinner consumption frequency during adolescence were protected against becoming overweight. Among males, increases in vegetable intake protected against the incidence of overweight 10 years later.
CONCLUSIONS: Findings suggest that obesity prevention interventions for adolescents should address weight-specific factors from within the domains of personal, behavioral, and socio-environmental factors such as promoting positive body image, decreasing unhealthy weight control behaviors, and limiting negative weight talk.

How important are family meals for adolescents and young adults?

1.Neumark-Sztainer D, Story M, Ackard D, Moe J, Perry C. Family meals among adolescents: Findings from a pilot study. Journal of Nutrition Education. 2000;32(6):335-40.

Abstract:
This study aimed to increase our understanding of family meal patterns among adolescenes. A school-based survey was completed by 252 junior and senior high school students. Nearly a third (30.7%) reported that their families had eaten a meal together at lease seven times over the past week, but a similar percentage (31.9%) reported two or fewer family meals over the past week. Frequent television viewing during meals was reported by about half (52.8%) of the respondents. Adolescents reported feeling more certain about making healthful food choices at family meals than in other eating situations. Findings from this pilot study indicate that further investigations of family meal patterns among youth and the associations between family meals and eating behaviors are warranted.

2.Neumark-Sztainer D, Story M, Ackard D, Moe J, Perry C. The “family meal”: Views of adolescents. Journal of Nutrition Education. 2000;32(6):329-34.

Abstract:
The study objectives were to (1) increase our knowledge about family meal. patterns of adolescents, (2) identify factors that adolescents perceive as reasons for not eating meals with their family and (3) assess adolescents’ perceptions on whether they eat more healthful foods at family meals than in other eating situations. Focus group discussions were conducted with 141 adolescents from 7th and 10th grade health education classes from urban public junior and senior high schools in Minnesota. Twenty-one focus groups were audio-taped, tapes were transcribed verbatim, transcripts were reviewed for emerging themes, and themes were coded using content analysis procedures. For some adolescents, family meals were part of their daily routine, whereas for others,family meals were not the norm. Diversity also existed with regard to the context of family meals, such as activities during meals and settings for meals. Major reasons for not having meals as a family included parent and teen schedules, teen desire for autonomy, dissatisfaction with family relations, and dislike of food served at family meals. Most of the adolescents thought that they would eat more healthful foods if they ate more often with their families. Key factors that appeared to influence whether participation in family meals would lead to a more healthful diet included food availability at meals, rules around mealtimes, and health-related attitudes of family members. There is great diversity in both the quantity and quality of meals in the families of adolescents. Health care providers working with youth and their families should inquire about family meals and encourage the practice of eating with family members, taking into account what is feasible for a particular family.

3.Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents. Journal of the American Dietetic Association. 2003;103(3):317-22.

Abstract:
OBJECTIVE: To examine family meal patterns and associations with sociodemographic characteristics and dietary intake in adolescents.
DESIGN: A population-based cross-sectional study design was employed. Adolescents completed the Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire within their schools. Subjects/setting The study population included 4,746 middle and high school students from Minneapolis/St. Paul public schools with diverse racial and socioeconomic backgrounds. Statistical analyses Associations were examined using cross tabulations, log-linear modeling, and linear regressions.
RESULTS: There was a wide distribution in the frequency of family meals during the previous week: never (14.0%), 1 or 2 times (19.1%), 3 to 6 times (40.1%), and 7 or more times (24.8%). Sociodemographic characteristics associated with more frequent family meals included gender (boys), school level (middle school), race (Asian American), mother’s employment status (not employed), and socioeconomic status (high). Frequency of family meals was positively associated with intake of fruits, vegetables, grains, and calcium-rich foods and negatively associated with soft drink consumption. Positive associations were also seen between frequency of family meals and energy; protein (percentage of total calories); calcium; iron; folate; fiber; and vitamins A, C, E, and B-6.
CONCLUSIONS: Family meals appear to play an important role in promoting positive dietary intake among adolescents. Feasible ways to increase the frequency of family meals should be explored with adolescents and their families.

4.Eisenberg ME, Olson RE, Neumark-Sztainer D, Story M, Bearinger LH. Correlations between family meals and psychosocial well-being among adolescents. Archives of Pediatrics and Adolescent Medicine. 2004;158(8):792-6.

Abstract:
OBJECTIVE: To determine the association between frequency of family meals and multiple indicators of adolescent health and well-being (tobacco, alcohol, and marijuana use; academic performance; self-esteem; depressive symptoms; and suicide involvement) after controlling for family connectedness.
METHODS: Data come from a 1998-1999 school-based survey of 4746 adolescents from ethnically and socioeconomically diverse communities in the Minneapolis/St Paul, Minn, metropolitan area. Logistic regression, controlling for family connectedness and sociodemographic variables, was used to identify relationships between family meals and adolescent. health behaviors.
RESULTS: Approximately one quarter (26.8%) of respondents ate 7 or more family meals in the past week, and approximately one quarter (23.1%) ate family meals 2 times or less. Frequency of family meals was inversely associated with tobacco, alcohol, and marijuana use; low grade point average; depressive symptoms; and suicide involvement after controlling for family connectedness (odds ratios, 0.76-0.93).
CONCLUSIONS: Findings suggest that eating family meals may enhance the health and well-being of adolescents. Public education on the benefits of family mealtime is recommended.

5.Neumark-Sztainer D, Wall M, Story M, Fulkerson JA. Are family meal patterns associated with disordered eating behaviors among adolescents? Journal of Adolescent Health. 2004;35(5):350-9.

Abstract:
PURPOSE: To examine associations between family meal patterns (frequency, priority, atmosphere, and structure of family meals) and disordered eating (unhealthy weight control behaviors, binge eating, and chronic dieting) in adolescent girls and boys.
METHODS: Survey and anthropometric data were collected from 4746 ethnically diverse adolescents from public middle and senior high schools who participated in the Project EAT study (Eating Among Teens). Variables of interest included family meal patterns and disordered eating behaviors. Logistic regressions were performed to examine associations between family meal patterns and disordered eating behaviors adjusting for body mass index, sociodemographic characteristics, family connectedness, and weight pressures within the home.
RESULTS: In general, adolescents who reported more frequent family meals, high priority for family meals, a positive atmosphere at family meals, and a more structured family meal environment were less likely to engage in disordered eating. For example, 18.1% of girls who reported 1-2 family meals/week engaged in extreme weight control behaviors compared with 8.8% of girls who reported 3-4 family meals/week. Making family meals a priority, in spite of scheduling difficulties, emerged as the most consistent protective factor for disordered eating. Associations between family meal patterns and disordered eating behaviors tended to be stronger among girls than among boys. Family meal patterns were more consistently associated with unhealthy weight control behaviors than with chronic dieting and binge eating. Although associations between family meals and disordered eating were weakened after adjusting for more global familial factors, including family connectedness and weight-specific pressures within the home, a number of the associations remained statistically significant, suggesting an independent relationship between family meals and disordered eating.
CONCLUSION: Family meals have the potential to play an important role in the prevention of unhealthy weight control behaviors among youth. Findings suggest that attention needs to be directed toward increasing family meal frequency and creating a positive environment for family meals.

6.Fulkerson JA, Neumark-Sztainer D, Story M. Adolescent and parent views of family meals. Journal of the American Dietetic Association. 2006;106(4):526-32.

Abstract:
OBJECTIVE: To examine and compare the family mealtime environment from the perspectives of both adolescents and parents.
DESIGN: Adolescents completed a school-based survey and parents participated in a telephone interview as part of Project EAT (Eating Among Teens).
SUBJECTS/SETTING: Participants were 902 adolescent females (n=424) and males (n=478) and one of their guardians/parents.
STATISTICAL ANALYSES PERFORMED: Frequencies, chi(2) analyses, and Spearman correlations were used to assess relationships.
RESULTS: Parents were more likely than adolescents to report eating five or more family meals per week, the importance of eating together, and scheduling difficulties (P<0.001). Younger adolescents were more likely than older adolescents to report eating five or more family meals per week, higher importance of eating together, and more rule expectations at mealtime (P<0.001), whereas older adolescents were more likely to report scheduling difficulties (P<0.001). Girls reported more family meals per week and more scheduling conflicts than boys did; boys reported more rules at mealtime than girls did (P<0.001).
CONCLUSIONS: Family meals are perceived positively by both adolescents and parents. Family meals may be a useful mechanism for enhancing family togetherness, and for role modeling behaviors that parents would like their children to emulate. Dietetics professionals can capitalize on positive attitudes toward family meals to help promote their frequency. Helping families learn to cook healthful, quick meals may reduce dependency on less healthful meal options, reduce the frequency of eating outside of the home, and promote greater nutritional intake.

7.Feldman S, Eisenberg M, Neumark-Sztainer D, Story M. Associations between watching TV during family meals and dietary intake among adolescents. Journal of Nutrition Education and Behavior. 2007;39:257-63.

Abstract:
OBJECTIVE: To examine associations between watching television during family meals and dietary intake among adolescents.
DESIGN: Cross-sectional study using survey data from a diverse sample of adolescents.
SETTING: Data were collected from a school-based survey during the 1998-1999 school year.
PARTICIPANTS: Middle and high school students (N = 4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%.
VARIABLES MEASURED: Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals.
ANALYSIS: General linear modeling comparing dietary intake across 3 groups.
RESULTS: 33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals.
CONCLUSIONS AND IMPLICATIONS: Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.

8.Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood. Journal of the American Dietetic Association. 2007;107(9):1502-10.

Abstract:
BACKGROUND: Cross-sectional research in adolescents has found that eating family meals is associated with better nutritional intake.
OBJECTIVE: To describe meal patterns of young adults and determine if family meal frequency during adolescence is associated with diet quality, meal frequency, social eating, and meal structure during young adulthood.
DESIGN: Population-based, 5-year longitudinal study in Minnesota.
SUBJECTS/SETTING: Surveys and food frequency questionnaires were completed by 946 female students and 764 male students in high school classrooms at Time 1 (1998-1999; mean age 15.9 years) and by mail at Time 2 (2003-2004; mean age 20.4 years).
STATISTICAL ANALYSES PERFORMED: Multiple linear regression models were used to predict mean levels of young adult outcomes from adolescent family meal frequency. Probability testing of trends in each outcome across ordered categories of family meal frequency used linear contrasts.
RESULTS: Family meal frequency during adolescence predicted higher intakes of fruit (P<0.05), vegetables (P<0.01), dark-green and orange vegetables (P=0.001), and key nutrients and lower intakes of soft drinks (P<0.05) during young adulthood. Frequency of family meals also predicted more breakfast meals (P<0.01) in females and for both sexes predicted more frequent dinner meals (P<0.05), higher priority for meal structure (P<0.001), and higher priority for social eating (P<0.001). Associations between Time 1 family meals and Time 2 dietary outcomes were attenuated with adjustment for Time 1 outcomes but several associations were still statistically significant.
CONCLUSIONS: Family meals during adolescence may have a lasting positive influence on dietary quality and meal patterns in young adulthood.

9.Eisenberg ME, Neumark-Sztainer D, Fulkerson JA, Story M. Family meals and substance use: Is there a long-term protective association? Journal of Adolescent Health. 2008;43(2):151-6.

Abstract:
PURPOSE: To examine 5-year longitudinal associations between family meal patterns and subsequent substance use in adolescents.
METHODS: A total of 806 Minnesota adolescents were surveyed in public schools in 1998-1999 (mean age, 12.8 years) and again by mail in 2003-2004 (mean age, 17.2 years) as part of a longitudinal population-based study. Logistic regression was used to estimate the odds of tobacco, alcohol, and marijuana use at follow-up for adolescents reporting regular family meals at baseline compared with those without regular family meals, adjusting for family connectedness and prior substance use.
RESULTS: Family meal frequency at baseline was associated with significantly lower odds of cigarette smoking, alcohol use, and marijuana use at follow-up among female adolescents, even after adjusting for baseline substance use and additional covariates. Family meals were not associated with use of any substance at follow-up for male adolescents after adjusting for baseline use.
CONCLUSIONS: Results from this study suggest that regular family meals in adolescence may have a long-term protective association with the development of substance use over 5 years among females. Parents should be encouraged to establish a pattern of regular family meals, as this activity may have long lasting benefits.

10.Fulkerson JA, Neumark-Sztainer D, Hannan PJ, Story M. Family meal frequency and weight status among adolescents: cross-sectional and 5-year longitudinal associations. Obesity. 2008;16(11):2529-34.

Abstract:
This study examined cross-sectional and 5-year longitudinal associations between the frequency of family meals and overweight status (>85th percentile for age and gender) in a large, diverse population of adolescents (n = 2,516). The population included two cohorts (midadolescence to young adulthood, n = 1,710, and early adolescence to midadolescence, n = 806). Logistic regression models tested cross-sectional and longitudinal (1999-2004) associations between family meal frequency and overweight status. Two sets of models are presented: (i) models adjusted only for baseline demographic characteristics and (ii) models also adjusted for physical activity, sedentary behaviors, and energy intake. Longitudinal models adjusted for baseline overweight status. Although significant inverse associations between family meal frequency and overweight status were observed for early adolescent females in all cross-sectional models (P < 0.001), longitudinal associations were not significant. Neither cross-sectional nor longitudinal associations were significant for males of either cohort and older females in any models. Young adolescent females who do not eat meals with their families may be at risk for overweight; however, the increased risk may not persist over a 5-year period. Eating family meals during high school may not protect against overweight during young adulthood. Although previous longitudinal research has suggested significant dietary and psychosocial benefits related to family meal frequency, the weight-related benefits of family meals may be more complex and deserving of further study, including an examination of the quality and quantity of food consumed at family meals.

11.Neumark-Sztainer D, Eisenberg ME, Fulkerson JA, Story M, Larson NI. Family meals and disordered eating in adolescents: longitudinal findings from project EAT. Archives of Pediatrics and Adolescent Medicine. 2008;162(1):17-22.

Abstract:
OBJECTIVE: To examine 5-year longitudinal associations between family meal frequency and disordered eating behaviors in adolescents.
DESIGN: Longitudinal study.
SETTING: Participants from 31 Minnesota schools completed in-class assessments in 1999 (time 1) and mailed surveys in 2004 (time 2).
PARTICIPANTS: Adolescents (N=2516) who completed Project EAT (Eating Among Teens)-I (time 1) and -II (time 2) assessments.
MAIN OUTCOME MEASURES: Time 1 family meal frequency and time 2 disordered eating behaviors, including extreme weight control behaviors (self-induced vomiting and use of laxatives, diet pills, or diuretics), less extreme unhealthy weight control behaviors (eating very little, fasting, using food substitutes, skipping meals, or smoking), binge eating, and chronic dieting.
RESULTS: Among adolescent girls, time 1 regular family meals (> or = 5 meals/wk) were associated with lower prevalences of time 2 extreme weight control behaviors (odds ratio, 0.71; 95% confidence interval, 0.52-0.97), even after adjusting for sociodemographic characteristics, body mass index, family connectedness, parental encouragement to diet, and extreme weight control behaviors at time 1. Associations with other disordered eating behaviors were also suggestive of a protective effect of family meals in unadjusted analyses but were not statistically significant in adjusted analyses. Among adolescent boys, regular family meals did not predict lower levels of disordered eating behaviors.
CONCLUSIONS: The high prevalence of disordered eating behaviors among adolescent girls and the protective role of family meals suggest a need for interventions aimed at promoting family meals. Further exploration of predictors of disordered eating behaviors in adolescent boys and the role of family meals is warranted.

12.Burgess-Champoux TL, Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Are family meal patterns associated with overall diet quality during the transition from early to middle adolescence? Journal of Nutrition Education and Behavior. 2009;41(2):79-86.

Abstract:
OBJECTIVE: To examine longitudinal associations of participation in regular family meals (>or= 5 meals/week) with eating habits and dietary intake during adolescence.
DESIGN: Population-based, longitudinal study (Project EAT: Eating Among Teens). Surveys were completed in Minnesota classrooms at Time 1 (1998-1999) and by mail at Time 2 (2003-2004).
SETTING: Baseline surveys were completed in Minneapolis/St. Paul, Minnesota, schools and by mail at follow-up.
PARTICIPANTS: 677 adolescents (303 males and 374 females) who were in middle school at Time 1 (mean age = 12.8 +/- 0.74 years) and high school at Time 2 (mean age = 17.2 +/- 0.59 years).
MAIN OUTCOME MEASURES: Dietary intake, frequency of meals, and fast-food intake patterns.
ANALYSIS: Generalized linear modeling stratified by gender and adjusted for race/ethnicity, socioeconomic status, and the Time 1 outcome.
RESULTS: Regular family meals were positively associated with Time 2 frequency of breakfast, lunch, and dinner meals for males and breakfast and dinner meals for females. Among males, regular family meals were negatively associated with Time 2 fast-food intake. Regular family meals were also positively associated with Time 2 mean daily intakes of vegetables, calcium-rich food, fiber, calcium, magnesium, potassium, iron, zinc, folate, and vitamins A and B(6) among both genders.
CONCLUSIONS AND IMPLICATIONS: Regular family meals during early adolescence may contribute to the formation of healthful eating habits 5 years later. Parents should be made aware of the importance of shared mealtime experiences.

13.Eisenberg ME, Neumark-Sztainer D, Feldman S. Does TV viewing during family meals make a difference in adolescent substance use? Preventive Medicine. 2009;48(6):585-7.

Abstract:
OBJECTIVE: Family meals are important to adolescent health, but relatively little is known about TV viewing during family meals. The present paper examines the role that TV viewing during family meals may have on substance use behaviors among adolescents.
METHODS: A diverse sample of 806 Minnesota high school students (mean age 17.2 years) provided survey data in 2003-2004 regarding family meal frequency, substance use behavior and general family connectedness. General linear modeling was used to compare substance use across three family meal/TV categories in a cross-sectional analysis.
RESULTS: 28.6% of participants ate regular family meals without TV, and 27.5% had regular family meals while watching TV. Significant differences in cigarette smoking, alcohol and marijuana use were found for females reporting regular family meals versus no regular family meals, but did not differ significantly by TV viewing. No significant differences were found across groups of males.
CONCLUSIONS: Results from this study indicate that TV viewing during family meals does not appear to attenuate the previously observed protective relationship between family meals and substance use for females. Benefits of family meals may be derived simply from having adolescents at home during mealtimes.

14.Berge JM, Wall M, Neumark-Sztainer D, Larson N, Story M. Parenting style and family meals: cross-sectional and 5-year longitudinal associations. Journal of the American Dietetic Association. 2010;110(7):1036-42. PMCID: PMC2906915.

Abstract:
BACKGROUND: Research on family meals in the past decade has shown a positive association between family meal frequency and adolescent healthy dietary intake. However, less is known about factors within the home environment, such as parenting style, that may be associated with family meal patterns.
OBJECTIVE: The purpose of this study is to test cross-sectional and 5-year longitudinal associations between parenting styles (authoritative, authoritarian, permissive, and neglectful) and the frequency of family meals among adolescents.
STUDY DESIGN: Data were from Project Eating Among Teens, a population-based study comprised of youth from diverse ethnic/racial and socioeconomic backgrounds. Two cohorts of adolescents (middle school and high school) completed in-class surveys in 1999 (Time 1) and mailed surveys in 2004 (Time 2). Multiple linear regression models were used to predict mean frequency of family meals at Time 1 and Time 2 from adolescent report of parenting style (both mother and father) at Time 1. Cross-sectional analyses included both adolescent cohorts (n=4,746) and longitudinal analyses included only the younger cohort (n=806) because family meal frequency was not assessed in the older cohort at Time 2.
RESULTS: Cross-sectional results for adolescent girls indicated a positive association between maternal and paternal authoritative parenting style and frequency of family meals. For adolescent boys, maternal authoritative parenting style was associated with more frequent family meals. Longitudinal results indicated that authoritative parenting style predicted higher frequency of family meals 5 years later, but only between opposite sex parent/adolescent dyads.
CONCLUSIONS: Future research should identify additional factors within the home environment that are associated with family meal frequency to develop effective interventions that result in increased family meals for youth. Also, future research should investigate the mealtime behaviors of authoritative parents and identify specific behaviors that dietetics practitioners and other health care providers could share with parents of adolescents to help them increase family meal frequency.

15.Neumark-Sztainer D, Larson NI, Fulkerson JA, Eisenberg ME, Story M. Family meals and adolescents: what have we learned from Project EAT (Eating Among Teens)? Public Health Nutrition. 2010;13(7):1113-21.

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

16.Berge JM, MacLehose R, Loth KA, Eisenberg ME, Fulkerson JA, Neumark-Sztainer D. Family meals: Associations with weight and eating behaviors among mothers and fathers. Appetite. 2012;58(3):1128-35. PMCID: PMC3340527.

Abstract:
Few studies have looked at the relationship between family meals and adult weight and health behaviors. The current study investigates the association between frequency of family meals and mothers’ and fathers’ body mass index (BMI), dietary intake, dieting behaviors and binge eating. Data from Project F-EAT (Families and Eating and Activity in Teens) were used for the current analysis. Socio-economically and racially/ethnically diverse mothers and fathers (n = 3488) of adolescents participating in a multi-level population-based study (EAT 2010) completed surveys mailed to their homes. Predicted means or probabilities were calculated for each outcome variable at each level of family meal frequency. Interactions between race/ethnicity and marital status with family meals were evaluated in all models. Overall, results indicated that having more frequent family meals was associated with increased consumption of fruits and vegetables for mothers and fathers, after adjusting for age, educational attainment, marital status and race/ethnicity. Other findings including less fast food intake for fathers and fewer dieting and binge eating behaviors for mothers were significantly associated with family meal frequency, but not consistently across all family meal categories or with BMI. Interactions by race/ethnicity and marital status were non-significant, indicating that family meals may be important for more healthful dietary intake across race and marital status. Future research should confirm findings in longitudinal analyses to identify temporality and strength of associations. (c) 2012 Elsevier Ltd. All rights reserved.

17.Berge JM, Jin SW, Hannan P, Neumark-Sztainer D. Structural and interpersonal characteristics of family meals: associations with adolescent body mass index and dietary patterns. Journal of the Academy of Nutrition and Dietetics. 2013;113(6):816-22. PMCID: PMC3660446.

Abstract:
The last decade of research has suggested that family meals play an important role in promoting healthful dietary intake in youth. However, little is known about the structural characteristics and interpersonal dynamics of family meals that might help to inform why family meals are protective for youth. The current mixed methods, cross-sectional study conducted in 2010-2011 includes adolescents and parents who participated in two linked population-based studies. Participants included 40 parents (91.5% female) and adolescents (57.5% female) from the Minneapolis/St Paul, MN, area participating in EAT (Eating and Activity Among Teens) 2010 and F-EAT (Families and Eating and Activity Among Teens). The structural (eg, length of the meal, types of foods served) and interpersonal characteristics (eg, communication, emotion/affect management) of family meals were described, and associations between interpersonal dynamics at family meals and adolescent body mass index and dietary intake were examined via direct observational methods. Families were videorecorded during two mealtimes in their homes. Results indicated that family meals were approximately 20 minutes in length, included multiple family members, were typically served family style (70%), and occurred in the kitchen 62% of the time and 38% of the time in another room (eg, family room, office). In addition, significant associations were found between positive interpersonal dynamics (ie, communication, affect management, interpersonal involvement, overall family functioning) at family meals and lower adolescent body mass index and higher vegetable intake. These findings add to the growing body of literature on family meals by providing a better understanding of what is happening at family meals in order to inform obesity-prevention studies and recommendations for providers working with families of youth.

18.Larson N, Fulkerson J, Story M, Neumark-Sztainer D. Shared meals among young adults are associated with better diet quality and predicted by family meal patterns during adolescence. Public Health Nutrition. 2013;16(5):883-92. PMCID: PMC3624057.

Abstract:
OBJECTIVE: To describe shared meal patterns and examine associations with dietary intake among young adults.
DESIGN: Population-based, longitudinal cohort study (Project EAT: Eating and Activity in Teens and Young Adults).
SETTING: Participants completed surveys and FFQ in high-school classrooms in Minneapolis/St. Paul, MN, USA in 1998-1999 (mean age=15.0 years, ‘adolescence’) and follow-up measures online or by mail in 2008-2009 (mean age=25.3 years, ‘young adulthood’).
SUBJECTS: There were 2052 participants who responded to the 10-year follow-up survey and reported on frequency of having shared meals.
RESULTS: Among young adults, the frequency of shared meals during the past week was as follows: never (9.9%), one or two times (24.7%), three to six times (39.1%) and seven or more times (26.3%). Having more frequent family meals during adolescence predicted a higher frequency of shared meals in young adulthood above and beyond other relevant sociodemographic factors such as household composition and parental status. Compared with young adults who never had family meals during adolescence, those young adults who reported seven or more family meals per week during adolescence had an average of one additional shared meal per week. Having more frequent shared meals in young adulthood was associated with greater intake of fruit among males and females, and with higher intakes of vegetables, milk products and some key nutrients among females.
CONCLUSIONS: Nutrition professionals should encourage families of adolescents to share meals often and establish the tradition of eating together, and work with young adults to ensure that healthy food and beverage choices are offered at mealtimes.

19.Larson N, MacLehose R, Fulkerson JA, Berge JM, Story M, Neumark-Sztainer D. Eating breakfast and dinner together as a family: associations with sociodemographic characteristics and implications for diet quality and weight status. Journal of the Academy of Nutrition and Dietetics. 2013;113(12):1601-9. PMCID: PMC3833880.

Abstract:
BACKGROUND: Research has shown that adolescents who frequently share evening meals with their families experience more positive health outcomes, including diets of higher nutritional quality. However, little is known about families eating together at breakfast.
OBJECTIVE: This study examined sociodemographic differences in family meal frequencies in a population-based adolescent sample. In addition, this study examined associations of family breakfast meal frequency with dietary quality and weight status.
DESIGN: Cross-sectional data from EAT 2010 (Eating and Activity in Teens) included anthropometric assessments and classroom-administered surveys completed in 2009-2010.
PARTICIPANTS/SETTING: Participants included 2,793 middle and high school students (53.2% girls, mean age=14.4 years) from Minneapolis/St Paul, MN, public schools. MAIN
OUTCOME MEASURES: Usual dietary intake was self-reported on a food frequency questionnaire. Height and weight were measured.
STATISTICAL ANALYSES PERFORMED: Regression models adjusted for sociodemographic characteristics, family dinner frequency, family functioning, and family cohesion were used to examine associations of family breakfast frequency with dietary quality and weight status.
RESULTS: On average, adolescents reported having family breakfast meals 1.5 times (standard deviation=2.1) and family dinner meals 4.1 times (standard deviation=2.6) in the past week. There were racial/ethnic differences in family breakfast frequency, with the highest frequencies reported by adolescents of black, Hispanic, Native American, and mixed race/ethnicity. Family breakfast frequency was also positively associated with male sex, younger age, and living in a two-parent household. Family breakfast frequency was associated with several markers of better diet quality (such as higher intake of fruit, whole grains, and fiber) and lower risk for overweight/obesity. For example, adolescents who reported seven family breakfasts in the past week consumed an average of 0.37 additional daily fruit servings compared with adolescents who never had a family breakfast meal.
CONCLUSIONS: Results suggest that eating breakfast together as a family can have benefits for adolescents’ dietary intake and weight status.

20.Neumark-Sztainer D, Wall M, Fulkerson J, Larson N. Changes in the frequency of family meals from 1999-2010 in the homes of adolescents: Trends by sociodemographic characteristics. Journal of Adolescent Health. 2013;52:201-6. PMCID: PMC3552297.

Abstract:
OBJECTIVE: To examine secular trends from 1999 to 2010 in family meal frequency in a population-based sample of adolescents across sociodemographic characteristics.
METHODS: A repeated cross-sectional design was used. Participants were from middle schools and high schools in the Minneapolis/St. Paul area and included 3,072 adolescents (mean age = 14.6 ± 1.8 years) in 1999 and 2,793 adolescents (mean age = 14.4 ± 2.0 years) in 2010 from diverse ethnic/racial and socioeconomic backgrounds. Trends in family meal frequency were examined using inverse probability weighting to control for changes in sociodemographic characteristics over time.
RESULTS: Family meal frequency remained fairly constant from 1999 to 2010 in the overall sample, but decreases were found in population subgroups including girls, middle school students (grade: 6-8), Asians, and youth from low socioeconomic backgrounds. Among youth from the lowest socioeconomic backgrounds, the mean number of family meals in the past week decreased from 4.0 in 1999 to 3.6 in 2010 (p = .003). Furthermore, the percentage of youth from low socioeconomic backgrounds eating five or more meals in the past week decreased from 46.9% in 1999 to 38.8% in 2010 (p < .001). In contrast, family meal frequency tended to increase over time among youth from higher socioeconomic backgrounds.
CONCLUSIONS: The widening gap in family meal frequency between youth from low and high socioeconomic backgrounds is concerning, particularly given the greater risk for poor health outcomes among low-income youth. Given findings from other studies suggesting multiple benefits of family meals, interventions to increase family meal frequency are needed that target adolescents and their families from the most vulnerable segments of the population.

21.Fulkerson JA, Loth K, Bruening M, Berge J, Eisenberg ME, Neumark-Sztainer D. Time 2 tlk 2nite: use of electronic media by adolescents during family meals and associations with demographic characteristics, family characteristics, and foods served. Journal of the Academy of Nutrition and Dietetics. 2014;114(7):1053-8. PMCID: PMC4063887.

Abstract:
We examined the frequency of adolescents’ use of electronic media (ie, television/movie watching, text messaging, talking on the telephone, listening to music with headphones, and playing with hand-held games) at family meals and examined associations with demographic characteristics, rules about media use, family characteristics, and the types of foods served at meals using an observational, cross-sectional design. Data were drawn from two coordinated, population-based studies of adolescents (Project Eating Among Teens 2010) and their parents (Project Families and Eating Among Teens). Surveys were completed during 2009-2010. Frequent television/movie watching during family meals by youth was reported by 25.5% of parents. Multivariate logistic regression analyses indicated significantly higher odds of mealtime media use (P<0.05) for girls and older teens. In addition, higher odds of mealtime media use (P<0.05) were also seen among those whose parents had low education levels or were black or Asian; having parental rules about media use significantly reduced these odds. Frequent mealtime media use was significantly associated with lower scores on family communication (P<0.05) and scores indicating less importance placed on mealtimes (P<0.001). Furthermore, frequent mealtime media use was associated with lower odds of serving green salad, fruit, vegetables, 100% juice, and milk at meals, whereas higher odds were seen for serving sugar-sweetened beverages (P<0.05). The ubiquitous use of mealtime media by adolescents and differences by sex, race/ethnicity, age, and parental rules suggest that supporting parents in their efforts to initiate and follow-through on setting mealtime media use rules may be an important public health strategy.

22.Neumark-Sztainer D, MacLehose R, Loth K, Fulkerson JA, Eisenberg ME, Berge J. What’s for dinner? Types of food served at family dinner differ across parent and family characteristics. Public Health Nutrition. 2014;17(1):145-55. PMCID: PMC3815492.

Abstract:
OBJECTIVE: To examine the types of food served at family dinner in the homes of adolescents and correlations with parent and family sociodemographic characteristics, psychosocial factors and meal-specific variables.
DESIGN: A cross-sectional population-based survey completed by mail or telephone by parents participating in Project F-EAT (Families and Eating and Activity in Teens) in 2009-2010.
SETTING: Homes of families with adolescents in Minneapolis/St. Paul urban area, MN, USA.
SUBJECTS: Participants included 1923 parents/guardians (90.8% female; 68.5% from ethnic/racial minorities) of adolescents who participated in EAT 2010.
RESULTS: Less than a third (28%) of parents reported serving a green salad at family dinner on a regular basis, but 70% reported regularly serving vegetables (other than potatoes). About one-fifth (21%) of families had fast food at family dinners two or more times per week. Variables from within the sociodemographic domain (low educational attainment) psychosocial domain (high work-life stress, depressive symptoms, low family functioning) and meal-specific domain (low value of family meals, low enjoyment of cooking, low meal planning, high food purchasing barriers and fewer hours in food preparation) were associated with lower healthfulness of foods served at family dinners, in analyses adjusted for sociodemographic characteristics.
CONCLUSIONS: There is a need for interventions to improve the healthfulness of food served at family meals. Interventions need to be suitable for parents with low levels of education; take parent and family psychosocial factors into account; promote more positive attitudes toward family meals; and provide skills to make it easier to plan and prepare healthful family meals.

Are the eating behaviors of adolescent and young adult vegetarians healthy?

1.Perry C, McGuire M, Neumark-Sztainer D, Story M. Characteristics of vegetarian adolescents in a multiethnic urban population. Journal of Adolescent Health. 2001;29(6):406-16.

Abstract:
PURPOSE: To examine the prevalence of adolescents’ vegetarianism in a multiethnic, urban population, and its correlates with demographic, personal, weight-related, and behavioral factors.
METHODS: Self-report and anthropometric data were collected from a representative sample of 4746 adolescents from 31 public middle schools and high schools in the Twin Cities area of Minnesota. Students answered questions concerning vegetarianism, food and weight, and health behaviors. Height and weight were directly measured. Comparisons were made between self-reported vegetarians and nonvegetarians; these analyses also assessed gender and race/ethnicity interactions. In the second set of analyses, demographic and behavioral characteristics of more restricted and semi-vegetarians were examined. Analyses were done by logistic regression.
RESULTS: Teenage vegetarians comprise about 6% of the sample. The vegetarians were more likely than nonvegetarians to be female, not black, weight- and body-conscious, dissatisfied with their bodies, and involved in a variety of healthy and unhealthy weight control behaviors. Vegetarians more often reported having been told by a physician that they had an eating disorder and were more likely to have contemplated and attempted suicide. Vegetarian males were found to be an especially high risk group for unhealthy weight control practices. Few ethnic group differences among vegetarians were noted. Adolescents who did not eat chicken and fish were at lower risk than those who also ate chicken and fish.
CONCLUSIONS: Adolescent vegetarians are at greater risk than others for involvement in unhealthy and extreme weight control behaviors. Vegetarian males are at particularly high risk. Vegetarianism among adolescents may therefore be a signal for preventive intervention. Adolescents who choose to become vegetarians may also need to learn how to healthfully do so.

2.Perry CL, McGuire MT, Neumark-Sztainer D, Story M. Adolescent vegetarians: how well do their dietary patterns meet the Healthy People 2010 objectives? Archives of Pediatrics and Adolescent Medicine. 2002;156:431-7.

Abstract:
OBJECTIVES: To examine whether adolescent vegetarians were more likely than nonvegetarian peers to meet the dietary recommendations of the Healthy People 2010 objectives and to examine differences in other nutrients between these 2 groups.
DESIGN: A total of 4746 adolescents from 31 middle and high schools in the Twin Cities area of Minnesota. Data were collected via self-report surveys, with a student response rate of 81.5%.
SETTING: Urban secondary schools.
PARTICIPANTS: Participants were equally divided by sex. The mean age was 14.9 years; 34.3% were in junior high school and 65.7% in high school. The racial/ethnic distribution was 48.5% white, 19.0% African American, 19.2% Asian American, 5.8% Hispanic, 3.5% American Indian, and 3.9% mixed or other.
MAIN OUTCOME MEASURES: Questions on vegetarian status and whether particular foods (eggs, dairy foods, chicken, fish) were excluded. Dietary intake was assessed using the Youth and Adolescent Food Frequency Questionnaire.
RESULTS: Vegetarian adolescents were significantly more likely than nonvegetarian adolescents to meet the Healthy People 2010 objectives. This was particularly noteworthy for total fat (70% vs 48%), saturated fat (65% vs 39%), daily servings of vegetables (26% vs 14%), and 5 or more servings of fruits and vegetables (39% vs 28%). Vegetarians were also less likely to eat fast food or drink regular soda and fruit drinks. Vegetarians consumed less vitamin B(12), more diet soda, more caffeine, and more iron.
CONCLUSION: Adolescent vegetarians have a dietary pattern that is more likely than nonvegetarians to meet the Healthy People 2010 objectives.

3.Robinson-O’Brien R, Perry CL, Wall MM, Story M, Neumark-Sztainer D. Adolescent and young adult vegetarianism: Better dietary intake and weight outcomes, but increased risk of disordered eating behaviors. Journal of the American Dietetic Association. 2009;109(4):648-55.

Abstract:
OBJECTIVE: Examine characteristics of current and former adolescent and young adult vegetarians and investigate the relationships between vegetarianism, weight, dietary intake, and weight-control behaviors.
DESIGN: Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT-II: Eating Among Teens).
SETTING: Participants completed a mailed survey and food frequency questionnaire in 2004.
PARTICIPANTS: Males and females (n=2,516), ages 15-23 years.
MAIN OUTCOME MEASURES: Weight status, dietary intake (fruit, vegetables, fat, calories), unhealthful weight-control behaviors.
ANALYSIS: Multiple regression models controlling for socioeconomic status and sex were used to test for significant differences between current, former, and never vegetarians within the younger and older cohort.
RESULTS: Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Current vegetarians in the younger and older cohorts had healthier dietary intakes than nonvegetarians with regard to fruits, vegetables, and fat. Among young adults, current vegetarians were less likely than never vegetarians to be overweight or obese. Adolescent and young adult current vegetarians were more likely to report binge eating with loss of control when compared to nonvegetarians. Among adolescents, former vegetarians were more likely than never vegetarians to engage in extreme unhealthful weight-control behaviors. Among young adults, former vegetarians were more likely than current and never vegetarians to engage in extreme unhealthful weight-control behaviors.
CONCLUSIONS AND IMPLICATIONS: Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults may experience the added benefit of decreased risk for overweight and obesity. However, current vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors. It would be beneficial for clinicians to inquire about current and former vegetarian status when assessing risk for disordered eating behaviors.

What do we know about fast food intake among adolescents and young adults?

1.French S, Story M, Neumark-Sztainer D, Fulkerson J, Hannan P. Fast food restaurant use among adolescents: Associations with nutrient intake, food choices, behavioral and psychosocial variables. International Journal of Obesity. 2001;25(12):1823-33.

Abstract:
OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 4746 adolescent students.
DESIGN: A survey was administered to students in classrooms at 31 secondary schools in a large metropolitan area in Minnesota, United States. Height and body weight were measured.
SUBJECTS: Students in grades 7-12 who were enrolled in participating schools, had parental consent and were in attendance on the day of data collection.
MEASUREMENTS: Frequency of fast food restaurant use (FFFRU), dietary intake, and demographic and behavioral measures were self-reported. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Height and body weight were directly measured.
RESULTS: FFFRU was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and was inversely associated with daily servings of fruit, vegetables and milk. FFFRU was positively associated with student employment, television viewing, home availability of unhealthy foods, and perceived barriers to healthy eating, and was inversely associated with students’ own and perceived maternal and peer concerns about healthy eating. FFFRU was not associated with overweight status.
CONCLUSIONS: FFFRU is associated with higher energy and fat intake among adolescents. Interventions to reduce reliance on fast food restaurants may need to address perceived importance of healthy eating as well as time and convenience barriers.

2.Boutelle K, Fulkerson JA, Neumark-Sztainer D, Story M, French SA. Fast food for family meals: Relationships with parent and adolescent food intake, home food availability and weight status. Public Health Nutrition. 2007;10(1):16-23.

Abstract:
OBJECTIVE: The purpose of the present study was to examine the prevalence of fast-food purchases for family meals and the associations with sociodemographic variables, dietary intake, home food environment, and weight status in adolescents and their parents.
DESIGN: This study is a cross-sectional evaluation of parent interviews and adolescent surveys from Project EAT (Eating Among Teens).
SUBJECTS: Subjects included 902 middle-school and high-school adolescents (53% female, 47% male) and their parents (89% female, 11% male). The adolescent population was ethnically diverse: 29% white, 24% black, 21% Asian American, 14% Hispanic and 12% other.
RESULTS: Results showed that parents who reported purchasing fast food for family meals at least 3 times per week were significantly more likely than parents who reported purchasing fewer fast-food family meals to report the availability of soda pop and chips in the home. Adolescents in homes with fewer than 3 fast-food family meals per week were significantly more likely than adolescents in homes with more fast-food family meals to report having vegetables and milk served with meals at home. Fast-food purchases for family meals were positively associated with the intake of fast foods and salty snack foods for both parents and adolescents; and weight status among parents. Fast-food purchases for family meals were negatively associated with parental vegetable intake.
CONCLUSIONS: Fast-food purchases may be helpful for busy families, but families need to be educated on the effects of fast food for family meals and how to choose healthier, convenient family meals.

3.Larson NI, Neumark-Sztainer D, Story M, Wall M, Harnack L, Eisenberg ME. Fast-food intake: Longitudinal trends during the transition to young adulthood and correlates of intake. Journal of Adolescent Health. 2008;43(1):79-86.

Abstract:
PURPOSE: Frequent fast food intake is associated with poorer diet quality and greater weight gain. The aims of this study were to describe changes in fast food intake during the transition from middle adolescence to young adulthood, and to identify baseline correlates of this eating behavior in early young adulthood.
METHODS: Data were drawn from Project EAT, a population-based, longitudinal study in Minnesota. Surveys were completed by 935 females and 751 males in high school classrooms at baseline (1998-1999; mean age = 15.9 years) and by mail at follow-up (2003-2004; mean age = 20.5 years).
RESULTS: Frequent intake of fast food (> or =3 times/week) was reported by 24% of males and 21% of females during adolescence. At follow-up, in early young adulthood the eating behavior increased among males (33%, p < .001), and there was no further increase among females (23%; p = .16). Baseline snack frequency was positively associated with frequency of fast food intake at follow-up among both genders. Baseline peer support for healthy eating among males and both concern about health and self-efficacy for healthy eating among females were inversely related to follow-up fast food intake. Among females, baseline perceptions of time and taste barriers to healthy eating, lunch frequency, television viewing, and unhealthy food availability at home were also positively associated with follow-up fast food intake.
CONCLUSIONS: Interventions are needed to address the high prevalence of frequent fast food intake among adolescents and young adults. Health professionals should help young people identify convenient and healthful food choices for meals and snacks consumed away from home.

4.Bauer K, Larson N, Nelson M, Story M, Neumark-Sztainer D. Socio-environmental, personal and behavioral predictors of fast food intake among adolescents. Public Health Nutrition. 2009;12(10):1767-74.

Abstract:
OBJECTIVE: To identify the socio-environmental, personal and behavioural factors that are longitudinally predictive of changes in adolescents’ fast-food intake.
DESIGN: Population-based longitudinal cohort study.
SETTING: Participants from Minnesota schools completed in-class assessments in 1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while in high school.
SUBJECTS: A racially, ethnically and socio-economically diverse sample of adolescents (n 800).
RESULTS: Availability of unhealthy food at home, being born in the USA and preferring the taste of unhealthy foods were predictive of higher fast-food intake after 5 years among both males and females. Among females, personal and behavioural factors, including concern about weight and use of healthy weight-control techniques, were protective against increased fast-food intake. Among males, socio-environmental factors, including maternal and friends’ concern for eating healthy food and maternal encouragement to eat healthy food, were predictive of lower fast-food intake. Sports team participation was a strong risk factor for increased fast-food intake among mates.
CONCLUSIONS: our findings suggest that addressing socio-environmental factors such as acculturation and home food availability may help reduce fast-food intake among adolescents. Additionally, gender-specific intervention strategies, including working with boys’ sports teams, family members and the peer group, and for girls, emphasizing the importance of healthy weight-maintenance strategies and the addition Of flavourful and healthy food options to their diet, may help reduce fast-food intake.

5.Bauer KW, Larson NI, Nelson MC, Story M, Neumark-Sztainer D. Fast food intake among adolescents: Secular and longitudinal trends from 1999 to 2004. Preventive Medicine. 2009;48(3):284-7.

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

6.Larson N, Neumark-Sztainer D, Laska MN, Story M. Young adults and eating away from home: Associations with dietary intake patterns and weight status differ by choice of restaurant. Journal of the American Dietetic Association. 2011;111(11):1696-703. PMCID: PMC3230226.

Abstract:
BACKGROUND: Young adults report frequent away-from-home eating; however, little is known regarding what types of restaurants are patronized or whether associations with dietary intake and weight status differ according to restaurant type.
OBJECTIVE: This cross-sectional study in a diverse sample of young adults examines sociodemographic differences in the frequency of eating at different types of fast-food and full-service (server brings food to table) restaurants. In addition, this study examines whether associations between away-from-home eating, dietary intake, and weight status differ according to restaurant type.
DESIGN: There were 1,030 men and 1,257 women (mean age=25.3 years) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). Participants were members of a longitudinal cohort who completed baseline surveys at schools in Minneapolis/St Paul, MN, and completed the EAT-III surveys online or by mail in 2008-2009.
MAIN OUTCOME MEASURES: Height, weight, and usual dietary intake were self-reported.
STATISTICAL ANALYSES PERFORMED: Regression models adjusted for sociodemographic characteristics were used to examine associations between frequency of restaurant use, dietary intake, and weight status.
RESULTS: More frequent use of fast-food restaurants that primarily served burgers and french fries was associated with higher risk for overweight/obesity; higher intake of total energy, sugar-sweetened beverages, and fat; and with lower intake of healthful foods and key nutrients. For example, those who reported burger-and-fries restaurant use on three or more occasions per week consumed nearly one additional sugar-sweetened beverage per day compared to those who reported burger-and-fries restaurant use on less than one occasion per week. More frequent use of fast-food restaurants that primarily served sandwiches/subs was related to a few markers of poorer diet quality, but unrelated to weight status. More frequent use of full-service restaurants was also unrelated to weight status and related to higher intake of vegetables.
CONCLUSIONS: There may be a need for interventions to promote healthier food choices among young adults who report frequent burger-and-fries restaurant use.

7.Forsyth A, Wall M, Larson N, Story M, Neumark-Sztainer D. Do adolescents who live or go to school near fast-food restaurants eat more frequently from fast-food restaurants? Health & Place. 2012;l18(6):1261-9. PMCID: PMC3501600.

Abstract:
This population-based study examined whether residential or school neighborhood access to fast food restaurants is related to adolescents’ eating frequency of fast food. A classroom-based survey of racially/ethnically diverse adolescents (n=2724) in 20 secondary schools in Minneapolis/St. Paul, Minnesota was used to assess eating frequency at five types of fast food restaurants. Black, Hispanic, and Native American adolescents lived near more fast food restaurants than white and Asian adolescents and also ate at fast food restaurants more often. After controlling for individual-level socio-demographics, adolescent males living near high numbers fast food restaurants ate more frequently from these venues compared to their peers.

8.Larson N, Hannan PJ, Fulkerson JA, Laska MN, Eisenberg ME, Neumark-Sztainer D. Secular trends in fast-food restaurant use among adolescents and maternal caregivers from 1999 to 2010. American Journal of Public Health. 2014;104(5):e62-9. PMCID: PMC3987596.

Abstract:
OBJECTIVES: We examined trends from 1999 to 2010 in adolescents’ self-reported fast-food restaurant use alongside maternal reports of fast-food consumption and purchasing from restaurants for family meals.
METHODS: Middle- and high-school student participants from Minneapolis-St Paul, Minnesota, represented diverse ethnic/racial and socioeconomic backgrounds. Adolescents completed classroom-administered surveys and maternal caregivers responded by phone or mail.
RESULTS: The overall prevalence of frequent fast-food consumption, defined as 3 or more times per week, decreased from 1999 to 2010 among adolescents (1999: 25%; 2010: 19%; P < .001) and maternal caregivers (1999: 17%; 2010: 11%; P < .001), but sociodemographic disparities were apparent. For example, the prevalence of frequent fast-food consumption remained highest and did not significantly decrease among Black or Native American youths. The overall prevalence of frequent fast-food purchases for family meals did not significantly decrease; large decreases were observed only among Hispanic families (1999: 18%; 2010: 6%; P < .001).
CONCLUSIONS: In light of previous findings linking frequent fast-food consumption to greater weight gain and poor nutrition, the observed decreases in consumption are encouraging and interventions are needed to address observed disparities.

What factors influence physical activity levels among adolescents and young adults? What are the risks and benefits of sports involvement?

1.McGuire M, Hannan P, Neumark-Sztainer D, Falkner-Cossrow N, Story M. Parental correlates of physical activity in a racially/ethnically-diverse adolescent sample. Journal of Adolescent Health. 2002;30(4):253-61.

Abstract:
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. (C) Society for Adolescent Medicine, 2002.

2.McGuire MT, Neumark-Sztainer DR, Story M. Correlates of time spent in physical activity and television watching in a multi-racial sample of adolescents. Pediatric Exercise Science. 2002;14:75-86.

Abstract:
This study assessed whether the correlates related to physical activity and television viewing differed across gender, grade, and racial groups. Adolescents (n = 4746) from 31 junior and senior high school completed a self-administered survey. Adolescents’ physical activity was related to their families’ and friends’ fitness concerns. Adolescents’ physical activity was also related to their own finess and health concerns. Few correlates of physical activity differed by gender, age, or race. Television viewing was negatively related to the family’s fitness concerns and health concerns; however, these factors accounted for a small amount of the variance in adolescents’ television viewing. None of the factors related to television viewing differed by age or race groups. Future studies will need to identify the factors related to physical activity and telelvision viewing among adolescents who are at greatest risk for inactivity.

3.Utter J, Neumark-Sztainer D, Jeffery R, Story M. Couch potatoes or french fries: Are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents? Journal of the American Dietetic Association. 2003;103(10):1298-305.

Abstract:
OBJECTIVE: To describe the demographic characteristics of adolescent boys and girls who engage in three sedentary behaviors (television/video use, computer use, and reading/homework), and to explore how each sedentary activity is associated with body mass index (BMI), dietary behaviors, and leisure time physical activity.
DESIGN: This study draws on data collected from Project EAT (Eating Among Teens), a school-based survey examining personal, behavioral, and socioenvironmental factors-that are associated with nutritional intake among adolescents.
SUBJECTS: The study sample consists of 4,746 middle and high school students from 31 public schools in a metropolitan area of the upper Midwest. All students were invited to participate. The overall response rate for Project EAT was 81.5%. Data collection was completed during the 1998-1999 school year.
STATISTICAL ANALYSES: Multivariate linear regression was used for examining associations between independent and dependent variables, controlling for age, race/ethnicity, and socioeconomic status. All differences were considered statistically significant at P<.05.
RESULTS: Among boys, television/video use and time spent reading/doing homework were positively associated with BMI (P-.<05), whereas for girls television/video and computer use were positively associated with BMI (P<.05). High television/ video use among boys and girls was associated with more unhealthful dietary behaviors (eg, increased consumption of soft drinks, fried foods, and snacks) (P<.05). In contrast, time spent reading/doing homework was associated with more healthful dietary behaviors (eg, increased consumption of fruits and vegetables) (P<.05). Leisure time physical activity was not associated with television/video use among boys or girls, but was positively associated with computer use and time spent reading/doing homework (P<.05).
APPLICATIONS/CONCLUSIONS: Messages and advice aimed at reducing time spent in sedentary activities should be targeted at television/video use instead of time spent reading, doing homework, or using a computer. Nutrition education should incorporate messages about the influence of the media and advertising on dietary behaviors.

4.Croll J, Neumark-Sztainer D, Story M, Wall MM, Perry C, Harnack L. Adolescents involved in weight-related and power team sports have better eating patterns and nutrient intakes than non-sport involved adolescents. Journal of the American Dietetic Association. 2006;106(5):709-17.

Abstract:
OBJECTIVE: To examine eating habits and energy and nutrient intake among adolescents participating in weight-related and power team sports and non-sport-involved adolescents.
DESIGN: Data were drawn from Project EAT (Eating Among Teens), which was conducted with 4,746 adolescents from 31 middle and high schools in the Minneapolis/St Paul metropolitan area. Setting Urban secondary schools. Subjects Adolescents reporting participation in a weight-related sport, a power team sport, or no consistent participation in a sport.
MAIN OUTCOME MEASURES: Meal and snack frequency, mean energy and nutrient intake, and mean physical activity. Statistical analyses performed Analyses were conducted by sex across the three groups. General linear models were used to compare mean energy and nutrient intake, composite nutrient adequacy, and mean physical activity across the three groups. Percentages of youth meeting nutrient recommendations were compared across the three groups using chi(2) tests.
RESULTS: For both males and females, youth involved in weight-related sports ate breakfast more frequently than non-sport-involved peers (females: 3.6 and 3.2 times per week, respectively, P < 0.01; males: 4.7 and 3.7 times per week, respectively, P < 0.01). Weight-related and power team sport-involved youth also had higher mean protein, calcium, iron, and zinc intakes than non-sport-involved peers. However, adolescent females had low calcium intake, regardless of sports involvement (weight-related sports 1,091 mg/day, power team sports 1,070 mg/day, and non-sport-involved 1,028 mg/day, P < 0.05).
CONCLUSIONS: Sport-involved adolescents have better eating habits and nutrient intake than their non-sport-involved peers. However, they are still in need of nutrition interventions, particularly around calcium intake.

5.Nelson MC, Neumark-Sztainer D, Hannan PJ, Sirard J, Story M. Longitudinal and secular trends in physical activity and sedentary behavior during adolescence. Pediatrics. 2006;118(6):e1627-34.

Abstract:
OBJECTIVE: There is little epidemiologic research on longitudinal and secular trends in weight-related health behaviors throughout the stages of adolescence. In particular, few data are available to assess secular trends in various sedentary behaviors. The objective of this research was to investigate longitudinal and secular trends in physical activity and sedentary behavior in a large, diverse cohort of adolescents.
METHODS: Project EAT-II is a 5-year longitudinal study (N = 2516) that includes 2 cohorts that allow for the observation of longitudinal changes from early to midadolescence (junior high to high school; n = 806; mean baseline age: 12.8 +/- 0.8 years) and mid- to late adolescence (high school to post-high school; n = 1710; mean baseline age: 15.8 +/- 0.8 years). EAT-II also examined secular trends in health behavior from 1999 to 2004 in midadolescence. The main outcome measures of the mixed-model regression analyses used in this research were self-reported weekly hours of moderate to vigorous physical activity, television/video viewing, and leisure-time computer use.
RESULTS: Our findings indicate substantial longitudinal changes in moderate to vigorous physical activity, particularly among girls (decreasing 5.9-4.9 hours/week from early to midadolescence and 5.1-3.5 hours/week from mid- to late adolescence), and leisure-time computer use, particularly among boys (increasing 11.4-15.2 hours/week from early to midadolescence and 10.4-14.2 hours/week from mid- to late adolescence). Secular trends further indicate dramatic increases in midadolescent computer use from 1999 to 2004; girls increased from 8.8 to 11.1 hours/week, and boys increased from 10.4 to 15.2 hours/week.
CONCLUSIONS: These adolescents experienced unfavorable shifts in activity patterns, such as longitudinal decreases in moderate to vigorous physical activity, coupled with longitudinal and secular increases in leisure-time computer use. Developing effective health promotion strategies that address a wide array of changing behavioral patterns will be important in promoting long-term health and active lifestyles among adolescents and young adults.

6.Bauer KW, Nelson MC, Boutelle KN, Neumark-Sztainer D. Parental influences on adolescents’ physical activity and sedentary behavior: longitudinal findings from Project EAT-II. International Journal of Behavioral Nutrition and Physical Activity. 2008;5:12. PMCID: PMC2265744.

Abstract:
BACKGROUND: The long-term role that parental encouragement and attitudes about fitness and exercise play in adolescents’ physical activity and sedentary behavior habits remains unclear. This paper aims to longitudinally examine how parental encouragement to be physically active and parental concern about staying fit are associated with adolescents’ physical activity and sedentary behavior habits five years later.
METHODS: Project EAT-II adolescent and young adult participants (1130 male, 1386 female) completed surveys while in middle school or high school (1998-1999), and again 5 years later. Participants were asked whether their mother and father encourage them to be physically active and care about staying fit and exercising. Adolescent moderate and vigorous physical activity (MVPA) and TV/video watching (hours/week) were assessed. Linear regression models adjusted for socio-demographic characteristics and baseline behavior were used to examine the association of Time 1 parental factors with behavioral outcomes among adolescents and young adults five years later (Time 2).
RESULTS: After adjustment for socio-demographic characteristics and baseline MVPA, adolescent-reported maternal and paternal encouragement to be active, and paternal care for fitness, were positively associated with weekly hours of MVPA after five years in young adult males (p for trend < or = .01). The positive relationship between maternal encouragement and MVPA approached significance among high-school aged females (p for trend = .06), and paternal encouragement was positively related to MVPA among high-school aged males (p for trend = .02). While maternal encouragement to be active was associated with decreased TV/video time among younger females (p for trend = .02), other parental factors were not associated with lower TV/video time among the other groups.
CONCLUSION: Parental encouragement to be active was associated with increased physical activity among males and younger females 5 years later. Younger adolescents appear to be especially influenced by their same-sex parent. These findings suggest that encouragement may be more influential than parental concern for fitness on adolescents’ physical activity habits. Further research is needed to determine how parents can help adolescents decrease sedentary behavior time.

7.Walters S, Barr-Anderson DJ, Wall M, Neumark-Sztainer D. Does participation in organized sports predict future physical activity for adolescents from diverse economic backgrounds. Journal of Adolescent Health. 2009;44(3):268-74.

Abstract:
PURPOSE: To examine cross-sectional and longitudinal associations between socioeconomic status (SES), gender, sports participation and moderate-to-vigorous physical activity (MVPA) in adolescents.
METHODS: Project EAT (Eating Among Teens), a population-based longitudinal study followed a socioeconomically and ethnically diverse sample of 1709 adolescents in 1998-1999 (Time 1) and 2003-2004 (Time 2). Mixed model regression analyses were used to examine longitudinal trends in MVPA as a function of SES and previous sports involvement.
RESULTS: For both genders, participation in organized sports and weekly hours of MVPA were positively associated with SES. On average, MVPA decreased between high school and young adulthood for both genders. Adolescents who participated in sports during high school showed a steeper decline in weekly hours of MVPA than their non-sports-participating counterparts. SES had a significant moderating effect on the change in MVPA over time for boys who participated in organized sports, with low SES boys showing a steeper decline in MVPA between time periods than higher SES boys. Although on average, a statistically significant difference in MVPA between previous sports participants and nonparticipants remained at Time 2, for all SES groups and both genders, the gap between hours of MVPA was either overcome or significantly narrowed by young adulthood.
CONCLUSIONS: Increased dependence on organized sports for MVPA may be insufficient to meet the needs of youth following high school, especially for low SES youth. Designing physical activity promotions that reach and address the unique needs of lower SES youth and families is a public health priority. (C) 2009 Society for Adolescent Medicine. All rights reserved.

8.Bauer KW, Laska MN, Fulkerson JA, Neumark-Sztainer D. Longitudinal and secular trends in parental encouragement for healthy eating, physical activity, and dieting throughout the adolescent years. Journal of Adolescent Health. 2011;49(3):306-11. PMCID: PMC3401949.

Abstract:
PURPOSE: Parental encouragement for healthy eating and physical activity has been found to be associated with the long-term healthy habits of adolescents, whereas parental encouragement to diet has been associated with disordered eating behaviors among adolescents. However, little is known about how parental encouragement changes as adolescents grow older (longitudinal trends), or how parental encouragement has changed over time (secular trends). This study examined 5-year longitudinal and secular trends in adolescents’ report of their parents’ encouragement to eat healthily, be physically active, and diet.
METHODS: Project Eating Among Teens surveyed a cohort of Minnesota adolescents (n = 2,516) in the years 1999 and 2004. Mixed-model regressions were used to assess changes in adolescents’ reports of parental encouragement from early to middle adolescence (middle school to high school) and from middle to late adolescence (high school to post-high school), and secular changes in parental encouragement among middle adolescents between the years 1999 and 2004.
RESULTS: Longitudinally, there were significant decreases in parental encouragement to eat healthy food, be active, and diet between early and middle adolescence. Between middle and late adolescence, among males parental encouragement for all behaviors decreased, whereas among females parental encouragement to diet increased. Few secular changes in parental encouragement were observed between 1999 and 2004.
CONCLUSION: Given the importance of parental support for healthy eating and physical activity, efforts should be made to help parents maintain a high level of encouragement for their children’s healthy behavior throughout adolescence. Parents of late adolescent females should aim to decrease the pressure on their daughters to diet during these critical developmental years.

9.Berge JM, Larson N, Bauer KW, Neumark-Sztainer D. Are parents of young children practicing healthy nutrition and physical activity behaviors? Pediatrics. 2011;127(5):881-7. PMCID: PMC3081185.

Abstract:
BACKGROUND: Although parenthood is a common life event in early adulthood, little is known about whether parenthood is associated with weight and weight-related health behaviors, including dietary intake and physical activity.
OBJECTIVE: In this article we examine whether parents of young children (aged </=5 years) report different dietary intake, physical activity, and BMIs compared with young adults without children.
METHODS: Data for this analysis were drawn from the second and third waves of Project EAT (Eating and Activity in Teens and Young Adults), a longitudinal population-based cohort study. Young adults (838 women, 682 men) from diverse ethnic and socioeconomic backgrounds were included. Gender-stratified linear regression models were used to examine associations between parental status and dietary intake, hours of physical activity, and BMI. Results were adjusted for each health behavior outcome level 5 years earlier (time 2).
RESULTS: Results indicate that although many dietary behaviors were the same between parents and nonparents, mothers reported greater consumption of sugar-sweetened beverages, total energy, and percent saturated fat compared with women without children. Both mothers and fathers had lower amounts of physical activity compared with nonparents. Mothers had higher mean BMIs than women without children. No difference was observed in BMIs between fathers and men without children.
CONCLUSIONS: Our findings suggest that pediatricians and health care providers may want to consider discussing dietary intake and physical activity with new parents to identify ways to engage in healthful behaviors given the daily demands of parenthood, both to improve parents’ own health and to help them model healthful behavior for their children.

10.Graham DJ, Sirard JR, Neumark-Sztainer D. Adolescents’ attitudes toward sports, exercise, and fitness predict physical activity 5 and 10 years later. Preventive Medicine. 2011;52(2):130-2. PMCID: PMC3062438.

Abstract:
OBJECTIVE: To determine whether adolescent attitudes towards sports, exercise, and fitness predict moderate-to-vigorous physical activity 5 and 10 years later.
METHOD: A diverse group of 1902 adolescents participating in Project Eating and Activity in Teens, reported weekly moderate-to-vigorous physical activity and attitudes toward sports, exercise, and fitness in Eating and Activity in Teens-I (1998-99), Eating and Activity in Teens-II (2003-04), and Eating and Activity in Teens-III (2008-09).
RESULTS: Mean moderate-to-vigorous physical activity was 6.4, 5.1, and 4.0 hours/week at baseline, 5-year, and 10-year follow-up, respectively. Attitudes toward sports, exercise, and fitness together predicted moderate-to-vigorous physical activity at 5 and 10 years. Among the predictors of 5- and 10-year moderate-to-vigorous physical activity, attitude’s effect size, though modest, was comparable to the effect sizes for sports participation and body mass index. Adolescents with more-favorable attitudes toward sports, exercise, and fitness engaged in approximately 30%-40% more weekly moderate-to-vigorous physical activity at follow-up (2.1 hour/week at 5 years and 1.2 hour/week at 10 years) than those with less-favorable attitudes.
CONCLUSION: Adolescents’ exercise-related attitudes predict subsequent moderate-to-vigorous physical activity independent of baseline behavior suggesting that youth moderate-to-vigorous physical activity promotion efforts may provide long-term benefits by helping youth develop favorable exercise attitudes.

11.Eisenberg ME, Wall M, Neumark-Sztainer D. Muscle-enhancing behaviors among adolescent girls and boys. Pediatrics. 2012;130(6):1019-26. PMCID: PMC3507247.

Abstract:
OBJECTIVE: Media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to youth. Identifying populations at risk for unhealthy muscle-enhancingbehaviors is of considerable public health importance. The current study uses a large and diverse population-based sample of adolescents to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement.
METHODS: Survey data from 2793 diverse adolescents (mean age = 14.4) were collected at 20 urban middle and high schools. Use of 5 muscle-enhancing behaviors was assessed (changing eating, exercising, protein powders, steroids and other muscle-enhancing substances), and a summary score reflecting use of 3 or more behaviors was created. Logistic regression was used to test for differences in each behavior across age group, race/ethnicity, socioeconomic status, BMI category, and sports team participation.
RESULTS: Muscle-enhancing behaviors were common in this sample for both boys and girls. For example, 34.7% used protein powders or shakes and 5.9% reported steroid use. Most behaviors were significantly more common among boys. In models mutually adjusted for all covariates, grade level, Asian race, BMI category, and sports team participation were significantly associated with the use of muscle-enhancing behaviors. For example, overweight (odds ratio = 1.45) and obese (odds ratio = 1.90) girls had significantly greater odds of using protein powders or shakes than girls of average BMI.
CONCLUSIONS: The use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. Pediatricians and other health care providers should ask their adolescent patients about muscle-enhancing behaviors.

12.Sirard J, Bruening M, Wall MM, Eisenberg M, Kim S, Neumark-Sztainer D. Physical activity and screen time in adolescents and their friends. American Journal of Preventive Medicine. 2013;44(1):48-55. PMCID: PMC3684163.

Abstract:
BACKGROUND: Little is known about the actual physical activity and screen time behaviors of an adolescent’s friends relative to the individual’s behavior.
PURPOSE: To determine the associations between an adolescent’s physical activity and screen time and his/her nominated friends’ physical activity and screen time.
METHODS: Data were obtained from EAT 2010 (Eating and Activity Among Teens), a large cross-sectional study (n = 2126) conducted in 20 middle schools and high schools in Minneapolis/St. Paul MN during the 2009-2010 academic year and analyzed during 2011. Each participant nominated up to six friends from a school roster, and data from those friends were obtained as part of the school-based data collection procedures. Physical activity and screen time were assessed with previously used and validated questionnaires. Generalized estimating equation models, stratified by gender, were used to assess associations between adolescents’ physical activity and screen time and their friends’ physical activity and screen time.
RESULTS: Physical activity for female adolescents was associated with their male and female friends’ physical activity, including their male and female best friends (all p < 0.05). Male adolescents’ physical activity was associated with their female friends’ physical activity (p < 0.03). Female adolescents’ screen time was associated with their male and female friends’ screen time (p <= 0.03), but not with that of their best friends. Male adolescents’ screen time was associated with only their female friends’ screen time (p = 0.04).
CONCLUSIONS: The consistent association between female adolescents’ physical activity and their friends’ physical activity indicates a need to include peer effects on adolescent female physical activity in future intervention work.

13.Berge JM, Bauer KW, Maclehose R, Eisenberg ME, Neumark-Sztainer D. Associations between relationship status and day-to-day health behaviors and weight among diverse young adults. Families, Systems & Health. 2014;32(1):67-77. PMCID: PMC4074022.

Abstract:
Previous research has shown strong positive associations between physical and psychological health outcomes and being in a committed relationship, such as marriage; however, little research has investigated whether being in a committed relationship is protective for day-to-day health behaviors such as dietary patterns and physical activity. This research examined associations between relationship status and day-to-day health behaviors (e.g., dietary intake, physical activity) and weight status among a diverse cohort of young adults. This cross-sectional study used data from Project EAT-III, a 10-year longitudinal population-based study (N = 1,853) of Midwest young adults. Young adult participants had an average age of 25.3 years, and were 45% male and 55% female. Participants were socioeconomically and racially/ethnically diverse, including 48.4% White, 18.6% African American, 5.9% Hispanic, 19.6% Asian, 3.3% Native American, and 4.2% mixed or other race/ethnicity. Results indicated that married men were more likely to be overweight/obese (body mass index >/= 25) compared with single/casually dating and committed dating/engaged men. Married women were more likely to eat breakfast >/=5 times per week compared with women in other relationship categories. No differences were observed in other health behaviors by relationship status. There were no significant interactions by race/ethnicity. Relationship status seems largely unrelated to young adults’ participation in physical activity and dietary behaviors. However, findings suggest that being married may be a risk factor for overweight/obesity in young adult men and may be a protective factor for health-related behaviors associated with overweight/obesity such as breakfast intake for young adult women.

14.Graham DJ, Wall MM, Larson N, Neumark-Sztainer D. Multicontextual correlates of adolescent leisure-time physical activity. American Journal of Preventive Medicine. 2014;46(6):605-16. PMCID: PMC4030467.

Abstract:
BACKGROUND: Adolescent moderate to vigorous physical activity (MVPA) is influenced by many factors. MVPA-promotion interventions would fare better if these multiple determinants were better understood.
PURPOSE: To simultaneously assess overall and relative contributions of factors from personal, family, friend, school, and neighborhood contexts to adolescent MVPA. It was hypothesized that (1) key correlates would emerge in each context and (2) factors from more- versus less-proximal contexts would relate more strongly to MVPA.
METHODS: Students in grades 6-12 (n=2,793; mean age=14.4 [SD=2.0] years; 53% girls) were recruited from 20 Minnesota public schools in 2009-2010 to participate in the Eating and Activity in Teens 2010 study. Regression analyses conducted in 2013 examined factors related to weekly MVPA. Data were collected from adolescent participants, their parents and friends, school teachers and administrators, and GIS sources.
RESULTS: Fifty multicontextual factors explained 25% of MVPA variance for boys and 27% for girls. Personal factors (e.g., self-efficacy) were most predictive of MVPA, followed by social factors (e.g., support for PA); environmental factors (e.g., access to PA resources) were least predictive of adolescent PA. Gender differences emerged for several predictors (e.g., in mutually adjusted analyses, MVPA among girls, but not boys, related positively to distance to trails and MVPA among female friends and fathers, and related negatively to perceived barriers).
CONCLUSIONS: Stronger linkages exist between adolescent MVPA and more-proximal (personal, family, and friend) factors compared to more-distal (school and neighborhood) factors, suggesting the importance of working with adolescents, their families, and friends to promote PA.

15.Taverno Ross SE, Larson N, Graham DJ, Neumark-Sztainer D. Longitudinal changes in physical activity and sedentary behavior from adolescence to adulthood: comparing U.S.-born and foreign-born populations. Journal of Physical Activity and Health. 2014;11(3):519-27. PMCID: PMC3661744.

Abstract:
BACKGROUND: This study compared moderate-to-vigorous physical activity (MVPA) and sedentary behavior in U.S.-born and foreign-born adolescents and young adults, and differences in behavior change from adolescence to young adulthood by nativity.
METHODS: Data on 2039 U.S.-born and 225 foreign-born participants from Project EAT-III (Eating and Activity in Teens and Young Adults) were used to examine MVPA, television/ DVD/video viewing, and computer use. Participants completed surveys at baseline in Minneapolis/St. Paul, MN secondary school classrooms in 1998-1999 (14.9 +/- 1.6 y) and follow-up measures online or by mail in 2008-2009 (25.3 +/- 1.6 y).
RESULTS: At both time points, foreign-born participants reported significantly lower levels of MVPA than their U.S.-born counterparts (P < .05). Foreign-born females at baseline and follow-up and foreign-born males at follow-up reported less television/DVD/video viewing compared with U.S.-born participants (P < .01). All participants experienced a significant decline in MVPA from baseline to follow-up (P < .001). Between-group analyses revealed a significantly greater decline in television/DVDs/video viewing for the foreign-born males compared with U.S.-born males from baseline to follow-up (mean change: foreign-born: -4.8 +/- 1.32 hrs/wk, U.S.-born: -0.6 +/- 0.6 hrs/wk; P < .01).
CONCLUSIONS: Differences in activity patterns between foreign-born and U.S.-born youth into young adulthood may contribute to disparities in chronic disease risk. Nativity, along with the social, environmental, and cultural context, should be considered when designing programs to promote MVPA and prevent obesity.

What do we know about steroid use?

1.Irving L, Wall M, Story M, Neumark-Sztainer D. Steroid use among adolescents: Findings from Project EAT. Journal of Adolescent Health. 2002;30:243-52.

Abstract:
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

2.van den Berg P, Neumark-Sztainer D, Cafri G, Wall M. Steroid use among adolescents: Longitudinal findings from Project EAT. Pediatrics. 2007;119:476-86.

Abstract:
OBJECTIVE: We examined the prevalence, persistence, secular and longitudinal trends, and predictors of steroid use in a diverse sample of adolescents.
PARTICIPANTS AND METHODS: Data are from Project EAT-II (Eating Among Teens), a 5-year longitudinal study of eating, activity, weight, and related variables in 2516 middle and high school students. Data were collected in 1999 (time 1) and 2004 (time 2).
RESULTS: Approximately 1.5% of adolescents reported steroid use at time 2. Use differed by ethnicity but not socioeconomic status. Steroid use was not stable across time, although the risk of use at time 2 was higher for girls and (marginally) for boys who used steroids at time 1. No secular trends were noted in middle adolescents’ steroid use between 1999 and 2004. Developmentally, steroid use decreased as adolescents grew older. Predictors of use for male adolescents included wanting to weigh more and reporting higher use of healthy weight-control behaviors. Female time 2 steroid users had higher BMIs and were less satisfied with their weight, had poorer nutrition knowledge and concern for health, and were marginally more likely to have participated in weight-related sports at time 1.
CONCLUSIONS: The prevalence of steroid use in adolescents was low but of concern. Although use was not persistent over 5 years, time 1 use was a risk factor for time 2 use in female adolescents. There was no change in the prevalence of steroid use by middle adolescents between 1999 and 2004 despite a great deal of public interest in steroids during this time period. Steroid use decreased as adolescents grew older. Weight-related variables predicted adolescents’ steroid use 5 years later, and health and nutrition knowledge and concern and (marginally) participation in weight-related sports further predicted use in female adolescents. These findings suggest that early preventive efforts may be most useful.

3.Vertalino M, Eisenberg ME, Story M, Neumark-Sztainer D. Participation in weight-related sports is associated with higher use of unhealthy weight control behaviors and steroid use. Journal of the American Dietetic Association. 2007;107:434-40.

Abstract:
OBJECTIVE: To determine whether adolescents who participate in a weight-related sport are at increased risk for unhealthful weight-control behaviors and steroid use.
DESIGN: This was a population-based study (Project EAT [Eating Among Teens]).
SUBJECTS/SETTING: Subjects were 4,746 adolescents (50.2% males, 49.8% females) from 31 public middle and high schools in the Minneapolis/St Paul area of Minnesota.
STATISTICAL ANALYSIS PERFORMED: Descriptive statistics, chi2 analyses, and multiple logistic regression were used. Data were adjusted for sociodemographic variables and body mass index.
MAIN OUTCOME VARIABLES: Unhealthful weight-control behaviors and steroid use.
RESULTS: More males (20.4%) than females (16.2%) reported participation in a weight-related sport. Males who reported participation in a weight-related sport had an increased risk of past-week vomiting (odds ratio [OR]=5.7), laxative use (OR=6.8), as well as past-year vomiting (OR=4.9), laxative use (OR=3.4), diuretic use (OR=6.0), and steroid use (OR=3.7), compared with those males who did not report participation. Females who reported participation in a weight-related sport had an increased risk of past week vomiting (OR=2.1), as well as past year vomiting (OR=2.0), laxative use (OR=2.6), and steroid use (OR=2.6), compared with those who did not report participation in a weight-related sport.
CONCLUSIONS: The current study shows that participation in a sport that adolescents perceive as emphasizing weight is strongly associated with unhealthful weight-control behaviors and steroid use. Preventive efforts, targeting parents, coaches, and adolescents are needed to decrease this risk.

How does teasing impact health?


1.Neumark-Sztainer D, Falkner N, Story M, Perry C, Hannan PJ, Mulert S. Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors. International Journal of Obesity and Related Metabolic Disorders. 2002;26(1):123-31.

Abstract:
OBJECTIVES: This study aimed to assess the prevalence of perceived weight-teasing and associations with unhealthy weight-control behaviors and binge eating in a population-based sample of youth. Particular focus was placed on overweight youth, who may be most vulnerable to weight-teasing.
METHODS: The study population included 4746 adolescents from St Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of Project EAT, a population-based study of eating patterns and weight concerns among teens.
RESULTS: There were statistically significant associations between perceived weight-teasing and weight status; both overweight and underweight youth reported higher levels of teasing than average weight youth. Very overweight youth (body mass index (BMI) greater than or equal to 95th percentile) were most likely to be teased about their weight; 63% of very overweight girls, and 58% of very overweight boys reported being teased by their peers, while weight-teasing by family members was reported by 47% of these girls and 34% of these boys. Youth who were teased about their weight, particularly overweight girls, reported that it bothered them. Perceived weight-teasing was significantly associated with disordered eating behaviors among overweight and non-overweight girls and boys. For example, among overweight youth, 29% of girls and 18% of boys who experienced frequent weight-teasing reported binge-eating as compared to 16% of girls and 7% of boys who were not teased.
CONCLUSIONS: Many adolescents, in particular those who are overweight, report being teased about their weight and being bothered by the teasing. Weight-teasing is associated with disordered eating behaviors that may place overweight youth at increased risk for weight gain. Educational interventions and policies are needed to curtail weight-related mistreatment among youth.

2.Eisenberg ME, Neumark-Sztainer D, Perry CL. Peer harassment, school connectedness, and academic achievement. Journal of School Health. 2003;73(8):311-6.

Abstract:
This study described peer harassment in a large, multiethnic sample of adolescents, and explored the relationship between experiencing peer harassment and both school connectedness and achievement. Survey data came from 4,746 students in grades 7-12 at 31 public schools in ethnically and socioeconomically diverse communities in a Midwestern state. Frequency of five types of harassment were analyzed with data on school connectedness and grades. Multivariate analysis controlled for gender, grade level, race/ethnicity, and socioeconomic status. Results indicate that most students periodically experience mistreatment; 10% to 17% report being treated disrespectfully, having others act superior, or being insulted at least once per week, and an additional 14% to 22% of students report suffering these behaviors a few times per month. Girls, Whites, Native Americans, and middle school students reported more harassment than boys, other ethnic groups, and high school students, respectively. Peer harassment related significantly to both aspects of school life; those who disliked school tended to suffer more mistreatment, and “B” students reported the least harassment on average. Young people mistreated by peers may not want to be in school and may thereby miss out on the benefits of school connectedness as well as educational advancement. The high prevalence of peer harassment and its association with school connectedness and school achievement provide justification for interventions aimed at prevention of peer harassment. A schoolwide approach using educational and policy components may provide an appropriate prevention strategy.

3.Eisenberg ME, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional well-being among adolescents. Archives of Pediatrics and Adolescent Medicine. 2003;157(8):733-8.

Abstract:
BACKGROUND: Verbal harassment, such as bullying and hate speech, has received considerable attention recently, but less is known about weight-based teasing and its potential harmful effects on young people’s psychosocial well-being.
OBJECTIVE: To determine the associations of weight-based teasing and body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts using a large sample of adolescents.
DESIGN: Secondary analysis of survey and anthropometric data.
SETTING: Ethnically and socioeconomically diverse communities in the urban and suburban school districts of the Minneapolis/St Paul metropolitan area.
PARTICIPANTS: A school-based sample of 4746 adolescents in grades 7 to 12 at 31 public middle schools and high schools.
MAIN OUTCOMES MEASURES: Weight-based teasing from peers or family members, body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts.
RESULTS: Of the eligible students, 81.5% participated; 30.0% of adolescent girls and 24.7% of adolescent boys were teased by peers, and 28.7% of adolescent girls and 16.1% of adolescent boys were teased by family members. Approximately 14.6% of adolescent girls and 9.6% of adolescent boys reported teasing from both of these sources. Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms, and thinking about and attempting suicide, even after controlling for actual body weight. These associations held for adolescent boys and girls, across racial, ethnic, and weight groups. Furthermore, teasing from 2 sources was associated with a higher prevalence of emotional health problems than either teasing from a single source or no teasing.
CONCLUSIONS: Physicians and other health care providers should recognize the importance of weight-based teasing for young patients. Policy, programs, and education should focus on increasing awareness of what constitutes weight-based teasing, its potentially harmful effects on adolescents’ emotional well-being, and reduction of this behavior.

4.Eisenberg ME, Neumark-Sztainer D, Haines J, Wall M. Weight-teasing and emotional well-being in adolescents: longitudinal findings from Project EAT. Journal of Adolescent Health. 2006;38(6):675-83.

Abstract:
PURPOSE: To determine if weight-teasing predicts subsequent low self-esteem, poor body image, and depressive symptoms; and to examine two mechanisms through which early teasing may influence later emotional health.
METHODS: A racially and socio-economically diverse sample of 2516 adolescents completed surveys for both Wave 1 (1998-99) and Wave 2 (2003-04) of the Project EAT study. Approximately one third of these were early adolescents who transitioned into middle adolescence, and two thirds were middle adolescents who transitioned into young adulthood. Multiple linear regression analysis was conducted in three stages to test Model A: the total effect of Time 1 teasing on Time 2 emotional health; Model B: Model A, mediated by Time 2 teasing and body mass index (BMI); and Model C: Model B, also mediated by Time 1 emotional health.
RESULTS: Approximately one third of males and slightly under half of females reported that they had been teased about their weight at Time 1. Time 1 teasing predicted lower self-esteem, lower body image, and higher depressive symptoms at Time 2 for males and females in the older and younger age groups. This relationship was fully mediated, however, by Time 2 teasing and BMI, and by Time 1 emotional health. Adjusted R2 statistics for the final models ranged from .11 to .36.
CONCLUSIONS: Weight-teasing in adolescence affects emotional well-being at 5-year follow-up, and appears to function through two mechanisms. Reducing early teasing and its concurrent damages to emotional health may prevent longer-term emotional health consequences.

5.Haines J, Neumark-Sztainer D, Eisenberg ME, Hannan PJ. Weight teasing and disordered eating behaviors in adolescents: longitudinal findings from Project EAT (Eating Among Teens). Pediatrics. 2006;117(2):e209-15.

Abstract:
OBJECTIVE: To assess whether weight-related teasing predicts the development of binge eating, unhealthy weight control behaviors, and frequent dieting among male and female adolescents.
METHODS: A prospective study was conducted with an ethnically and socioeconomically diverse sample of 2516 adolescents who completed surveys at both time 1 (1998-1999) and time 2 (2003-2004) of the Project EAT (Eating Among Teens) study.
RESULTS: In 1998-1999, approximately one fourth of participants reported being teased about their weight at least a few times a year. After adjustment for age, race/ethnicity, socioeconomic status (SES), and BMI, boys who were teased about their weight were more likely than their peers to initiate binge eating with loss of control and unhealthy weight control behaviors 5 years later. The predicted prevalence for incident binge eating behaviors with loss of control among boys who were teased was 4.1% as compared with 1.4% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. For unhealthy weight control behaviors at time 2, the predicted prevalence was 27.5% among boys who were teased and 19.3% for boys who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. Girls who were teased were more likely than their peers to become frequent dieters. The predicted prevalence for incident frequent dieting among girls who were teased was 18.2% as compared with 11.0% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI.
CONCLUSIONS: Weight teasing in adolescence predicts disordered eating behaviors at 5-year follow-up. The patterns of these associations differ by gender. Reducing teasing through educational interventions and policies may reduce the level of disordered eating behaviors among youths.

6.Haines J, Neumark-Sztainer D, Hannan PJ, Eisenberg ME. Longitudinal and secular trends in weight-related teasing during adolescence. Obesity (Silver Spring). 2008;16:S18-S23.

Abstract:
OBJECTIVE: To examine 5-year longitudinal and secular trends in weight-related teasing among adolescents.
METHODS AND PROCEDURES: Project EAT-II (Eating Among Teens-II) followed 2,516 adolescents (females = 1,386, 55.1%) prospectively from 1999 to 2004. EAT-II included two cohorts allowing the observation of longitudinal changes in reported weight-related teasing as participants transitioned from early to mid-adolescence (middle school to high school) and from mid- to late-adolescence (high school to post-high school). EAT-II also allowed the examination of secular trends in reported teasing among middle adolescents in 1999 and 2004.
RESULTS: In 1999, approximately one-quarter of adolescents in the total sample (including both overweight and nonoverweight youth) reported being teased about their weight in early adolescence and mid-adolescence. Prevalence rates of teasing were higher among overweight youth (early adolescence: females 42.4%, males 44.6%; mid-adolescence: females 31.2%, males 40.8%). Longitudinal trends suggest that weight-related teasing decreased among overweight males and females in the younger cohort as they transitioned from early adolescence to mid-adolescence. In the older cohort of youth, teasing decreased in the total sample of females as they transitioned from mid-adolescence to older adolescence. Analyses of age-matched secular trends among middle adolescents showed that the prevalence of weight-related teasing remained stable among most adolescent subgroups and declined among overweight males between 1999 and 2004.
DISCUSSION: Weight-related teasing is prevalent through the various stages of adolescence. Our findings point to a need for ongoing interventions, throughout adolescence, which focus on reducing weight-related teasing and improving social supports for affected youth.

7.van den Berg P, Neumark-Sztainer D, Eisenberg ME, Haines J. Racial/ethnic differences in weight-related teasing in adolescents. Obesity (Silver Spring). 2008;16 Suppl 2:S3-10.

Abstract:
OBJECTIVE: The current study examined general, peer, and family weight teasing across race/ethnicity and weight status (average weight, overweight, obese) in adolescents. For those participants who reported peer or family weight teasing, the extent to which this teasing bothered them was also reported.
METHODS AND PROCEDURES: Data were from the first wave of Project EAT (Eating Among Teens), a longitudinal study of eating and weight-related variables in 4,746 adolescent boys and girls. Participants completed a survey and their height and weight were measured.
RESULTS: Prevalences of general weight teasing were similar across race/ethnicity. Asian-American boys, black boys, and Asian-American girls reported lower prevalences of peer teasing than whites. Hispanic, Asian-American, and mixed/other girls reported higher prevalences of family weight teasing than did white girls. In nearly all racial/ethnic groups for all three teasing variables, obese adolescents were significantly more likely to report having been teased, compared to average-weight adolescents. In some racial/ethnic groups overweight adolescents were also significantly more likely than average-weight adolescents to report having been teased. Among girls who were teased, fewer black and mixed/other girls were bothered by peer teasing, compared to white girls. Similarly, fewer girls from most racial/ethnic groups were bothered by family weight teasing, compared to white girls.
DISCUSSION: The results of the current study suggest that weight-based teasing is a problem for all youth, and especially so for overweight and obese youth, regardless of racial/ethnic group. Asian-American adolescents may experience somewhat less weight teasing from peers, and possibly more weight teasing from family members. One-quarter to one-half of those teased by family or peers were bothered by it, and more white girls were bothered than other groups. Efforts to eradicate weight stigmatization could provide benefits to a sizable number of adolescents across a variety of racial and ethnic groups.

8.Eisenberg ME, Berge JM, Fulkerson JA, Neumark-Sztainer D. Weight comments by family and significant others in young adulthood. Body Image. 2011;8(1):12-9. PMCID: PMC3101896.

Abstract:
Weight teasing is common among adolescents, but less is known about the continuation of this experience during young adulthood. The present study uses survey data from a diverse sample of 2287 young adults, who participated in a 10-year longitudinal study of weight-related issues to examine hurtful weight comments by family members or a significant other. Among young adults, 35.9% of females and 22.8% of males reported receiving hurtful weight-related comments by family members, and 21.2% of females and 23.8% of males with a significant other had received hurtful weight-related comments from this source. Hispanic and Asian young adults and overweight/obese young adults were more likely to report receiving comments than those in other groups. Weight teasing during adolescence predicted hurtful weight-related comments in young adulthood, with some differences by gender. Findings suggest that hurtful weight talk continues into young adulthood and is predicted by earlier weight teasing experiences.

9.Eisenberg ME, Berge JM, Fulkerson JA, Neumark-Sztainer D. Associations between hurtful weight-related comments by family and significant other and the development of disordered eating behaviors in young adults. Journal of Behavioral Medicine. 2012;35(5):500-8. PMCID: PMC3337892.

Abstract:
Research has found that weight-teasing is associated with disordered eating in adolescents. This study expands on the existing research by examining associations between hurtful weight comments by family and a significant other and disordered eating in young adults. Data come from 1,902 young adults (mean age 25) who completed surveys in 1998, 2003 and 2009. Correlations were examined between receiving hurtful comments from family and significant others, and four disordered eating behaviors in young adulthood, adjusting for prior disordered eating and prior teasing. Disordered eating behaviors were common in young adulthood, and were associated with hearing hurtful weight-related comments from family members and a significant other, for both females and males. Disordered eating prevention activities, which include messages about the potential harm associated with hurtful weight-related comments, should be expanded to address young adults, and programs may want to target relationship partners.

10.Bucchianeri MM, Eisenberg M, Neumark-Sztainer D. Weightism, racism, classism, and sexism: Shared forms of harassment in adolescents. Journal of Adolescent Health. 2013;53(1):47-53. PMCID: PMC3691304.

Abstract:
PURPOSE: To document the prevalence of harassment on the basis of weight, race/ethnicity, and socioeconomic status, as well as sexual harassment, among a diverse population of adolescents. Specifically, this study examined rates of each type of harassment reported across groups within the corresponding sociodemographic category (e.g., racial/ethnic category differences in prevalence of racial harassment), and also explored patterns of “cross-harassment” (i.e., differences in prevalence of each harassment type across all other sociodemographic characteristics).
METHODS: We used data from Project Eating and Activity in Teens 2010 for the study. The sample was composed of 2,793 adolescents (53% female; 81% nonwhite). We conducted regression analyses to yield prevalence estimates of each type of harassment in each demographic and body mass index category.
RESULTS: Weight- and race-based harassment (35.3% and 35.2%, respectively) was most prevalent, followed by sexual harassment (25.0%) and socioeconomic status-based harassment (16.1%). Overweight and obese adolescents reported disproportionately higher rates of all forms of harassment than did normal-weight and underweight adolescents. In addition, Asian and mixed-/other race adolescents were more vulnerable to harassment overall compared with those from other racial/ethnic groups.
CONCLUSIONS: Harassment experiences are prevalent among adolescent boys and girls. Differential rates of each type of harassment are reported across groups within the corresponding sociodemographic category, but a pattern of cross-harassment also is evident, such that differences in prevalence of each type of harassment emerge across a variety of sociodemographic characteristics. Adolescents from various intersecting sociodemographic and weight-status groups are particularly vulnerable to certain types of harassment.

11.Haines J, Hannan PJ, van den Berg P, Eisenberg ME, Neumark-Sztainer D. Weight-related teasing from adolescence to young adulthood: longitudinal and secular trends between 1999 and 2010. Obesity (Silver Spring). 2013;21(9):E428-34. PMCID: PMC3714368.

Abstract:
OBJECTIVE: To examine longitudinal trends from 1999-2010 in weight-related teasing as adolescents transition to young adulthood and to examine secular trends in teasing among early and middle adolescents over the same time period.
DESIGN AND METHODS: To examine longitudinal changes we used data from 2,287 participants in Project EAT-III, an ongoing cohort that followed two age cohorts of adolescents from 1999 to 2010. Over the study period the younger cohort transitioned from early adolescence to early young adulthood and the older cohort transitioned from middle adolescence to middle young adulthood. To examine how levels of teasing among early and middle adolescents changed from 1999-2010 (secular trends), we compared baseline data from EAT-I to cross-sectional data from a new cohort of early and middle adolescents that was established in 2010.
RESULTS: In 1999, 29% of early adolescent and 23% of middle adolescent females reported being teased. Approximately 18% of males in both age groups reported being teased in 1999. Longitudinal trends suggest that weight-related teasing remained stable among all subgroups as they transitioned to young adulthood, except among early adolescent males where teasing increased to 27% in early young adulthood. Analyses of age-matched secular trends show that teasing decreased by 10.4% among early adolescent females and by 7.6% among middle adolescent males from 1999-2010.
CONCLUSION: Results suggest that interventions that focus on reducing weight-based discrimination are needed throughout adolescence and young adulthood. The secular decrease in weight-related teasing is promising, but the high prevalence of teasing remains a public health concern.

12.Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. Journal of Adolescent Health. 2014;54(6):724-9. PMCID: PMC4107652.

Abstract:
PURPOSE: To explore relationships between harassment (i.e., race-, weight-, socioeconomic-status (SES)-based, and sexual) and health-related outcomes, including self-esteem, depressive symptoms, body satisfaction, substance use, and self-harm behavior, among diverse adolescents.
METHOD: Cross-sectional analysis using data from a population-based study of adolescents participating in Eating and Activity in Teens 2010 (EAT 2010) (n = 2,793; mean age = 14.4 years). Sample was socioeconomically and racially/ethnically diverse (81% racial/ethnic minority; 54% low or low-middle income).
RESULTS: Having experienced any type of harassment was significantly associated with poor self-esteem, depressive symptoms, low body satisfaction, substance use, and self-harm behaviors. After mutually adjusting for other types of harassment, weight-based harassment was consistently associated with lower self-esteem and lower body satisfaction in both genders (standardized betas ranged in magnitude from .39 to .48); sexual harassment was significantly associated with self-harm and substance use in both genders (ORs: 1.64 to 2.92); and both weight-based and sexual harassment were significantly associated with depressive symptoms among girls (standardized betas = .34 and .37). Increases in the number of different harassment types reported by adolescents were associated with elevated risk for alcohol, cigarette, and marijuana use, and self-harm (ORs: 1.22 to 1.42) as well as emotional well-being (standardized betas: .13 to .26).
CONCLUSIONS: Having had any harassment experience was significantly associated with a variety of negative health and well-being outcomes among adolescents, and risk for these outcomes increases with the number of harassment types an adolescent experiences. Early detection and intervention to decrease harassment experiences may be particularly important in mitigating psychological and behavioral harm among adolescents.

13.Lampard AM, MacLehose RF, Eisenberg ME, Neumark-Sztainer D, Davison KK. Weight-related teasing in the school environment: associations with psychosocial health and weight control practices among adolescent boys and girls. Journal of Youth and Adolescence. 2014;43(10):1770-80. PMCID: PMC4085153.

Abstract:
Weight-related teasing has been found to be associated with low self-esteem, depressive symptoms, body dissatisfaction, and weight control behaviors in adolescents. While research has typically examined weight-related teasing directed towards the individual, little is known about weight-related teasing at the school level. This study aimed to determine the association between the school-level prevalence of weight-related teasing and psychosocial factors, body dissatisfaction and weight control behaviors in adolescents. Adolescents (N = 2,793; 53.2% female) attending 20 US public middle and high schools were surveyed as part of the Eating and Activity in Teens (EAT) 2010 study. Generalized estimating equations were used to estimate the association between school-level weight-related teasing and health variables, controlling for individual-level weight-related teasing, clustering of individuals within schools, and relevant covariates. A greater school-level prevalence of weight-related teasing was associated with lower self-esteem and greater body fat dissatisfaction in girls, and greater depressive symptoms in boys, over and above individual-level weight-related teasing. Dieting was associated with the school-level prevalence of weight-related teasing in analysis adjusted for covariates in girls, but not following adjustment for individual-level weight-related teasing. Unhealthy weight control behaviors, extreme weight control behaviors, and muscle-enhancing behaviors were not associated with the school-level prevalence of weight-related teasing in girls or boys. Findings from the current study, in conjunction with previous findings showing associations between weight-related teasing, psychological concerns, and weight control behaviors, highlight the importance of implementing strategies to decrease weight-related teasing in schools.

Which adolescents and young adults are at greatest risk for unhealthy weight control behaviors? How can these unhealthy behaviors be prevented?

1.Fulkerson JA, McGuire MT, Neumark-Sztainer D, Story M, French SA, Perry CL. Weight-related attitudes and behaviors of adolescent boys and girls who are encouraged to diet by their mothers. International Journal of Obesity. 2002;26(12):1579-87.

Abstract:
OBJECTIVE: To assess the relationships between mothers’ reports of dieting and encouraging adolescents to diet and adolescents’ reports of their own dieting practices and weight-related concerns.
DESIGN: Cross-sectional study of parent interviews and adolescent surveys in an ethnically-diverse sample.
SUBJECTS: A total of 810 adolescents (n = 381 boys and n = 429 girls) and their mothers.
RESULTS: Mothers’ dieting was associated with their adolescent girls’ weight-related concerns and behaviors, but these associations were not significant after adjusting for girls’ body mass index (BMI). In contrast, mothers’ encouragement for sons to diet was associated with sons’ binge eating, dieting and other weight-control behaviors, even after controlling for sons’ BMI. Compared with mothers who did not encourage their child to diet, mothers who encouraged their child to diet were significantly heavier women and were more likely to view their child as overweight. Forty-three percent of boys and 46% of girls who were encouraged by their mothers to diet were classified as nonoverweight by federal guidelines.
CONCLUSIONS: Boys who are encouraged by their mothers to diet may be at risk for health-compromising eating and dieting behaviors, particularly binge-eating, fasting, eating a little bit of food and skipping meals. Parents who are concerned about their children’s weight should be educated to encourage healthy eating habits and physical activity to promote their children’s health, including healthy weight control.

2.Neumark-Sztainer D, Croll J, Story M, Hannan PJ, French S, Perry C. Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys – Findings from Project EAT. Journal of Psychosomatic Research. 2002;53(5):963-74.

Abstract:
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 concems/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concems/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 concems/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.

3.Neumark-Sztainer D, Wall MM, Story M, Perry CL. Correlates of unhealthy weight-control behaviors among adolescents: Implications for prevention programs. Health Psychology. 2003;22(1):88-98.

Abstract:
This study aimed to identify correlates of unhealthy weight-control behaviors in adolescents to guide the development of programs aimed at the primary prevention of disordered eating. A model explaining unhealthy weight-control behaviors was tested among 4,746 adolescents using structural equation modeling. Models fit the data well and explained 76% of the variance in unhealthy weight-control behaviors among girls and 63% among boys. Weight-body concerns were a strong correlate of unhealthy weight-control behaviors in both girls and boys. Models also emphasized the importance of weight-specific social norms within the adolescent’s proximal environment. Findings suggest the importance of addressing weight-body concerns within prevention programs and extending interventions beyond classroom settings to ensure changes in weight-related norms among peer groups and family members.

4.Neumark-Sztainer D, Hannan PJ, Story M, Perry CL. Weight-control behaviors among adolescent girls and boys: Implications for dietary intake. Journal of the American Dietetic Association. 2004;104(6):913-20.

Abstract:
OBJECTIVE: To examine associations between healthful and unhealthful weight-control behaviors and dietary intake among adolescents.
DESIGN: Cross-sectional survey (Project EAT [Eating Among Teens]).
SUBJECTS/SETTING: The study population included 4, 144 middle and high school students from Minneapolis/St. Paul public schools from diverse racial and socioeconomic backgrounds.
STATISTICAL ANALYSES: Dietary intake patterns were compared across adolescent girls and boys reporting unhealthful, only healthful, or no weight-control behaviors in unadjusted analyses and analyses adjusted for sociodemographic factors and energy intake.
RESULTS: Among girls, mean intakes differed across weight-control behaviors for all foods and nutrients examined. P values ranged from P=.006 to P<.001. Girls using unhealthful weight-control behaviors had significantly lower intakes of fruit; vegetables; grains; calcium; iron; vitamins A, C, and B-6; folate; and zinc than girls using only healthful weight-control behaviors. Compared with girls reporting no weight-control behaviors, girls using unhealthful weight-control behaviors had lower intakes of grains, calcium, iron, vitamin B-6, folate, and zinc. In contrast to the girls, boys reporting unhealthful weight-control behaviors did not have poorer dietary intakes than boys not using weight-control behaviors or using only healthful behaviors. Among boys, there were no significant differences in mean intakes of vegetables; grains; calcium; iron; vitamins A, C, and B-6; folate; and zinc. Furthermore, boys using unhealthful weight-control behaviors had higher fruit intakes (P=.002) than boys reporting no weight-control behaviors.

CONCLUSIONS: Adolescent girls who engage in unhealthful weight-control behaviors are at increased risk for dietary inadequacy. The findings demonstrate a need for interventions to prevent unhealthful weight-control behaviors in adolescent girls, and to promote healthful weight-control behaviors when indicated.

5.Eisenberg ME, Neumark-Sztainer D, Story M, Perry C. The role of social norms and friends’ influences on unhealthy weight-control behaviors among adolescent girls. Social Science and Medicine. 2005;60(6):1165-73.

Abstract:
Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends’ dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends’ involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends’ dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR= 1.47, CI 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR= 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI =.97-1.50), even after controlling for friends’ dieting behaviors. The social influences examined here were not associated with UWCBs among underweight (< 15th percentile) or overweight (> 95th percentile) girls. Findings suggest that social norms, particularly from within one’s peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed. (C) 2004 Elsevier Ltd. All rights reserved.

6.Crow S, Eisenberg ME, Story M, Neumark-Sztainer D. Psychosocial and behavioral correlates of dieting among overweight and non-overweight adolescents. Journal of Adolescent Health. 2006;38(5):569-74.

Abstract:
PURPOSE: To examine correlates of dieting behavior in overweight and non-overweight youth.
METHODS: Data came from Project EAT (Eating Among Teens), a study of eating and weight-related attitudes, behaviors, and psychosocial variables among 4746 adolescents in public schools. Logistic regression was used to compare dieters and non-dieters, and to examine interactions of dieting and overweight Status.
RESULTS: Approximately one third (31.8%) of the sample was overweight. Dieting in the previous year was reported by 55.2% of girls and 25.9% of boys. Dieting was associated with similarly elevated rates of extreme weight control behaviors, body dissatisfaction, and depression in both the non-overweight and overweight groups for both boys and girls. Girls reporting dieting behavior in both the non-overweight and overweight groups had similarly elevated risk for cigarette use, alcohol use, and marijuana use.
CONCLUSIONS: The negative correlates of dieting are similarly common among teens of varying weight status. These data suggest that dieting may not be a preferred method of weight management, even for overweight adolescents. Regardless of weight status, dieting may be a marker for other unhealthy behaviors and depressed mood in adolescents. (c) 2006 Society for Adolescent Medicine. All rights reserved.

7.Keery H, Eisenberg ME, Boutelle K, Neumark-Sztainer D, Story M. Relationships between maternal and adolescent weight-related behaviors and concerns: The role of perception. Journal of Psychosomatic Research. 2006;61(1):105-11.

Abstract:
OBJECTIVE: The purpose of this study was to explore the relationship between maternal and adolescent weight-related behaviors and concerns in a population-based sample.
METHODS: Participants were 810 adolescents (n=429 girls and n=381 boys) and their mothers/guardians. Adolescents were part of the Project EAT (Eating Among Teens) study, which was a comprehensive study of eating patterns and weight concerns among adolescents in Minnesota. Outcome variables included child’s body dissatisfaction, weight concerns, dieting, and use of healthy and unhealthy weight control behaviors.
RESULTS: Adolescents reported lower rates of maternal dieting than mothers. Maternal self-report of dieting was not significantly associated with children’s weight-related concerns. Children’s perceptions of their mothers’ behaviors were significantly related to their level of weight concerns and use of weight control behaviors.
CONCLUSION: Adolescents’ perceptions of maternal behavior affect their weight-related concerns and behaviors. This suggests that mothers who choose to diet should model healthy choices in the areas of nutrition and physical activity.

8.Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M. Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare five years later? Journal of the American Dietetic Association. 2006;106:559-68.

Abstract:
OBJECTIVE: To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later.
DESIGN: Population-based 5-year longitudinal study.
PARTICIPANTS: Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).
MAIN OUTCOME MEASURES: Weight status, binge eating, extreme weight control, and self-reported eating disorder.
STATISTICAL ANALYSIS: Multiple linear and logistic regressions.
RESULTS: Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors.
CONCLUSIONS: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

9.Neumark-Sztainer D, Wall M, Haines J, Story M, Eisenberg M. Why does dieting predict weight gain in adolescents? Findings from Project EAT-II: A five-year longitudinal study. Journal of the American Dietetic Association. 2007;107:448-55.

Abstract:
OBJECTIVE: Dieting has been found to predict weight gain in adolescents, but reasons for this association remain unclear. This study aimed to explore potential mechanisms by which dieting predicts weight gain over time in adolescents.
DESIGN: Population-based, 5-year longitudinal study.
PARTICIPANTS: Adolescents (n=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).
MAIN OUTCOME MEASURE: Body mass index (BMI) change over 5 years.
STATISTICAL ANALYSIS: Multiple regressions were used to examine associations between Time 1 dieting and Time 2 binge eating, breakfast consumption, fruit and vegetable intake, and physical activity. Associations were then examined between these behaviors and BMI change. Finally, to test for mediating effects, associations between dieting and BMI change were examined with and without the inclusion of these behaviors, and regression coefficients were compared.
RESULTS: In female adolescents, dieting predicted increased binge eating (P<0.001) and decreased breakfast consumption (P=0.030). In male adolescents, dieting predicted increased binge eating (P<0.001), decreased physical activity (P=0.006), and a trend toward decreased breakfast consumption (P=0.064). These behaviors were also associated with increases in BMI. The association between dieting and BMI increase was weakened, but still remained significant, after binge eating, breakfast consumption, fruit/vegetable intake, and physical activity were included in the model being tested. Thus, the longitudinal association between dieting and BMI increase was partially mediated by these behaviors.
CONCLUSIONS: In part, dieting may lead to weight gain via the long-term adoption of behavioral patterns that are counterproductive to weight management.

10.Ackard DM, Vik N, Neumark-Sztainer D, Schmitz KH, Hannan P, Jacobs DR. Disordered eating and body dissatisfaction among adolescents with type 1 diabetes and a population-based comparison sample. Pediatric Diabetes. 2008;9:312-9.

Abstract:
OBJECTIVE: To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a population-based sample of youth.
SUBJECTS: A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT).
METHOD: Participants completed surveys and anthropometric measurements of height and weight.
RESULTS: Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes.
CONCLUSIONS: Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.

11.Loth K, van den Berg P, Eisenberg ME, Neumark-Sztainer D. Stressful life events and disordered eating behaviors: findings from Project EAT. Journal of Adolescent Health. 2008;43(5):514-6.

Abstract:
Associations between stressful life events and disordered eating behaviors were examined in 1708 older adolescents. Stressful life events were positively associated with extreme weight control behaviors and binge eating in both male and female respondents, emphasizing the importance of screening for disordered eating behaviors among adolescents who report experiencing stressful life events.

12.Larson NI, Neumark-Sztainer D, Story M. Weight control behaviors and dietary intake among adolescents and young adults: Longitudinal findings from Project EAT. Journal of the American Dietetic Association. 2009;109(11):1869-77.

Abstract:
BACKGROUND: Cross-sectional research has found that dieting during adolesence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships.
OBJECTIVE: To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults.
DESIGN: Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004.
SUBJECTS/SETTING: The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2.
OUTCOME MEASURES AND STATISTICAL ANALYSES PERFORMED: Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting).
RESULTS: Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior.
CONCLUSIONS: Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.

13.Linde JA, Wall MM, Haines J, Neumark-Sztainer D. Predictors of initiation and persistence of unhealthy weight control behaviors in adolescents. International Journal of Behavioral Nutrition and Physical Activity. 2009;6:72. PMCID: PMC2773233.

Abstract:
BACKGROUND: Unhealthy weight control behaviours (UWCB) among adolescents have significant health and weight consequences. The current longitudinal study aimed to identify personal and socio-environmental predictors of initiation or persistence of adolescent UWCB, in order to inform development of programs aimed at both preventing and stopping UWCB.
METHODS: A diverse sample included 1106 boys and 1362 girls from 31 middle schools and high schools in the United States who were enrolled in Project EAT (Eating Among Teens). Project EAT explored personal, behavioural, and socio-environmental factors associated with dietary intake and body weight in adolescence. Participants completed questionnaires to assess demographics, UWCB (including several methods of food restriction, purging by vomiting or medications, smoking to control weight, or food substitutions) and personal and socio-environmental variables at two time points, five years apart, between 1998 and 2004. Logistic regression models examined personal and socio-environmental predictors of initiation and persistence of UWCB among Project EAT participants.
RESULTS: Results indicate that 15.5% of boys and 19.7% of girls initiated UWCB by Time 2, and 15.9% of boys and 43.3% of girls persisted with these behaviours from Time 1 to Time 2. After controlling for race/ethnicity and weight status changes between assessments, logistic regression models indicated that similar factors and patterns of factors were associated significantly with initiation and persistence of UWCB. For both boys and girls, personal factors had more predictive value than socio-environmental factors (Initiation models: for boys: R(2) = 0.35 for personal vs. 0.27 for socio-environmental factors; for girls, R(2) = 0.46 for personal vs. 0.26 for socio-environmental factors. Persistence models: for boys: R(2) = 0.53 for personal vs. 0.33 for socio-environmental factors; for girls, R(2) = 0.41 for personal vs. 0.19 for socio-environmental factors). The weight concerns model was the strongest predictor among all individual models [Initiation odds ratios (ORs) and 95% confidence interval (CI): 4.84 (3.32-7.01) for boys and 5.09 (3.55-7.30) for girls; persistence OR (CI): 4.55 (2.86-7.14) for boys and 3.45 (2.50-4.76) for girls].
CONCLUSION: In general, predictors of initiation and persistence of UWCB were similar, suggesting that universal and selective prevention programs can target similar risk factors.

14.Neumark-Sztainer D, Wall M, Story M, Sherwood NE. Five-year longitudinal predictive factors for disordered eating in a population-based sample of overweight adolescents: implications for prevention and treatment. International Journal of Eating Disorders. 2009;42(7):664-72.

Abstract:
OBJECTIVE: The objective of this study is to identify predictors of prevalence and incidence of disordered eating (binge eating and extreme weight control behaviors) among overweight adolescents.
METHOD: Five-year longitudinal associations were examined in 412 overweight adolescents who participated in Project EAT-I and II.
RESULTS: Among both overweight males and females, risk factors for disordered eating included exposure to weight loss magazine articles, higher weight importance, and unhealthy weight control behaviors, while family connectedness, body satisfaction, and regular meals were protective factors, although there were some differences in predictors of prevalence (total cases) versus incidence (new cases) of disordered eating. Among males, poor eating patterns, including fast food and sweetened beverage intake, increased risk for disordered eating, and the use of healthy weight control behaviors was protective.
DISCUSSION: Attention should be directed toward decreasing disordered eating among overweight adolescents. Findings suggest the importance of promoting positive family relationships, psychological health, and regular meals, and steering adolescents away from overemphasizing weight and using unhealthy weight control behaviors.

15.Eisenberg ME, Neumark-Sztainer D. Friends’ dieting and disordered eating behaviors among adolescents five years later: findings from Project EAT. Journal of Adolescent Health. 2010;47:67-73.

Abstract:
OBJECTIVE: Use of disordered eating behaviors is common among adolescents, and cross-sectional research has suggested that friends may be an important influence, especially among females. The current study seeks to expand upon this literature using a longitudinal design and a large, diverse sample of male and female youth
METHODS: A total of 2,516 adolescents provided survey data at baseline (1998-1999) and follow-up (2003-2004) regarding their friends’ involvement in dieting and their own experience of chronic dieting, unhealthy weight control, extreme weight control, and binge eating. General linear modeling was used to generate predicted probabilities of disordered eating at follow-up across four levels of friends’ dieting at baseline, adjusting for baseline use of disordered eating, and other covariates. Interaction terms were used to determine whether the association between friends’ dieting and disordered eating differed across age cohorts.
RESULTS: One-third of participants reported that their friends were “not at all” involved in dieting at baseline, and 8.8% reported that their friends were very involved in dieting. Friends’ dieting at baseline was positively associated with chronic dieting, unhealthy weight control behaviors, extreme weight control behaviors, and binge eating 5 years later among females, and with extreme weight control behaviors five years later among males. For both males and females, these associations were similar across age groups.
CONCLUSIONS: Interventions targeting friendship groups rather than focusing solely on individuals may be an important strategy for the prevention of disordered eating. Health care providers may wish to ask adolescents about their friends’ eating and dieting practices so as to address these issues in a clinical setting.

16.van den Berg PA, Keery H, Eisenberg M, Neumark-Sztainer D. Maternal and adolescent report of mothers’ weight-related concerns and behaviors: longitudinal associations with adolescent body dissatisfaction and weight control practices. Journal of Pediatric Psychology. 2010;35(10):1093-102. PMCID: PMC2980944.

Abstract:
OBJECTIVE: This population-based study examined mothers’ weight-related concerns and behaviors (weight status, weight dissatisfaction, dieting, and encouraging child to diet) at baseline, as assessed by both mothers and adolescents, and associations with adolescents’ body dissatisfaction and weight control practices 5 years later.
METHODS: Adolescents and their mothers (n = 443 pairs) were surveyed in 1998-1999; adolescents were resurveyed in 2003-2004.
RESULTS: Baseline maternal report of higher levels of her weight-related concerns/behaviors was associated with greater body dissatisfaction in girls 5 years later, controlling for adolescent weight status and other covariates. Baseline maternal report of weight-related concerns/behaviors was also associated with greater prevalence of trying to lose weight in both boys and girls 5 years later. Baseline adolescent report of higher maternal weight-related concerns/behaviors was associated with a higher prevalence of trying to lose weight 5 years later in girls.
CONCLUSIONS: These findings highlight the importance of mothers’ weight-related concerns and behaviors for adolescents’ weight-related outcomes.

17.Ackard DM, Fulkerson JA, Neumark-Sztainer D. Psychological and behavioral risk profiles as they relate to eating disorder diagnoses and symptomatology among a school-based sample of youth. International Journal of Eating Disorders. 2011;44(5):440-6.

Abstract:
OBJECTIVE: Examine substance use, depression, self-esteem, and suicidality by eating disorder (ED) classifications among nonclinical youth.
METHOD: A school-based sample of 4,746 youth completed anthropometric measures and Project EAT survey items matched to DSM-IV ED criteria. Logistic regression analyses and general linear models compared three threshold (AN, BN, or BED), two subthreshold (binge-eating and/or compensatory behaviors not meeting ED diagnosis, or body image disturbance without disordered eating) and one asymptomatic ED classifications.
RESULTS: Subthreshold and threshold classifications reported lower self-esteem and greater substance use, depression, suicidal ideation/attempts than asymptomatic youth. The BED group had higher depressive mood, and BED and BN had lower self-esteem, than the subthreshold groups. Odds ratios for suicidality were highest among the BN group and lowest among the body image disturbance group.
DISCUSSION: Subthreshold and threshold classifications are associated with compromised health, suggesting the importance of addressing the continuum of weight/shape concerns and disordered eating behaviors within prevention and treatment interventions.

18.Ackard DM, Fulkerson JA, Neumark-Sztainer D. Stability of eating disorder diagnostic classifications in adolescents: five-year longitudinal findings from a population-based study. Eating Disorders. 2011;19(4):308-22.

Abstract:
This study examined the stability of eating disorder (ED) classifications among a population-based sample of male and female adolescents (n = 2,516) who participated in Project EAT-II, a five-year longitudinal study. Cross-tabulations using weighted data identified diagnostic stability across six classifications (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Binge Eating and/or Compensatory Behaviors not meeting ED diagnosis, Body Image Disturbance without disordered eating, and Asymptomatic). One-third (32.6%) of adolescents who were asymptomatic at baseline and over half of those who were symptomatic at baseline reported symptoms five years later. All males and 82% of females with a threshold diagnosis at baseline remained symptomatic five years later, but rarely within the same classification. In conclusion, the presence of ED symptoms in adolescence strongly predicts ED symptoms five years later. ED diagnoses and classifications were unstable over time, underscoring the critical need for prevention efforts and periodic assessment and encouraging early detection and intervention among adolescents.

19.Neumark-Sztainer D, Eisenberg ME, Wall M, Loth KA. Yoga and Pilates: associations with body image and disordered-eating behaviors in a population-based sample of young adults. International Journal of Eating Disorders. 2011;44(3):276-80. PMCID: PMC3010485.

Abstract:
OBJECTIVE: To examine associations between participating in mind-body activities (yoga/Pilates) and body dissatisfaction and disordered eating (unhealthy and extreme weight control practices and binge eating) in a population-based sample of young adults.
METHOD: The sample included 1,030 young men and 1,257 young women (mean age: 25.3 years, SD = 1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults).
RESULTS: Among women, disordered eating was prevalent in yoga/Pilates participants and nonparticipants, with no differences between the groups. Men participating in yoga/Pilates were more likely to use extreme weight control behaviors (18.6% vs. 6.8%, p = .006) and binge eating (11.6% vs. 4.2%, p = .023), and marginally more likely to use unhealthy weight control behaviors (49.1% vs. 34.5%; p = .053), than nonparticipants after adjusting for sociodemographics, weight status, and overall physical activity.
DISCUSSION: Findings suggest the importance of helping yoga/Pilates instructors recognize that their students may be at risk for disordered eating.

20.Neumark-Sztainer D, Wall M, Larson NI, Eisenberg ME, Loth K. Dieting and disordered eating behaviors from adolescence to young adulthood: findings from a 10-year longitudinal study. Journal of the American Dietetic Association. 2011;111(7):1004-11. PMCID: PMC3140795.

Abstract:
BACKGROUND: Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood.
OBJECTIVE: To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood.
DESIGN: Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010).
PARTICIPANTS/SETTING: The study population included 2,287 young adults (55% girls, 52% nonwhite). The sample included a younger group (mean age 12.8+/-0.7 years at baseline and 23.2+/-1.0 years at follow-up) and an older group (mean age 15.9+/-0.8 at baseline and 26.2+/-0.9 years at follow-up).
STATISTICAL ANALYSES PERFORMED: Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline.
RESULTS: In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors 10 years later. Tracking was particularly consistent for the older girls and boys transitioning from middle adolescence to middle young adulthood.
CONCLUSIONS: Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts before the onset of harmful behavioral patterns as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.

21.Eisenberg ME, Wall MM, Shim JJ, Bruening M, Loth K, Neumark-Sztainer D. Associations between friends’ disordered eating and muscle-enhancing behaviors. Social Science and Medicine. 2012;35(5):500-8. PMCID: PMC3509792.

Abstract:
Dieting, unhealthy weight control and muscle-enhancing behaviors are common among adolescents: friends are a probable source of influence on these behaviors. The present study uses data provided by nominated friends to examine associations between friends’ disordered eating and muscle-enhancing behaviors and participants’ own behaviors in a diverse sample of American youth. Male and female adolescents (mean age = 14.4) completed surveys and identified their friends from a class roster; friends’ survey data were then linked to each participant. Participants (N = 2126) who had at least one nominated friend were included in the analytic sample. Independent variables were created using the same weight control and muscle-enhancing behaviors reported by nominated friends, and were used in logistic regression models to test associations between participants’ and their friends’ behaviors, stratified by gender. Results indicated that dieting, disordered eating and muscle-enhancing behaviors were common in this sample, and selected friends’ behaviors were associated with the same behaviors in participants. For example, girls whose friends reported extreme weight control behaviors had significantly greater odds of using these behaviors than girls whose friends did not report these same behaviors (OR = 2.39). This research suggests that friends’ weight- and shape-related behaviors are a feature of social relationships, and is the first report demonstrating these associations for muscle-enhancing behaviors. Capitalizing on the social element may be important to the development of increasingly effective intervention and prevention programs.

22.Neumark-Sztainer D, Wall M, Story M, Standish AR. Dieting and unhealthy weight control behaviors during adolescence: associations with 10-year changes in body mass index. Journal of Adolescent Health. 2012;50(1):80-6. PMCID: PMC3245517.

Abstract:
BACKGROUND: Dieting and unhealthy weight control behaviors are common among adolescents and questions exist regarding their long-term effect on weight status.
OBJECTIVE: To examine 10-year longitudinal associations between dieting and unhealthy weight control behaviors and changes in body mass index (BMI) from adolescence to young adulthood.
METHODS AND PROCEDURES: A diverse population-based sample of middle school and high school adolescents participating in Project EAT (Eating and Activity in Teens and Young Adults) was followed up for 10 years. Participants (N = 1,902) completed surveys in 1998-1999 (Project EAT-I), 2003-2004 (Project EAT-II), and 2008-2009 (Project EAT-III). Dieting and unhealthy weight control behaviors at Time 1 and Time 2 were used to predict 10-year changes in BMI at Time 3, adjusting for sociodemographic characteristics and Time 1 BMI.
RESULTS: Dieting and unhealthy weight control behaviors at both Time 1 and Time 2 predicted greater BMI increases at Time 3 in males and females, as compared with no use of these behaviors. For example, females using unhealthy weight control behaviors at both Time 1 and Time 2 increased their BMI by 4.63 units as compared with 2.29 units in females not using these behaviors (p < .001). Associations were found in both overweight and nonoverweight respondents. Specific weight control behaviors at Time 1 that predicted larger BMI increases at Time 3 included skipping meals and reporting eating very little (females and males), use of food substitutes (males), and use of diet pills (females).
CONCLUSIONS: Findings clearly indicate that dieting and unhealthy weight control behaviors, as reported by adolescents, predict significant weight gain over time.

23.Quick V, Larson N, Eisenberg ME, Hannan PJ, Neumark-Sztainer D. Self-weighing behaviors in young adults: tipping the scale toward unhealthy eating behaviors? Journal of Adolescent Health. 2012;51(5):468-74. PMCID: PMC3478783.

Abstract:
PURPOSE: This study examined associations between frequency of self-weighing and healthy weight-control behaviors (WCBs), unhealthy WCBs, muscle-enhancing behaviors (e.g., steroid use, protein powders), and psychological well-being (i.e., self-esteem, depression, body satisfaction) in a community sample of young adults.
METHODS: Data were drawn from Project EAT-III (Eating and Activity in Teens and Young Adults), the third wave of a population-based study. Participants included young adults (n = 2,287, mean age = 25.3 years) from the Minneapolis/St. Paul metropolitan area.
RESULTS: Self-weighing a few times per week or more frequently was reported by 18% of young adult women and 12% of young adult men. Linear regression models, adjusted for body mass index and demographic characteristics, indicated that in both women and men, more frequent self-weighing was associated with a higher prevalence of dieting, both healthy and unhealthy WCBs, and muscle-enhancing behaviors. Additionally, young women who reported more frequent self-weighing were more likely to report binge eating. More frequent self-weighing was also associated with more depressive symptoms and lower self-esteem in women and lower body satisfaction in young men.
CONCLUSIONS: More frequent self-weighing is associated with healthy and unhealthy weight-control practices, muscle-enhancing behaviors, and poorer psychological well-being in young adults. Young adults engaging in self-weighing behaviors should be screened for these health indicators and counseled as appropriate. Before recommending self-weighing as a weight-monitoring tool, health care providers should ensure that young adults are not at risk for an unhealthy preoccupation with body weight or shape.

24.Berge J, MacLehose R, Loth K, Eisenberg M, Bucchianeri MM, Neumark-Sztainer D. Parent conversations about healthful eating and weight: Associations with adolescent disordered eating behaviors. Journal of the American Medical Association – Pediatrics. 2013;167(8):746-53. PMCID: PMC3737359.

Abstract:
IMPORTANCE: The prevalence of weight-related problems in adolescents is high. Parents of adolescents may wonder whether talking about eating habits and weight is useful or detrimental.
OBJECTIVE: To examine the associations between parent conversations about healthful eating and weight and adolescent disordered eating behaviors.
DESIGN: Cross-sectional analysis using data from 2 linked multilevel population-based studies.
SETTING: Anthropometric assessments and surveys completed at school by adolescents and surveys completed at home by parents in 2009-2010.
PARTICIPANTS: Socioeconomically and racially/ethnically diverse sample (81% ethnic minority; 60% low income) of adolescents from Eating and Activity in Teens 2010 (EAT 2010) (n = 2793; mean age, 14.4 years) and parents from Project Families and Eating and Activity in Teens (Project F-EAT) (n = 3709; mean age, 42.3 years).
EXPOSURE: Parent conversations about healthful eating and weight/size.
MAIN OUTCOMES AND MEASURES: Adolescent dieting, unhealthy weight-control behaviors, and binge eating.
RESULTS: Mothers and fathers who engaged in weight-related conversations had adolescents who were more likely to diet, use unhealthy weight-control behaviors, and engage in binge eating. Overweight or obese adolescents whose mothers engaged in conversations that were focused only on healthful eating behaviors were less likely to diet and use unhealthy weight-control behaviors. Additionally, subanalyses with adolescents with data from 2 parents showed that when both parents engaged in healthful eating conversations, their overweight or obese adolescent children were less likely to diet and use unhealthy weight-control behaviors.
CONCLUSIONS AND RELEVANCE: Parent conversations focused on weight/size are associated with increased risk for adolescent disordered eating behaviors, whereas conversations focused on healthful eating are protective against disordered eating behaviors.

25.Denny KN, Loth K, Eisenberg ME, Neumark-Sztainer D. Intuitive eating in young adults: Who is doing it, and how is it related to disordered eating behaviors? Appetite. 2013;60:13-9. PMCID: PMC3511603.

Abstract:
Intuitive eating (i.e., reliance on physiologic hunger and satiety cues to guide eating) has been proposed as a healthier, more effective, and more innate alternative to current strategies of weight management. The current study explored intuitive eating among young adults according to socio-demographic characteristics and body mass index (BMI), and examined associations between intuitive and disordered eating behaviors. Data were drawn from Project EAT-III, a population-based study of 2287 young adults (mean age: 25.3 years). More males reported trusting their bodies to tell them how much to eat than did females. Intuitive eating was inversely associated with BMI in both genders. Males and females who reported trusting their body to tell them how much to eat had lower odds of utilizing disordered eating behaviors compared to those that did not have this trust. Females who reported that they stop eating when they are full had lower odds of chronic dieting and binge eating than those who do not stop eating when full. Overall, this study found that intuitive eating practices are inversely associated with a number of harmful outcomes. Clinicians should discuss the concept of intuitive eating with their young adult patients to promote healthier weight-related outcomes.

26.Eisenberg M, Berge J, Neumark-Sztainer D. Dieting and encouragement to diet by significant others: associations with disordered eating in young adults. American Journal of Health Promotion. 2013;27(6):370-7. PMCID: PMC3899838.

Abstract:
PURPOSE: Examine the role of perceived significant other’s modeling or encouragement of dieting in young adults’ disordered eating behaviors.
DESIGN: Online survey data were collected (2008-2009) as part of an ongoing study examining weight and related issues in young people.
SETTING: Participants were originally recruited as students at middle and high schools in Minnesota (1998-1999).
SUBJECTS: One thousand two hundred ninety-four young adults (mean age 25.3, 55% female, 50% white) with significant others.
MEASURES: Participants were asked if their significant other diets or encourages them to diet. Behaviors included unhealthy weight control, extreme weight control, and binge eating.
ANALYSIS: General linear models estimated the predicted probability of using each behavior across levels of significant other’s dieting or encouraging dieting, stratifying by gender, and adjusting for demographics and body mass index.
RESULTS: Perceived dieting and encouragement to diet by significant others were common. Disordered eating behaviors were positively associated with significant other’s dieting and encouragement to diet, particularly for females. In models including both perceived dieting and encouragement, encouragement remained significantly associated with disordered eating. For example, women’s binge eating was almost doubled if their significant other encouraged dieting “very much” (25.5%) compared to “not at all” (13.6%, p = .015).
CONCLUSION: There is a strong association between disordered eating behaviors and perceived modeling and encouragement to diet by significant others in young adulthood.

27.Lopez-Guimera G, Neumark-Sztainer D, Hannan P, Faquet J, Loth K, Sanchez Carracedo D. Unhealthy weight-control behaviors, dieting and weight status: A cross-cultural comparison between North American and Spanish adolescents. European Eating Disorders Review. 2013;21(4):276-83. PMCID: PMC3756811.

Abstract:
The aim of the current study was to examine and compare dieting and unhealthy weight-control behaviours (UWCB) in population-based samples in two large urban areas in Spain (Barcelona) and in the USA (Twin Cities of Minneapolis and St. Paul, Minnesota). Additionally, use of UWCB across weight categories was explored in both samples. Participants included 1501 adolescents from Barcelona (48% girls, 52% boys) and 2793 adolescents from the Twin Cities (53% girls, 47% boys). The main outcome measures were dieting, UWCB (less extreme and extreme) and weight status. Although dieting and UWCB were prevalent in both samples, particularly among girls, the prevalence was higher in the US sample. In both countries, the report of dieting and use of UWCB was highest among overweight and obese youth. Prevention interventions that address the broad spectrum of eating and weight-related problems should be warranted in light of the high prevalence and co-occurrence of overweight and unhealthy weight-related behaviours.

28.Berge JM, Wall M, Larson N, Eisenberg ME, Loth KA, Neumark-Sztainer D. The unique and additive associations of family functioning and parenting practices with disordered eating behaviors in diverse adolescents. Journal of Behavioral Medicine. 2014;37(2):205-17. PMCID: PMC3605198.

Abstract:
To examine the unique and additive associations of family functioning and parenting practices with adolescent disordered eating behaviors (i.e., dieting, unhealthy weight control behaviors, binge eating). Data from EAT (Eating and Activity in Teens) 2010, a population-based study assessing eating and activity among racially/ethnically and socio-economically diverse adolescents (n = 2,793; mean age = 14.4, SD = 2.0; age range = 11-19) was used. Logistic regression models were used to examine associations between adolescent dieting and disordered eating behaviors and family functioning and parenting variables, including interactions. All analyses controlled for demographics and body mass index. Higher family functioning, parent connection, and parental knowledge about child’s whereabouts (e.g. who child is with, what they are doing, where they are at) were significantly associated with lower odds of engaging in dieting and disordered eating behaviors in adolescents, while parent psychological control was associated with greater odds of engaging in dieting and disordered eating behaviors. Although the majority of interactions were non-significant, parental psychological control moderated the protective relationship between family functioning and disordered eating behaviors in adolescent girls. Clinicians and health care providers may want to discuss the importance of balancing specific parenting behaviors, such as increasing parent knowledge about child whereabouts while decreasing psychological control in order to enhance the protective relationship between family functioning and disordered eating behaviors in adolescents.

29.Loth KA, MacLehose R, Bucchianeri M, Crow S, Neumark-Sztainer D. Predictors of dieting and disordered eating behaviors from adolescence to young adulthood. Journal of Adolescent Health. 2014;55(5):705-12.

Abstract:
PURPOSE: To identify personal and socioenvironmental factors associated with the persistence of dieting or disordered eating from adolescence to young adulthood and factors associated with the initiation of dieting or disordered eating during young adulthood.
METHODS: Participants (n = 4,746) completed EAT-I surveys as adolescents; EAT-III surveys were completed 10 years later by 1,902 of the original participants (1,082 females and 820 males).
RESULTS: Study results indicate that there are personal factors, including weight concerns, weight importance, depressive symptoms and body satisfaction, present during adolescence that are predictive of an individual’s engagement in dieting or disordered eating behaviors 10 years later. For example, among both males and females, weight importance was found to be predictive of continued dieting and disordered eating from adolescence through young adulthood. For example, 26.1% of males with low levels of weight concern at baseline reported engaging in persistent disordered eating as compared with 60.4% of males with high levels of weight concern at baseline (prevalence difference: 34.3; 95% confidence interval: 10.5-58.1; p < .01). Parental weight concerns, peer dieting, and weight teasing at baseline were not found to be predictive of dieting or disordered eating at 10-year follow-up.
CONCLUSIONS: Personal factors identified during adolescence were found to be predictive of both persistent dieting and disordered eating from adolescence into young adulthood, as well as initiation of these behaviors during young adulthood. In particular, weight concerns and weight importance were found to be predictive in most models providing support for inclusion of these factors in adolescent health screening.

30.Loth KA, MacLehose RF, Fulkerson JA, Crow S, Neumark-Sztainer D. Are food restriction and pressure-to-eat parenting practices associated with adolescent disordered eating behaviors? International Journal of Eating Disorders. 2014;47(3):310-4. PMCID: PMC3963280.

Abstract:
OBJECTIVE: To examine associations between parental pressure-to-eat and food restriction and adolescent disordered eating behaviors, within a sample of parent-adolescent pairs.
METHOD: Adolescents (N = 2,231) and their parents (N = 3,431) participated in two, coordinated, population-based studies designed to examine factors associated with weight and weight-related behaviors in adolescents.
RESULTS: Overall, higher levels of pressure-to-eat or food restriction were significantly and positively associated with use of disordered eating behaviors among boys. For every one unit increase [Scale Range: 1 (low control) to 4 (high control)] in mothers’ food restriction, boys were twice as likely to engage in extreme weight control behaviors (p</= .01). Examination of the association between food-related parenting practices and disordered eating behaviors among girls revealed fewer significant associations. However, analyses revealed that for every one unit increase in mothers’ food restriction, girls were 1.33 times more likely to engage in extreme weight control behaviors (p = .04).

DISCUSSION: Study findings provide evidence of an association between controlling food-related parenting practices and adolescent disordered eating behaviors, particularly in boys. Future longitudinal research is needed to establish directionality of observed associations.

What have we learned about how media might influence adolescents and young adults?

1.Utter J, Neumark-Sztainer D, Wall M, Story M. Reading magazine articles about dieting and associated weight control behaviors among adolescents. Journal of Adolescent Health. 2003;32(1):78-82.

Abstract:
The purpose was to examine the sociodemographic characteristics of adolescents who read magazine articles about dieting/weight loss and the relationship between reading these types of magazine articles and psychosocial well-being and weight control behaviors. Dieting-related magazine exposure was associated with indicators of psychosocial distress and unhealthy dieting; interventions that address media consumption should reach out to all youth regardless of ethnic and social backgrounds (C) Society for Adolescent Medicine, 2003.

2.van den Berg P, Neumark-Sztainer D, Hannan PJ, Haines J. Dieting advice from magazines-helpful or harmful? Five year associations with weight-control behaviors and psychological outcomes in adolescents. Pediatrics. 2007;119(1):e30-7.

Abstract:
OBJECTIVE: The purpose of this study was to evaluate the association between frequent reading of magazine articles about dieting/weight loss and weight-control behaviors and psychological outcomes 5 years later in a sample of adolescents.
PARTICIPANTS AND METHODS: Data are from Project EAT (Eating Among Teens), a 5-year longitudinal study of eating, activity, weight, and related variables in 2516 middle and high school students. In 1999 (time 1), participants completed surveys and had their height and weight measured. In 2004 (time 2), participants were resurveyed.
RESULTS: For female adolescents, the frequency of healthy, unhealthy, and extreme weight-control behaviors increased with increasing magazine reading after adjusting for time 1 weight-control behaviors, weight importance, BMI, and demographic covariates. The odds of engaging in unhealthy weight-control behaviors (such as fasting, skipping meals, and smoking more cigarettes) were twice as high for the most frequent readers compared with those who did not read magazine articles about dieting and weight loss. The odds of using extreme weight-control behaviors (such as vomiting or using laxatives) were 3 times higher in the highest frequency readers compared with those who did not read such magazines. There were no significant associations for either weight-control behaviors or psychological outcomes for male adolescents.
CONCLUSIONS: Frequent reading of magazine articles about dieting/weight loss strongly predicted unhealthy weight-control behaviors in adolescent girls, but not boys, 5 years later. Findings from this study, in conjunction with findings from previous studies, suggest a need for interventions aimed at reducing exposure to, and the importance placed on, media messages regarding dieting and weight loss.

3.van den Berg P, Paxton SJ, Keery H, Wall M, Guo J, Neumark-Sztainer D. Body dissatisfaction and body comparison with media images in males and females. Body Image. 2007;4(3):257-68.

Abstract:
This study examined the role of media body comparison as a mediator of the relationships between psychological factors and sociocultural pressures to be thin and body dissatisfaction in both females and males. Participants were 1,386 females (mean age = 19.37 years) and 1,130 males (mean age = 19.46) from diverse backgrounds who completed a self-report questionnaire. Path analysis was used to test a cross-sectional model in which media body comparison mediated the impact of self-esteem, depressive mood, parent dieting environment, friend dieting, TV exposure, magazine message exposure, weight teasing and body mass index (BMI) on body dissatisfaction. In females, media body comparison partially or fully mediated relationships between self-esteem, depressive mood, friend dieting, magazine message exposure and BMI, and body dissatisfaction. In males, media body comparison was not a significant predictor of body dissatisfaction. This research particularly highlights the need to further examine processes that are involved in the development of body dissatisfaction in males.

4.Barr-Anderson DJ, van den Berg P, Neumark-Sztainer D, Story M. Characteristics associated with older adolescents who have a television in their bedrooms. Pediatrics. 2008;121(4):718-24.

Abstract:
OBJECTIVES. The goals were to examine the prevalence of adolescents having a television in their bedroom and to describe associated personal, social, and behavioral characteristics.
METHODS: Participants included 781 adolescents ( mean age: 17.2 years) who completed a mailed Project Eating Among Teens II questionnaire. The relationships between adolescents having a television in their bedroom and sociodemographic, behavioral, and personal characteristics were examined.
RESULTS: Nearly two thirds ( 62%) of participants had a bedroom television. Gender, race/ethnicity, socioeconomic status, and age were associated with the presence of a bedroom television. Compared with girls without a bedroom television, girls with a bedroom television reported less time spent in vigorous activity ( 1.8 vs 2.5 hours/week), more time spent watching television ( 20.7 vs 15.2 hours/week), lower vegetable intake ( 1.7 vs 2.0 servings per day), greater sweetened beverage consumption ( 1.2 vs 1.0 servings per day), and fewer family meals ( 2.9 vs 3.7 meals per week). Compared with boys without a bedroom television, boys with a bedroom television reported more time spent watching television ( 22.2 vs 18.2 hours/week), lower fruit intake ( 1.7 vs 2.2 servings per day), fewer family meals ( 2.9 vs 3.6 meals per week), and lower grade point average ( 2.6 vs 2.9). Twice as many youths with a television in their bedroom were heavy television users ( watched >5 hours/day), compared with youths without a television in their bedroom ( 16% vs 8%).
CONCLUSIONS: Adolescents with a bedroom television reported more television viewing time, less physical activity, poorer dietary habits, fewer family meals, and poorer school performance. Refraining from placing a television in teenagers’ rooms may be a first step in helping to decrease screen time and subsequent poor behaviors associated with increased television watching.

What do we know about binge eating in teens and young adults?

1.Ackard DM, Neumark-Sztainer D. Binge eating among youth: Defining and addressing the problem. Minnesota Health Care News. 2003:28-9.

2.Ackard DM, Neumark-Sztainer D. Binge eating among youth: Scope of the problem and implications for physicians. Minnesota Physician. 2003;17(7):19, 38.

3.Ackard DM, Neumark-Sztainer D, Story M, Perry C. Overeating among adolescents: Prevalence and associations with weight-related characteristics and psychological health. Pediatrics. 2003;111(1):67-74.

Abstract:
OBJECTIVE: To assess the prevalence of overeating among adolescents and to examine associations between overeating and sociodemographic characteristics, weight status, dieting behaviors, body satisfaction, depressive mood, self-esteem, and suicide.
METHOD: A school-based sample of 4746 boys and girls in public middle and high schools in Minnesota completed the Project EAT (Eating Among Teens) survey and anthropometric measurements of height and weight.
RESULTS: Overall, 17.3% of girls and 7.8% of boys reported objective overeating in the past year. Youths who engaged in overeating were more likely to be overweight or obese, to have dieted in the past year, to be trying to lose weight currently, and to report that weight and shape are very important to their overall feelings about self. Youths who met criteria for binge eating syndrome (high frequency of objective overeating with loss of control and distress regarding the binge eating) scored significantly lower on measures of body satisfaction and self-esteem and higher on a measure of depressive mood than those who reported either subclinical or no binge eating. Overeating was associated with suicide risk; more than one fourth of girls (28.6%) and boys (27.8%) who met criteria for binge eating syndrome reported that they had attempted suicide.
CONCLUSIONS: Overeating among adolescents is associated with a number of adverse behaviors and negative psychological experiences. As the current study is cross-sectional, it is not possible to ascertain cause and effect. Future research should seek to identify whether objective overeating is an early warning sign of additional psychological distress or is a potential consequence of compromised psychological health. Clinical implications are discussed.

4.Goldschmidt AB, Wall M, Loth KA, Le Grange D, Neumark-Sztainer D. Which dieters are at risk for the onset of binge eating? A prospective study of adolescents and young adults. Journal of Adolescent Health. 2012;51(1):86-92. PMCID: PMC3383602.

Abstract:
PURPOSE: Dieting is a well-established risk factor for binge eating, yet the majority of dieters do not develop binge eating problems. The purpose of the current study was to examine psychosocial factors involved in the relation between dieting and binge eating over a 10-year follow-up period.
METHODS: A population-based sample (n = 1,827) completed surveys assessing eating habits, psychological functioning, and weight status at 5-year intervals spanning early/middle adolescence (time 1), late adolescence/early young adulthood (time 2), and early/middle young adulthood (time 3). Dieting, along with depression symptoms, self-esteem, and teasing experiences at time 1 and time 2, was used to predict new onset binge eating at time 2 and time 3, respectively. Interactions between dieting status and varying degrees of these psychosocial factors in relation to binge eating onset were also tested.
RESULTS: Dieters were two to three times more likely than nondieters to develop binge eating problems over 5-year follow-ups. At most time points, depression symptoms and self-esteem predicted binge eating onset beyond the effects of dieting alone. Detrimental levels of these factors among dieters (relative to nondieters) increased the likelihood of binge eating onset only during the later follow-up period.
CONCLUSIONS: Depression and self-esteem appear to be particularly salient factors involved in the relation between dieting and binge eating onset among adolescents and young adults. Early identification of these factors should be a priority to prevent the development of binge eating problems among already at-risk individuals.

5.Goldschmidt AB, Wall MM, Choo TH, Bruening M, Eisenberg ME, Neumark-Sztainer D. Examining associations between adolescent binge eating and binge eating in parents and friends. International Journal of Eating Disorders. 2014;47(3):325-8. PMCID: PMC4050969.

Abstract:
OBJECTIVE: Binge eating is prevalent among adolescents, but little is known about how parents and friends may influence such behaviors. This study examined associations between adolescent binge eating behaviors, and similar behaviors in their parents and friends.
METHOD: Participants were 2,770 target adolescent boys and girls who had at least one friend and/or parent who also participated. Logistic regression, stratified by gender, examined associations between parents’ and friends’ self-reported binge eating, and similar behaviors in target adolescents.
RESULTS: Girls’ binge eating was associated with their male friends’ (odds ratio = 2.33; p = 0.03) and fathers’ binge eating (odds ratio = 3.38; p = 0.02), but not with their female friends’ or mothers’ binge eating (p > 0.05). For boys, binge eating was not associated with parents’ or friends’ behavior.
DISCUSSION: Adolescent girls’ binge eating is associated with similar behaviors in their other-sex parents and friends. Results should be replicated, and mechanisms explaining this relation should be further explored.

6.Goldschmidt AB, Wall MM, Loth KA, Bucchianeri MM, Neumark-Sztainer D. The course of binge eating from adolescence to young adulthood. Health Psychology. 2014;33(5):457-60. PMCID: PMC3843976.

Abstract:
OBJECTIVE: The course of binge eating in adolescence is variable, and little is known about factors maintaining binge eating behaviors. The current study sought to characterize the course of binge eating and identify psychosocial factors associated with its maintenance.
METHOD: A population-based sample reported on binge eating, depression symptoms, self-esteem, and body satisfaction at 5-year intervals spanning early/middle adolescence (Time 1 [T1]), late adolescence/early young adulthood (Time 2 [T2]), and early/middle young adulthood (Time 3 [T3]). Logistic regression examined factors predicting maintenance or cessation of binge eating.
RESULTS: A total of 15.8% of participants with binge eating at T1 continued to report binge eating at T2, and 42.0% of participants with binge eating at T2 continued to report binge eating at T3. From T1 to T2, improvements in self-esteem predicted cessation of binge eating. From T2 to T3, cessation of binge eating was predicted by improved body satisfaction, greater decreases in depression symptoms, and greater improvements in self-esteem.
CONCLUSIONS: Binge eating is relatively stable from late adolescence/early young adulthood to early/middle young adulthood, but less so from middle/late adolescence to late adolescence/early young adulthood. Improvements in psychosocial functioning during this timeframe may improve the outcome of binge eating, although mechanisms responsible for psychosocial changes (e.g., treatment involvement) require further investigation. Self-esteem appears to be a particularly salient factor involved in binge eating cessation and should be targeted in prevention and treatment programs.

What factors are related to psychosocial health and well-being in teens and young adults?

1.Fulkerson JA, Sherwood NE, Perry CL, Neumark-Sztainer D, Story M. Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample. Preventive Medicine. 2004;38(6):865-75.

Abstract:
BACKGROUND: Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample.
METHODS: Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups.
RESULTS: Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males.
CONCLUSIONS: Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents.

2.Erickson JD, Patterson JM, Wall MM, Neumark-Sztainer D. Risk behaviors and emotional well-being in youth with chronic health conditions. Children’s Health Care. 2005;34(3):181-92.

Abstract:
Using a cross-sectional comparison group design, 4,746 ethnically diverse middle and high school students from 31 public schools in a metropolitan area were surveyed about their health, emotional factors (self-esteem, depressive symptoms, and suicidality), and behaviors (tobacco, alcohol, and drug use). Based on regression analyses that adjusted for gender, race, school level, and socioeconomic status, adolescents with chronic health conditions were significantly more likely to report depressive symptoms and low self-esteem than adolescents without chronic health conditions; they were almost twice as likely to have considered suicide and over 31/2 times more likely to have attempted suicide. They also reported greater use of cigarettes, marijuana, and illicit drugs. Given the extent of behavioral and emotional problems among adolescents with chronic health conditions, appropriate referrals and mental health services for these adolescents are warranted.

3.Ackard DM, Neumark-Sztainer D, Story M, Perry C. Parent-child connectedness and behavioral and emotional health among adolescents. American Journal of Preventive Medicine. 2006;30(1):59-66.

Abstract:
BACKGROUND: This study sought to examine teen perceptions of mother-child and father-child connectedness, with focus on valuing parental opinions and perception of parental communication and caring, and associations with behavioral and emotional health.
METHODS: A population-based sample of 4746 students in public schools completed the 2001 Project EAT (Eating Among Teens) survey.
RESULTS: Overall, the majority of girls and boys reported valuing their parents’ opinion when making serious decisions and believing that their parents cared about them. Yet, one fourth of girls and boys felt unable to talk to their mother about problems, and over half of girls and one third of boys felt unable to talk to their father. Valuing friends’ opinions over parents’ opinions, and perceiving low parental communication and caring were associated with unhealthy weight control, substance use, suicide attempts, body dissatisfaction, depression, and low self-esteem. Of significant concern, compared to their peers who reported feeling that their mother cared quite a bit or very much, youths who reported feeling as though their mother cared very little or not at all about them reported particularly high prevalence rates of unhealthy weight control behaviors (63.49% girls, 25.45% boys); suicide attempts (33.51% girls, 21.28% boys); low self-esteem (47.15% girls, 24-56% boys); and depression (63.52% girls, 33.35% boys).
CONCLUSIONS: Adolescents’ perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends’ opinions for serious decisions were significantly associated with compromised behavioral and emotional health. Interventions aimed at improving the parent-child relationship may provide an avenue toward preventing health risk behaviors in youth.

4.Ackard DM, Eisenberg ME, Neumark-Sztainer D. The long-term impact of adolescent dating violence on the behavioral and psychological health of male and female youth. Journal of Pediatrics. 2007;151(5):476-81.

Abstract:
OBJECTIVE: To evaluate the long-term impact of adolescent dating violence (ADV) on behavioral and psychological health.
STUDY DESIGN: From a diverse sample of older adolescents who completed Project EAT in 1999 (wave 1) and 2004 (wave 2; mean age 20.4), 23 male and 102 female adolescents reporting ADV were compared with 671 male and 720 female adolescents reporting no ADV.
RESULTS: ADV was positively associated with cigarette smoking and suicide attempts for both sexes, binge-eating and suicidal ideation in male adolescents, and smoking marijuana and high depressive symptoms in female adolescents in analyses unadjusted for wave 1 outcomes. In analyses adjusted for wave 1, in female adolescents, ADV was significantly associated with smoking cigarettes, marijuana use, and high depressive symptoms and marginally associated with suicide attempts; in male adolescents, ADV was significantly associated with smoking cigarettes and marginally associated with binge-eating and suicidal ideation. ADV was significantly associated with an overall high-risk profile (presence > or = 3 health outcomes) for both sexes; results remained significant in female adolescents after adjusting for wave 1.
CONCLUSIONS: ADV is associated with greater likelihood of problematic health factors and increases nonspecific risk toward behavioral and psychological impairment in youth, particularly female adolescents.

5.Fulkerson JA, Strauss J, Neumark-Sztainer D, Story M, Boutelle KN. Correlates of psychosocial well-being among overweight adolescents: The role of the family. Journal of Consulting and Clinical Psychology. 2007;75(1):181-6.

Abstract:
An ethnically diverse sample of at-risk-for-overweight and overweight youths (body mass index greater than the 85th percentile for age and gender; n = 667 male participants, and n = 684 female participants) completed a school-based survey measuring family variables (connectedness, mealtime environment, and weight commentary), psychosocial well-being (depressed mood, body satisfaction, and self-esteem), and unhealthy weight-control behaviors; all measures were assessed concurrently. Hierarchical linear regression analyses revealed that measures of general family connectedness, priority of family meals, and positive mealtime environment were significantly positively associated with psychological well-being and inversely associated with depressive symptoms and unhealthy weight-control behaviors. Familial weight commentary (i.e., weight-based teasing and parental encouragement to diet) was associated with many indicators of poor psychological health. The authors conclude that greater psychosocial well-being and fewer unhealthy weight-control behaviors are associated with making family time at meals a priority, creating a positive mealtime atmosphere, and refraining from weight commentary.

6.Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social isolation, psychological health, and protective factors in adolescence. Adolescence. 2007;42(166):265-86.

Abstract:
This study investigates the relationships among social isolation, psychological health, and protective factors in adolescents. Feelings of social isolation may influence psychological health in adolescents, but protective factors such as family connectedness, school connectedness, and academic achievement may also play a key role. The sample included 4,746 adolescents from 31 middle and high schools. Participants responded to 221 survey questions regarding peer relationships, psychological health, school connectedness, family relationships, and academic achievement. The findings revealed that social isolation was associated with an increased risk for depressive symptoms, suicide attempts, and low self-esteem. Protective factors influenced associations between social isolation and psychological health. Implications for prevention such as building healthy peer relationships, promoting family connectedness, and developing school-based interventions are discussed.

7.Crow S, Eisenberg ME, Story M, Neumark-Sztainer D. Suicidal behavior in adolescents: relationship to weight status, weight control behaviors, and body dissatisfaction. International Journal of Eating Disorders. 2008;41(1):82-7.

Abstract:
OBJECTIVE: Suicide is associated with full syndromal eating disorders, but it is unclear whether subsyndromal eating disorders carry the same risk. This study examined associations between suicidal behaviors and extreme and less extreme weight control behaviors (EWCB and LWCB, such as fasting, vomiting, meal skipping, etc.), body dissatisfaction, and weight status in adolescents.
METHOD: Data on body dissatisfaction, depressive symptoms, suicidal ideation and attempts, and body mass index (BMI) were drawn from Project EAT, a survey of 4,746 7th-12th grade students. Multivariate logistic regression examined associations between eating- and weight-related variables and suicidality.
RESULTS: Suicidal ideation and suicide attempts were more commonly observed in adolescents with EWCB (boys: ideation OR = 2.12, attempts OR = 4.10; girls: ideation OR = 1.66, attempts OR = 2.29), LWCB (boys: ideation OR = 1.33, attempts OR = 1.76; girls: ideation OR = 1.77, attempts OR = 1.80), as well as body dissatisfaction (boys: ideation OR = 1.75, attempts OR = 2.23; girls: ideation OR = 1.77, attempts OR = 1.81), even after controlling for depressive symptoms. No association was observed between BMI and suicidal attempts or ideation.
CONCLUSION: Thus, it appears that suicidal behavior in adolescents is associated even with low-level eating disorder symptoms.

8.Crow SJ, Eisenberg ME, Story M, Neumark-Sztainer D. Are body dissatisfaction, eating disturbances, and body mass index predictors of suicidal behavior in adolescents? A longitudinal study. Journal of Consulting and Clinical Psychology. 2008;76:887-92. PMCID: PMC2575643.

Abstract:
Disordered eating, body dissatisfaction, and obesity have been associated cross sectionally with suicidal behavior in adolescents. To determine the extent to which these variables predicted suicidal ideation and attempts, the authors examined these relationships in a longitudinal design. The study population included 2,516 older adolescents and young adults who completed surveys for Project EAT-II (Time 2), a 5-year follow-up study of adolescents who had taken part in Project EAT (Time 1). Odds ratios for suicidal behaviors at Time 2 were estimated with multiple logistic regression. Predictor variables included Time 1 extreme and unhealthy weight control behaviors (EWCB and UWCB), body dissatisfaction, and body mass index percentile. Suicidal ideation was reported by 15.2% of young men and 21.6% of young women, and suicide attempts were reported by 3.5% of young men and 8.7% of young women. For young women, suicidal ideation at Time 2 was predicted by Time 1 EWCB. The odds ratio for suicide attempts was similarly elevated in young women who had reported EWCB at Time 1. These odds ratios for both suicidal ideation and suicide attempts remained elevated even after controlling for Time 2 depressive symptoms. In young men, EWCB was not associated with suicidal ideation or suicide attempts 5 years later. Body mass index and body dissatisfaction did not predict suicidal ideation or suicide attempts in young men or young women. These results emphasize the importance of EWCB.

9.Boutelle K, Eisenberg ME, Becker M, Neumark-Sztainer D. The reciprocal relationship between parent-child connectedness and adolescent emotional functioning over 5 years. Journal of Psychosomatic Research. 2009;66(4):309-16.

Abstract:
PURPOSE: The purpose of this study was to evaluate the reciprocal relationship between parent-child connectedness and depressive symptoms, self-esteem, and body satisfaction over 5 years in a diverse sample of 2516 male and female adolescents.
METHODS: Youth completed Project Eating Among Teens surveys at Time 1 (1998-1999) and Time 2 (2003-2004). Multiple linear regression analysis was conducted to evaluate relationships between parent-child connectedness and adolescents’ emotional functioning, controlling for baseline parent-child connectedness. The reciprocal relationship was also evaluated using the same methods.
RESULTS: Parent-child connectedness was associated with increased body satisfaction for females, increased self-esteem for males, and decreased depressive symptoms for both males and females. The reciprocal relationship results showed that, among females, self-esteem was associated with increased parent-child connectedness while depressive symptoms predicted decreased parent-child connectedness. In males, body satisfaction was associated with increased parent-child connectedness.
CONCLUSIONS: Parent-child connectedness and youth emotional functioning reciprocally influenced each other over the 5-year period of this study. Interventions aimed at strengthening the parent-child relationship throughout adolescence may protect emotional health and prevent longer-term emotional consequences in young adults.

10.Eisenberg ME, Ackard DM, Resnick MD, Neumark-Sztainer D. Casual sex and emotional health in sexually active young adults: Are “friends with benefits” psychologically damaging? Perspectives on Sexual and Reproductive Health. 2009;41:231-7.

Abstract:
CONTEXT: Speculation in public discourse suggests that sexual encounters outside a committed romantic relationship may be emotionally damaging for young people, and federal abstinence aducation policy has required teaching that sexual activity outside of a marital relationship is likely to have harmful psychological consequences.
METHODS: In 2003-2004, a diverse sample of 1,311 sexually active young adults (mean age, 20.5) participating in a longitudinal study in Minnesota completed a survey including measures of sexual behavior and psychological well-being. Chi-square tests were used to compare the prevalence of recent casual partnerships by selected demographic and personal categories. General linear modeling was then used to compare mean levels of each psychological well-being measure between those reporting recent casual partners and those reporting committed partners; partner type was measure both dichotomously and categorically.
RESULTS: One-fifth of participants reported that their most recent sex partner was a casual partner (i.e., causal acquaintance or close but nonexclusive partner). Casual partnerships were more common among men than among women (29% vs. 14%), and the proportions of male and female respondents reporting a recent causal partner differed by race or ethnicity. Scores of psychological well-being were generally consistent across sex partner categories, and no significant associations between partner type and well-being were found in adjusted analyses.
CONCLUSIONS: Young adults who engage in causal sexual encounters do not appear to be at greater risk for harmful psychological outcomes than sexually active young adults in more committed relationships.

11.Fox CK, Barr-Anderson DJ, Neumark-Sztainer D, Wall M. Physical activity and sports team participation: associations with academic outcomes in middle school and high school students. Journal of School Health. 2010;80(1):31-7.

Abstract:
BACKGROUND: Previous studies have found that higher physical activity levels are associated with greater academic achievement among students. However, it remains unclear whether associations are due to the physical activity itself or sports team participation, which may involve requirements for maintaining certain grades, for example. The purpose of this study is to examine the associations between sports team participation, physical activity, and academic outcomes in middle and high school students.
METHODS: Data were drawn from Project EAT (Eating Among Teens), a survey of middle and high school students (n = 4746). Students self-reported their weekly hours of physical activity, sports team participation, and academic letter grades. Two statistical models were considered: first, 2 separate regression analyses with grade point average (GPA) as the outcome and either sports team participation or physical activity as the predictor; second, a single regression with GPA as the outcome and both sports team participation and physical activity as the simultaneous predictors.
RESULTS: For high school girls, both physical activity and sports team participation were each independently associated with a higher GPA. For high school boys, only sports team participation was independently associated with a higher GPA. For middle school students, the positive association between physical activity and GPA could not be separated from the relationship between sports team participation and a higher GPA.
CONCLUSIONS: Regardless of whether academic success was related to the physical activity itself or to participation on sports teams, findings indicated positive associations between physical activity involvement and academic achievement among students.

12.Loth KA, Mond J, Wall M, Neumark-Sztainer D. Weight status and emotional well-being: longitudinal findings from Project EAT. Journal of Pediatric Psychology. 2011;36(2):216-25.

Abstract:
OBJECTIVES: To learn more about how overweight is associated with emotional well-being in adolescents and examine change in associations over time.
METHODS: A prospective study was conducted with a sample of 2,516 adolescents who participated in Project EAT-I (1999) and Project EAT-II (2004).
RESULTS: At baseline, overweight participants had lower body satisfaction and decreased self-esteem as compared to normal weight participants. Additionally, an association was found between overweight and depressive symptoms among males during middle adolescence. Longitudinal findings suggest that the adverse impact of overweight on emotional well-being persists into young adulthood, including a marked increase in depressive mood among overweight males between early and middle adolescence.
CONCLUSIONS: The persistent nature of the association between overweight and emotional well-being suggests that the normal developmental process of adolescence will not “take care” of this association. Instead, clinicians should regularly screen overweight adolescents for markers of poor emotional well-being and consider intervention when appropriate.

13.Taliaferro LA, Eisenberg ME, Johnson KE, Nelson TF, Neumark-Sztainer D. Sport participation during adolescence and suicide ideation and attempts. International Journal of Adolescent Medicine and Health. 2011;23(1):3-10.

Abstract:
BACKGROUND: Most research regarding sport participation and suicide risk found protective relationships. However, all studies in this area were based on cross-sectional designs.
OBJECTIVE: To fill a gap in research by exploring associations between sport involvement and suicide ideation and attempts (suicidality) based on a 5-year longitudinal, population-based study.
STUDY GROUP: Participants (n = 739) completed surveys in middle school and high school.
METHODS: Logistic regression analysis compared suicidality during high school across four groups: youth who participated in sport in both middle and high school, youth who participated only in middle school or only in high school, and youth who did not participate in sport during adolescence.
RESULTS: Compared to non-participants, youth involved in sport in both middle and high school had lower odds of suicidal ideation during high school. Youth who discontinued sport after middle school had higher odds of attempting suicide during high school than non-participants.
CONCLUSIONS: Remaining involved in sport throughout adolescence can offer mental health benefits. Future research should identify mechanisms that account for protective relationships between involvement in sport throughout adolescence and suicidality, and identify factors that explain deleterious relationships for youth who discontinue sport early in adolescence.

14.Ackard DM, Eisenberg ME, Neumark-Sztainer D. Associations between dating violence and high-risk sexual behaviors among male and female older adolescents. Journal of Child and Adolescent Trauma. 2012;5(4):344-52.

Abstract:
This study sought to evaluate associations between adolescent dating violence victimization (DV) and high-risk sexual behaviors. Males (n = 71) and females (n = 189) reporting DV were compared to 671 males and 720 females (overall mean age 20.4 years) reporting no DV on high-risk sexual behaviors (casual sexual partner, multiple sexual partners, no contraceptive use, unprotected intercourse). DV was reported by 9.6% males and 20.8% females. All males reporting both physical and sexual DV acknowledged high-risk sexual behavior. Furthermore, most female peers (75.2%) reporting physical and sexual DV acknowledged high-risk sexual behavior. Health programs and care professionals should target violence prevention and contraception education, and promote early intervention to reduce high-risk sexual behaviors, particularly among those reporting dating violence.

15.Berge JM, Bauer KW, Eisenberg ME, Denny K, Neumark-Sztainer D. Psychosocial and Health Behavior Outcomes of Young Adults with Asthma or Diabetes. Journal of Community Medicine & Health Education. 2012;2(4):144. PMCID: PMC3843966.

Abstract:
PURPOSE: Previous research has shown a relationship between childhood/adolescent chronic conditions and negative health behaviors, psychological outcomes, and social outcomes. Less is known about whether these negative outcomes are experienced by young adults with chronic health conditions. The purpose of this paper is to investigate how young adults’ BMI, health behaviors, and psychological and social outcomes differ depending on whether they have diabetes, asthma, or neither of these chronic conditions.
METHODS: Data were drawn from the third wave of Project EAT-III: Eating and Activity in Young Adults, a population-based study of 2287 young adults (mean age = 25.3; range 19.8 – 31.2). General linear models were used to test differences in BMI, health behaviors (e.g., fast food intake) and psychosocial outcomes (e.g. depressive symptoms) by young adults’ chronic disease status.
RESULTS: Young adults with diabetes had higher BMIs, engaged in less physical activity and more unhealthy weight control behaviors and binge eating, had lower self-esteem and lower body satisfaction, and experienced more depressive symptoms and appearance-based teasing compared to young adults with asthma or no chronic conditions, after adjusting for age, race/ethnicity, socio-economic status (SES) and, when relevant, for BMI. There were no significant differences between young adults with asthma and young adults with no chronic condition on all of the psychosocial and health behavior outcomes.
CONCLUSIONS: Young adults with diabetes reported higher prevalence of negative health behaviors and psychosocial outcomes. Providers may find it useful to assess for negative health behaviors and psychosocial variables with young adults with diabetes in order to improve treatment and quality of life for these individuals.

16.Quick V, Loth K, MacLehose R, Linde JA, Neumark-Sztainer D. Prevalence of adolescents’ self-weighing behaviors and associations with weight-related behaviors and psychological well-being. Journal of Adolescent Health. 2013;52(6):738-44. PMCID: PMC3664119.

Abstract:
PURPOSE: To examine the relationships between self-weighing frequency, and weight-related behaviors and psychological well-being in a population-based sample of adolescents.
METHODS: This study compared weight-related behaviors between infrequent and frequent self-weighers, stratified by weight status and gender. Data were from Project EAT 2010 (Eating and Activity in Teens), a population-based study of 2,778 adolescents.
RESULTS: Approximately 14% of girls and boys weighed themselves frequently (weekly or more). In comparison to girls who were infrequent self-weighers, girls who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and have lower self-esteem and greater body dissatisfaction. In comparison to boys who were infrequent self-weighers, boys who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and report greater depressive symptoms. Among overweight adolescents, in addition to being associated with these harmful outcomes, frequent self-weighing was associated with the use of healthy weight control behaviors and with higher levels of moderate-to-vigorous activity.
CONCLUSIONS: Findings indicate that adolescents who frequently self-weigh themselves are at increased risk for a number of problematic health behaviors and poorer psychological outcomes. For overweight adolescents, frequent self-weighing was additionally associated with a number of positive outcomes. Based upon these findings, any recommendations for weight monitoring should be made cautiously; all adolescents, including overweight adolescents, should be advised not to engage in frequent self-weighing behaviors. Furthermore, any adolescents engaging in frequent self-weighing behaviors should be monitored for problematic outcomes.

17.Widome R, Wall M, Laska M, Eisenberg M, Neumark-Sztainer D. Adolescence to young adulthood: When socioeconomic disparities in substance use emerge. Substance Use and Misuse. 2013;48(14):1522-9. PMCID: PMC4060522

Abstract:
We examined trends in cigarette, alcohol, and marijuana use by eventual educational attainment in 1,902 participants from Project EAT, a 10-year longitudinal study following participants from early adolescence through young adulthood. Generally, for cigarettes and marijuana, disparities were evident by early adolescence with prevalence of use highest among those who had no secondary education. With alcohol, use diverged during young adulthood when the college group reported the most weekly alcohol use while those without postsecondary education reported greatest daily use. When disparities in substance use behaviors first emerge and later escalate can guide how to craft and target interventions.

What have we learned about body image issues in teens and young adults?

1.Neumark-Sztainer D, Goeden C, Story M, Wall M. Associations between body satisfaction and physical activity in adolescents: Implications for programs aimed at preventing a broad spectrum of weight-related disorders. Eating Disorders. 2004;12:125-37.

Abstract:
This study examined associations among body satisfaction and physical and sedentary activities in 4,746 adolescents. Boys with lower body satisfaction reported significantly less physical activity and more TV viewing than boys with higher body satisfaction. In girls, trends were similar, but associations were not statistically significant. Associations were similar among overweight youth. In no instances, were lower levels of body satisfaction significantly associated with higher physical activity levels. These findings suggest that interventions that strive for increased physical activity in youth should avoid strategies that may lead to decreases in body satisfaction. Rather, programs should simultaneously strive to increase physical activity and improve body satisfaction. This type of approach may be effective in preventing obesity while avoiding increasing participants’risk for a low body satisfaction, unhealthy weight control practices, and eating disorders.

2.Kelly AM, Wall MM, Eisenberg ME, Story M, Neumark-Sztainer D. Adolescent girls with high body satisfaction: Who are they and what can they teach us? Journal of Adolescent Health. 2005;37:391-6.

Abstract:
PURPOSE: The purpose of this study was 2-fold: (1) to determine the prevalence of high body satisfaction in a multi-ethnic, urban population of adolescent females, and (2) to examine the demographic, socioenvironmental, personal, and behavioral factors associated with high body satisfaction among adolescent girls.
METHODS: The study population included 2,357 female middle and high school students who completed surveys in 1998-1999. High body satisfaction and its association with a range of socioenvironmental, personal, and behavioral factors were assessed. Associations were examined through comparisons of means (unadjusted and adjusted for grade level, race, socioeconomic status, and body mass index [BMI]) for continuous variables, and percentages and odds ratios for dichotomized variables.
RESULTS: Over a quarter (26.7%) of adolescent girls reported high body satisfaction. High body satisfaction was most common among African-American (40.1%) and underweight girls (39.0%). In adjusted analyses, girls with high body satisfaction were more likely to report parental and peer attitudes that encouraged healthy eating and exercising to be fit (p < .001) versus dieting, and less likely to report personal weight-related concerns and behaviors (p < .001).
CONCLUSIONS: The immediate subculture in which adolescent girls exist may play an important role in fostering high body satisfaction. Parents and health care providers often struggle with how to address the topic of weight management in teens without causing further injury to body image. Findings from the present study suggest the importance of providing a social environment that focuses on health and fitness, rather than on weight control, to increase adolescent girls’ likelihood of being satisfied with their bodies.

3.Eisenberg ME, Neumark-Sztainer D, Paxton SJ. Five-year change in body satisfaction among adolescents. Journal of Psychosomatic Research. 2006;61(4):521-7.

Abstract:
OBJECTIVE: The present study uses longitudinal data to examine changes in body satisfaction among male and female adolescents from baseline to 5 years.
METHODS: A diverse sample of 2516 adolescents completed surveys in 1999 and 2004, reporting satisfaction with 10 body parts or attributes, height/weight, and other characteristics. Multivariable general linear modeling was used to estimate change in body satisfaction from Time 1 to Time 2, by age group, race, and change in body mass index (BMI) category.
RESULTS: Body satisfaction decreased over 5 years (mean satisfaction change = -0.79) in all groups except older adolescent females. Scores decreased significantly more among younger adolescents than older adolescents, among some racial/ethnic groups of males, and among those whose BMI increased. However, among males, change in body satisfaction depended on BMI category at baseline.
CONCLUSIONS: Different types of prevention programs addressing body image may be needed for males and females at different developmental stages and may need to address changes in BMI.

4.Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health. 2006;39:244-51.

Abstract:
PURPOSE: This study addresses the question, “Does body satisfaction matter?” by examining longitudinal associations between body satisfaction and weight-related health-promoting and health-compromising behaviors five years later among adolescents.
METHODS: Project EAT-II followed an ethnically and socioeconomically diverse sample of 2516 adolescents from 1999 (Time 1) to 2004 (Time 2). Associations between body satisfaction at Time 1 and health behaviors at Time 2 were examined, adjusting for sociodemographic characteristics and Time 1 health behaviors, with and without adjustment for body mass index (BMI).
RESULTS: In females, lower body satisfaction predicted higher levels of dieting, unhealthy and very unhealthy weight control behaviors and binge eating, and lower levels of physical activity and fruit and vegetable intake. After adjusting for BMI, associations between body satisfaction and dieting, very unhealthy weight control behaviors, and physical activity remained statistically significant. In males, lower body satisfaction predicted higher levels of dieting, healthy, unhealthy, and very unhealthy weight control behaviors, binge eating, and smoking, and lower levels of physical activity. After adjusting for BMI, associations between body satisfaction and dieting, unhealthy weight control behavior, and binge eating remained statistically significant.
CONCLUSIONS: The study findings indicate that, in general, lower body satisfaction does not serve as a motivator for engaging in healthy weight management behaviors, but rather predicts the use of behaviors that may place adolescents at risk for weight gain and poorer overall health. Interventions with adolescents should strive to enhance body satisfaction and avoid messages likely to lead to decreases in body satisfaction.

5.Paxton SJ, Eisenberg ME, Neumark-Sztainer D. Prospective predictors of body dissatisfaction in adolescent girls and boys: A five year longitudinal study. Developmental Psychology. 2006;42(5):888-99.

Abstract:
This study investigated prospective risk factors for increases in body dissatisfaction in adolescent girls and boys in the Eating Among Teens Project. At the time of first assessment (Time 1), participants were a cohort of early adolescent girls (N=440) and boys (N=366) and a cohort of middle adolescent girls (N=946) and boys (N=764). Participants were followed up 5 years later (Time 2). Potential prospective risk factors examined included body mass index, socioeconomic status, ethnicity, parent dieting environment, peer environment, and psychological factors. Predictors of Time 2 body dissatisfaction were Time 1 body dissatisfaction, body mass index, socioeconomic status, being African American, friend dieting and teasing, self-esteem, and depression. However, the profile of predictors differed across the samples.

6.Paxton SJ, Neumark-Sztainer D, Hannan PJ, Eisenberg ME. Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child and Adolescent Psychology. 2006;35(4):539-49.

Abstract:
This research examined whether body dissatisfaction prospectively predicted depressive mood and low self-esteem in adolescent girls and boys 5 years later. Participants were early-adolescent girls (n = 440, Time 1 M age = 12.7 years) and boys (n = 366, Time 1 M age = 12.8 years) and midadolescent girls (n = 946, Time 1 M age = 15.8 years) and boys (n = 764, Time 1 M age = 15.9 years). After controlling for Time 1 of the relevant dependent variable, ethnicity, socioeconomic status, and body mass index, Time 1 body dissatisfaction was a unique predictor of Time 2 depressive mood and low self-esteem in early-adolescent girls (depressive mood: F = 4.80, p < .05; self-esteem: F = 9.64, p < .01) and midadolescent boys (depressive mood: F = 12.27, p < .001; self-esteem: F = 9.38, p < .01) but not in early-adolescent boys or midadolescent girls. These findings are consistent with the hypothesis that body dissatisfaction is a risk factor for depressive mood and low self-esteem in both girls and boys but in different phases of adolescence.

7.van den Berg P, Neumark-Sztainer D. Fat ‘n happy 5 years later: Is it bad for overweight girls to like their bodies? Journal of Adolescent Health. 2007;41:415-7.

Abstract:
Does a moderate degree of body dissatisfaction motivate overweight adolescents to lose weight? We examined the relationship between body satisfaction and BMI 5 years later in overweight adolescent girls from Project EAT (Eating Among Teens), and found that girls with higher body satisfaction gained less weight over 5 years.

8.van den Berg PA, Mond J, Eisenberg M, Ackard D, Neumark-Sztainer D. The link between body dissatisfaction and self-esteem in adolescents: similarities across gender, age, weight status, race/ethnicity, and socioeconomic status. Journal of Adolescent Health. 2010;47(3):290-6. PMCID: PMC2923488.

Abstract:
PURPOSE: The present study examined whether the cross-sectional association between body dissatisfaction and low self-esteem varies across gender, age, body weight status, race/ethnicity, and socioeconomic status (SES). We also examined the association longitudinally.
METHODS: A school-based survey of eating, weight, and related attitudes was conducted with a diverse sample of adolescents aged 11-18 years (N = 4,746). Height and weight were measured in the schools at Time 1. Participants were resurveyed through mails 5 years later (Time, 2; N = 2,516).
RESULTS: The relationship between body dissatisfaction and self-esteem was strong and significant in both boys and girls (all p values < .0001), and did not differ significantly between genders (p = .16), or between the middle school and high school cohorts in either boys (p = .79) or girls (p = .80). Among girls, the relationship between body dissatisfaction and self-esteem was strong, but did vary across weight status, race/ethnicity, and SES (all p values = .0001-.03). The relationship was nonsignificant in underweight girls (p = .36), and weaker but still significant among black, Asian, and low SES group girls (all p values < .0001) in comparison to white and high SES group girls. Among boys, the association did not differ significantly across demographic groups (all p values = .18-.79). In longitudinal analyses, the strength of the association did not change significantly as adolescents grew older.
CONCLUSIONS: Findings indicate that body dissatisfaction and self-esteem are strongly related among nearly all groups of adolescents. This suggests the importance of addressing body image concerns with adolescents of all backgrounds and ages.

9.Loth KA, Bauer KW, Wall M, Berge J, Neumark-Sztainer D. Body satisfaction during pregnancy. Body Image. 2011;8(3):297-300. PMCID: PMC3124621.

Abstract:
The current study examines how body satisfaction of pregnant women compares to that of nonpregnant women. The sample included 68 pregnant and 927 nonpregnant young women who participated in a population-based longitudinal study examining eating and weight concerns in young adults. Body satisfaction was assessed using a 10-item modified version of the Body Shape Satisfaction Scale. The longitudinal design allowed for the assessment of body satisfaction among women both prior to and during their pregnancy. Mean body satisfaction was higher in pregnant women (32.6, 95% CI: 30.7-34.5) than nonpregnant women (29.6, 95% CI: 29.1-30.1) with moderate effect size 0.32, after adjusting for body satisfaction and body mass index prior to pregnancy, indicating that pregnant women experienced a significant increase in body satisfaction from the time prior to their pregnancy (p=.003) despite weight gain. These findings have important implications for clinicians delivering weight-related messages to women during pregnancy.

10.Mond J, van den Berg P, Boutelle K, Hannan P, Neumark-Sztainer D. Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: findings from the project EAT study. Journal of Adolescent Health. 2011;48(4):373-8. PMCID: PMC3214691.

Abstract:
PURPOSE: We tested the hypothesis that, at two different stages of adolescence, impairment in emotional well-being associated with obesity is mediated by body dissatisfaction (BD).
METHODS: Self-reported measures of BD, emotional well-being (self-esteem, depressive mood), height and weight, and socio-demographic information were completed by the same female (n = 366) and male (n = 440) participants during early (mean age = 12.8 years) and late (17.3 years) adolescence. For each measure and at each time point, the hypothesis of mediation was tested using the methods suggested by Baron and Kenny (1986).
RESULTS: The conditions of complete mediation were satisfied in all the six cases for which an effect of obesity on emotional well-being was observed. That is, in each of these cases, obesity was no longer associated with lower self-esteem or with higher depressive mood after the effects of BD were statistically controlled. Among females, there was no association between obesity and depressive mood at either time point.
CONCLUSION: Impairment in the emotional well-being of overweight adolescents, where this is observed, may be primarily due to the effects of weight-related BD. This appears to be the case for both boys and girls and during both early and late adolescence. The findings are consistent with the view that BD is central to the health and well-being of children and adolescents who are overweight and that distress associated with negative body image may warrant greater attention in the context of obesity prevention and treatment programs.

11.Bucchianeri MM, Arikian A, Hannan PJ, Eisenberg ME, Neumark-Sztainer D. Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body Image. 2013;10(1):1-7. PMCID: PMC3814026.

Abstract:
Given mixed findings regarding the unique trajectories of female and male adolescents’ body dissatisfaction over time, comprehensive longitudinal examinations are needed. This 10-year longitudinal, population-based study, with 1902 participants from diverse ethnic/racial and socioeconomic backgrounds in the Minneapolis/St. Paul metropolitan area, examined changes in body dissatisfaction from adolescence to young adulthood. Results revealed that: (a) female and male participants’ body dissatisfaction increased between middle and high school, (b) body dissatisfaction increased further during the transition to young adulthood, and (c) this increase was associated with an increase in BMI over time, such that the upward trend in body dissatisfaction became nonsignificant when BMI was controlled. These results highlight a trend in which diverse female and male youth are increasingly dissatisfied with their bodies as their BMI increases from middle school to young adulthood, and emphasize the need for targeted prevention efforts to intervene in this trajectory and mitigate potential harm.

What have we learned about research with adolescents and young adults?

1.Larson N, Neumark-Sztainer D, Harwood EM, Eisenberg ME, Wall M, Hannan PJ. Do young adults participate in surveys that ‘go green’? Response rates to a web and mailed survey of weight-related behaviors. International Journal of Child Health and Human Development. 2011;4(2):225-31. PMCID: PMC3501214.

Abstract:
There is a paucity of research regarding the contextual factors that influence health behaviors to inform the development of programs and services for youth during the transition from adolescence to young adulthood. Researchers are thus in need of efficient strategies for surveying diverse populations of young adults. This study among a population-based sample of young adults aimed to 1) examine response to a mixed-mode survey design (web and mailed surveys) and 2) identify demographic correlates of response mode. Young adults who participated in previous study waves were invited to participate in the third wave of a 10-year longitudinal study (Project EAT-III: 2008-2009) examining factors associated with weight-related behaviors. Participants were mailed invitation letters providing the web address and a unique password for completing the survey. Nonresponders were mailed three reminder invitations; the third mailing included the paper form, and all other mailings included a postage-paid card for requesting the paper form. Most completed surveys (82.1% of n=2,287) were returned by respondents within the first four months of fielding prior to the mailing which included the paper form. Nearly all of these early responders (92.6% of n=1,878) and 86.5% of the full respondent sample (n=1,979 of 2,287) completed the web form. Response to the web versus mailed paper form of the survey was associated with age >25 years, higher socioeconomic status, current employment, student status, and having no children. The combination of web and mailed survey modes is an effective strategy for conducting data collection in demographically diverse, young adult populations.

2.Larson NI, Neumark-Sztainer D, Story M, van den Berg P, Hannan PJ. Identifying correlates of young adults’ weight behavior: Survey development. American Journal of Health Behavior. 2011;35(6):712-25. PMCID: PMC3297483.

Abstract:
OBJECTIVE: To describe the development and psychometric properties of survey measures relevant to eating, physical activity, and weight-related behaviors among young adults.
METHODS: Focus groups and reliability testing guided the development of the Project EAT-III survey. The final survey was completed by 2287 young adults.
RESULTS: The systematic process employed led to a psychometrically sound and developmentally appropriate survey. Test-retest reliabilities for items included on the final survey were mostly moderate to good, and Cronbach alphas were >0.7 for 83% of developed scales.
CONCLUSIONS: Future studies may find the systematic process used to be helpful in creating other weight-related surveys.

3.Forsyth A, Van Riper D, Larson N, Wall M, Neumark-Sztainer D. Creating a replicable, valid cross-platform buffering technique: The sausage buffer for measuring food and physical activity built environments. International Journal of Health Geographics. 2012;11(14):14. PMCID: PMC3391988.

Abstract:
BACKGROUND: Obesity researchers increasingly use geographic information systems to measure exposure and access in neighborhood food and physical activity environments. This paper proposes a network buffering approach, the “sausage” buffer. This method can be consistently and easily replicated across software versions and platforms, avoiding problems with proprietary systems that use different approaches in creating such buffers.
METHODS: In this paper, we describe how the sausage buffering approach was developed to be repeatable across platforms and places. We also examine how the sausage buffer compares with existing alternatives in terms of buffer size and shape, measurements of the food and physical activity environments, and associations between environmental features and health-related behaviors. We test the proposed buffering approach using data from EAT 2010 (Eating and Activity in Teens), a study examining multi-level factors associated with eating, physical activity, and weight status in adolescents (n=2,724) in the Minneapolis/St. Paul metropolitan area of Minnesota.
RESULTS: Results show that the sausage buffer is comparable in area to the classic ArcView 3.3 network buffer particularly for larger buffer sizes. It obtains similar results to other buffering techniques when measuring variables associated with the food and physical activity environments and when measuring the correlations between such variables and outcomes such as physical activity and food purchases.
CONCLUSIONS: Findings from various tests in the current study show that researchers can obtain results using sausage buffers that are similar to results they would obtain by using other buffering techniques. However, unlike proprietary buffering techniques, the sausage buffer approach can be replicated across software programs and versions, allowing more independence of research from specific software.

4.Larson N, Harnack L, Neumark-Sztainer D. Assessing dietary intake during the transition to adulthood: A comparison of age-appropriate FFQ for youth/adolescents and adults. Public Health Nutrition. 2012;15(4):627-34. PMCID: PMC3343720.

Abstract:
OBJECTIVE: Assessing changes in dietary intake during the transition from adolescence to adulthood is challenging given the need for age-appropriate tools at different developmental stages. The present study investigated the comparability of intake estimates as assessed with the youth/adolescent and adult forms of Willett’s FFQ.
DESIGN: Young adults were first asked to complete the adult FFQ as part of a larger study, Project EAT-III (Eating and Activity in Teens and Young Adults). A stratified random sample of respondents was invited to complete the youth/adolescent FFQ by mail within a 3-week period.
SETTING: Participants were members of a longitudinal cohort who completed baseline surveys (including the adolescent FFQ) at schools in Minneapolis/St. Paul, Minnesota and completed Project EAT-III surveys online or by mail in 2008-2009.
SUBJECTS: There were ninety-one men and 103 women (median age = 24.6 years) who completed both forms of the FFQ.
RESULTS: The adolescent and adult forms did not provide comparable absolute intake estimates. However, with few exceptions, correlation coefficients between intake estimates were moderate (r = 0.4-0.6). Furthermore, the percentage of individuals classified into the same quartile rank category based on their responses to the adolescent and adult forms was >/=50 % for fibre, vitamins A and E, and servings of fruit (excluding juice), vegetables, dairy, whole grains and soft drinks.
CONCLUSIONS: Although responses on the adolescent and adult FFQ cannot be compared to describe changes in absolute intake over time, these tools provide comparable intake rankings and may be used together in longitudinal studies to investigate influences on diet.

5.Wall MM, Larson NI, Forsyth A, Van Riper DC, Graham DJ, Story MT, et al. Patterns of obesogenic neighborhood characteristics and adolescent weight status: a comparison of statistical approaches. American Journal of Preventive Medicine. 2012;42(5):e65-e75. PMCID: PMC3380614.

Abstract:
BACKGROUND: Few studies have addressed the potential influence of neighborhood characteristics on adolescent obesity risk, and findings have been inconsistent.
PURPOSE: Identify patterns among neighborhood food, physical activity, street/transportation, and socioeconomic characteristics and examine their associations with adolescent weight status using three statistical approaches.
METHODS: Anthropometric measures were taken on 2682 adolescents (53% female, mean age=14.5 years) from 20 Minneapolis/St. Paul MN schools in 2009-2010. Neighborhood environmental variables were measured using GIS data and by survey. Gender-stratified regressions related to BMI z-scores and obesity to (1) separate neighborhood variables; (2) composites formed using factor analysis; and (3) clusters identified using spatial latent class analysis in 2012.
RESULTS: Regressions on separate neighborhood variables found a low percentage of parks/recreation, and low perceived safety were associated with higher BMI z-scores in boys and girls. Factor analysis found five factors: away-from-home food and recreation accessibility, community disadvantage, green space, retail/transit density, and supermarket accessibility. The first two factors were associated with BMI z-score in girls but not in boys. Spatial latent class analysis identified six clusters with complex combinations of both positive and negative environmental influences. In boys, the cluster with highest obesity (29.8%) included low SES, parks/recreation, and safety; high restaurant and convenience store density; and nearby access to gyms, supermarkets, and many transit stops.
CONCLUSIONS: The mix of neighborhood-level barriers and facilitators of weight-related health behaviors leads to difficulties disentangling their associations with adolescent obesity; however, statistical approaches including factor and latent class analysis may provide useful means for addressing this complexity.

6.Sirard JR, Hannan PJ, Cutler GJ, Graham DJ, Neumark-Sztainer D. Evaluation of 2 self-report measures of physical activity with accelerometry in young adults. Journal of Physical Activity and Health. 2013;10(1):85-96. PMCID: PMC3521871.

Abstract:
BACKGROUND: The purpose of this paper is to evaluate self-reported physical activity of young adults using 1-week and 1-year recall measures with an accelerometer as the criterion measure.
METHODS: Participants were a subsample (N = 121, 24 +/- 1.7 yrs) from a large longitudinal cohort study. Participants completed a detailed 1-year physical activity recall, wore an accelerometer for 1 week and then completed a brief 1-week physical activity recall when they returned the accelerometer.
RESULTS: Mean values for moderate-to-vigorous physical activity (MVPA) from the 3 instruments were 3.2, 2.2, and 13.7 hours/wk for the accelerometer, 1-week recall, and 1-year recall, respectively (all different from each other, P < .001). Spearman correlations for moderate, vigorous, and MVPA between the accelerometer and the 1-week recall (0.30, 0.50, and 0.40, respectively) and the 1-year recall (0.31, 0.42, and 0.44, respectively) demonstrated adequate validity.
CONCLUSIONS: Both recall instruments may be used for ranking physical activity at the group level. At the individual level, the 1-week recall performed much better in terms of absolute value of physical activity. The 1-year recall overestimated total physical activity but additional research is needed to fully test its validity.

General linear models estimated the predicted probability