Changes in dietary habits and prevalence of cardiovascular risk factors among school students in Macao,China

ObjectiveGiven the increasing burden of childhood obesity, it is important to examine the changes in dietary habits and prevalence of cardiovascular risk factors among Macao students.MethodsA cross-sectional study was conducted among primary and secondary school students in Macao, China in 2014–2015 with addition to data collected from 2008 to 2009 for comparison. The dietary behaviours, prevalence of obesity and dyslipidaemia were compared by study period.SubjectsIn 2014–2015, dietary assessment was conducted among 3635 students, physical assessment was conducted among 1427 school students. In 2008–2009, dietary assessment was conducted among 4271 students, physical assessment was conducted among 1700 school students.ResultsWhen compared with students in 2008, higher percentage of students from present study period consumed dairy products, crispy food and chocolate, while fewer students had fruits, vegetables and fried food at least once every day. Despite lower prevalence of elevated total cholesterol and low-density-lipoprotein cholesterol, the rate of general obesity, low high-density-lipoprotein cholesterol and hyperglycaemia has increased significantly in 2014–2015. Students aged 12–14 consumed less fruits and vegetables and suffered from higher rate of general and abdominal obesity, as well as low high-density-lipoprotein cholesterol and elevated serum triglycerides in 2014–15.ConclusionsThe students’ diet had both favourable and unfavourable changes. The rate of obesity and dyslipidaemia rises, while the situation for students aged 12–14 is more concerning.     

Sunscreen use among US high school students, 1999-2003

The purpose of this paper was to examine sunscreen use among US high school students. Data were derived from the Centers for Disease Control and Prevention's 1999, 2001, and 2003 national Youth Risk Behavior Surveys, which are cross-sectional surveys of health risk behaviors among high school students in the United States. In 2003, 1 in 7 (14.2%) high school students reported routine sunscreen or sunblock use, and this behavior varied by sex, race/ethnicity, grade in school, and geographic region. The use of sunscreen or sunblock with a sun protection factor of 15 or higher when outside for more than 1 hour on a sunny day did not change from 1999 to 2003. Parent and child education about the importance of skin cancer prevention practices, including sunscreen use, and a school environment supportive of sun-safe practices are necessary to help reduce risk for skin cancer.     

Does being a “SunSmart School” influence hat-wearing compliance? An ecological study of hat-wearing rates at Australian primary schools in a region of high sun exposure

BackgroundChildhood sun exposure is an important risk factor for skin cancer. Anecdotal evidence suggests that hats are under-utilized by Australian primary school students.MethodsThe proportion of students and adult role-models wearing hats was observed at 36 primary schools (63.9% SunSmart schools [SSS]) in Townsville (latitude 19.3°S; high to extreme maximum daily UV-index year round), Queensland, Australia, from 2009 to 2011.ResultsOverall, 52.2% of 28,775 students and 47.9% of 2954 adults were observed wearing a hat. Hat use (all styles) among SSS and non-SunSmart school (NSSS) students was similar before (24.2% vs 20.5%; p = 0.701), after (25.4% vs 21.7%; p = 0.775) and during school-hours (93.0% vs 89.2%; p = 0.649) except SSS students wore gold-standard (broad-brim/bucket/legionnaire) hats during school play-breaks more often in the warmer months (October–March) than NSSS students (54.7% vs 37.4%; p = 0.02). Although the proportion of adults who wore hats (all styles) was similar at SSS and NSSS (48.2% vs 46.8%; p = 0.974), fewer adults at SSS wore them before school (3.7% vs 10.2%; p = 0.035).ConclusionsSunSmart status is not consistently associated with better hat-wearing behavior. The protective nature of hats and the proportion of school students and adult role-models wearing them could be improved, possibly by offering incentives to schools that promote sun-safety.     

Dietary and Weight-Related Behaviors and Body Mass Index among Hispanic,Hmong, Somali,and White Adolescents

BackgroundThe 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.ObjectiveOur aim was to describe dietary intake and weight-related concerns and behaviors among Hispanic, Hmong, and Somali adolescents and compare them with white adolescents.DesignWe 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/settingCurrent 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 analysisMultivariable 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.ResultsThere 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.ConclusionsThere 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.     

Trends in exposure to pro-tobacco advertisements over the Internet,in newspapers/magazines,and at retail stores among U.S. middle and high school students, 2000–2012

BackgroundMost tobacco use begins during youth. Thus, this study assessed the prevalence, trends, and correlates of pro-tobacco advertising among United States students in grades 6–12 during 2000–2012.MethodsData from the 2000–2012 National Youth Tobacco Survey were analyzed to assess self-reported exposure to pro-tobacco advertisements through three media: over the Internet, in newspapers/magazines, and at retail stores. Trends during 2000–2012 were assessed in a binary logistic regression model (P < 0.05).ResultsAmong all middle and high school students, the overall prevalence of exposure to Internet pro-tobacco advertisements increased from 22.3% to 43.0% during 2000–2012 (P < 0.001 for linear trend). During the same period, declines were observed in the overall prevalence of exposure to pro-tobacco advertisements in newspapers/magazines (65.0% to 36.9%) and at retail stores (87.8% to 76.2%) (P < 0.001 for all linear trends).ConclusionExposure to pro-tobacco advertisements over the Internet increased significantly during 2000–2012 among United States middle and high school students, while a decline in exposure to advertisements in newspapers or magazines, and at retail stores occurred during the same period. However, over two-thirds of students still reported retail store exposure to pro-tobacco advertisements in 2012. Enhanced and sustained efforts would be beneficial to reduce even more exposure to all forms of pro-tobacco advertisements among youths.     

Prevalence and Correlates of Sunscreen Use Among US High School Students

Sun exposure during childhood and adolescence increases the risk of skin cancer later in life. To determine the prevalence and correlates of sunscreen use among US high school students, researchers assessed data on sunscreen use, demographic characteristics, and health behaviors obtained from the 1999 Youth Risk Behavior Survey (YRBS). This survey used a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12 (N = 15,349). Overall, 13.3% (95% confidence interval, +/- 1.3) of students used sunscreen always or most of the time (i.e., frequent use). Frequent sunscreen use was lower among males (8.6%, +/- 1.2) than females (18.1%, +/- 1.9) and among Blacks (4.8%, +/- 1.7) and Hispanics (10.8%, +/- 2.8) than Whites (16.5%, +/- 1.9). Frequent sunscreen use decreased with age. Infrequent use of sunscreen was associated with other risky health behaviors, such as driving after drinking or riding in a car with a drinking driver, smoking cigarettes, being sexually active, and being physically inactive. Results indicate a need for health education interventions addressing sunscreen use that target high school students.     

Peer Reviewed: Risks to Health Among American Indian/Alaska Native High School Students in the United States

Introduction

According to the World Health Organization, the 10 leading risk factor causes of death in high-income countries are tobacco use, high blood pressure, overweight and obesity, physical inactivity, high blood glucose, high cholesterol, low fruit and vegetable intake, urban air pollution, alcohol use, and occupational risks. We examined the prevalence of some of the leading risks to health among nationally representative samples of American Indian/Alaska Native (AI/AN) high school students and compared rates across racial/ethnic groups.

Methods

We combined data from the 2001, 2003, 2005, 2007, and 2009 national Youth Risk Behavior Survey. The survey is a biennial, self-administered, school-based survey of 9th- through 12th-grade students in the United States. Overall response rates for the surveys ranged from 63% to 72%. Of 73,183 participants, 952 were AI/AN students.

Results

For 7 of the 16 variables examined in this study, the prevalence among AI/AN high school students was higher than the prevalence among white high school students. For 1 variable (ate fruit and vegetables <5 times per day), the prevalence among AI/AN students was significantly lower than that among white students. The prevalence for the remaining 8 variables was similar among AI/AN students and white students. These findings also show differences in the prevalence of some behaviors among AI/AN, black, and Hispanic students.

Conclusion

These findings show the prevalence of some health risk behaviors was significantly higher among AI/AN high school students than among high school students in other racial/ethnic groups.     

Driver and passenger seatbelt use among U.S. high school students

BACKGROUND: In 2005, 40% of motor-vehicle occupant deaths in the group aged 16-19 years involved passengers. Although seatbelts can reduce crash mortality by 50% or more, little is known about the differences in driver-versus-passenger seatbelt use among teens. METHODS: In 2007, data from the 2001 and 2003 Youth Risk Behavior Surveys were analyzed for 12,731 black, white, and Hispanic high school students aged >/=16 years reporting seatbelt use as both drivers and passengers. Seatbelt use was compared for driver- and passenger-seat positions, and stratified by age, gender, race/ethnicity, school grades, and histories of either drinking and driving or riding with a drinking driver. RESULTS: Overall, 59% of students always used seatbelts when driving, but only 42% always buckled up as passengers. Across all covariate strata, passenger seatbelt use was significantly less prevalent than driver seatbelt use (p<0.001). A concordance analysis showed that only 38% of students always wore seatbelts both when driving and while riding as a passenger. Multivariate analyses indicated that, regardless of seat position, seatbelt use was lower for young men, blacks, students with poor grades, and students who reported either drinking and driving or riding with a drinking driver. CONCLUSIONS: U.S. high school students aged >/=16 years are significantly less likely to wear seatbelts as passengers than as drivers. Interventions designed to promote seatbelt use among teens need to address this disparity.     

Association of childhood and teen school performance and obesity in young adulthood in the US National Longitudinal Survey of Youth

BackgroundThe literature suggests an association between poor school performance and obesity. However, little is known about academic achievement and behavior as possible risk factors for future obesity.MethodThe analysis was based on data from 3172 participants aged 6 to 25 years from the US National Longitudinal Survey conducted 1986 to 2010. Academic achievement, behavior problems and body mass index (BMI) were assessed at childhood (6–9) and teenhood (10–14). Height and weight were self-reported at pre-young adulthood (15–18) and young adulthood (19–25).ResultsBased on logistic regression stratified by sex and race/ethnicity, academic and behavioral deficiencies during childhood and teenhood were risk factors for young adult obesity with some sex and ethnic/racial differences. The highest prevalence rates of obesity by race/ethnicity and sex are as follows: black/Hispanic females, those in the lowest quartile of teen reading and math (32.8%); black/Hispanic males, those in lowest quartile of teen reading (26.1%); white males, those in the highest quartile of behavioral problems (21.9%); and white females, those in the lowest quartile teen math (23.2%).ConclusionPoor school performance in childhood and teenhood is associated with an increased risk of adult obesity. Prospective studies should further examine the association of school performance and adult obesity and whether programs directed at improving school performance may have secondary gains in preventing obesity.     

Flavored-Little-Cigar and Flavored-Cigarette Use Among U.S. Middle and High School Students

PurposeFlavors can mask the harshness and taste of tobacco, making flavored tobacco products appealing to youth. We assessed the prevalence and correlates of flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students in 2011.MethodsData were obtained from the 2011 National Youth Tobacco Survey, a nationally representative school-based survey of U.S. students in grades 6–12. National estimates of current flavored-little-cigar use, flavored-cigarette use, and combined use of either product were calculated overall and among current smokers by respondent characteristics, including sex, race/ethnicity, school level, and grade. Additionally, intention to quit tobacco and smoking frequency were assessed by flavored product use.ResultsThe overall prevalence of current use was 4.2% for flavored cigarettes, 3.3% for flavored little cigars, and 6.3% for either product. Among current cigar smokers, 35.9% reported using flavored little cigars, and among current cigarette smokers, 35.4% reported using flavored cigarettes. Among current cigar or cigarette smokers, 42.4% reported using flavored little cigars or flavored cigarettes. Flavored product use among current smokers was higher among non-Hispanic whites than among blacks and Hispanics, higher among high school students than middle school students, and increased with grade. Among cigar smokers, prevalence of no intention to quit tobacco was higher among flavored-little-cigar users (59.7%) than nonusers (49.3%).ConclusionsMore than two fifths of U.S. middle and high school smokers report using flavored little cigars or flavored cigarettes, and disparities in the use of these products exist across subpopulations. Efforts are needed to reduce flavored tobacco product use among youth.     

Disparities in gestational age–specific fetal mortality rates in the United States, 2009–2013

PurposeAlthough studies have examined overall temporal changes in gestational age–specific fetal mortality rates, there is little information on the current status of racial/ethnic differences. We hypothesize that differences exist between racial/ethnic groups across gestational age and that these differences are not equally distributed.MethodsUsing the 2009–2013 data from US fetal death and live birth files for non-Hispanic white (NHW); non-Hispanic black (NHB); Hispanic; and American Indian/Alaska Native (AIAN) women, we conducted analyses to examine fetal mortality rates and estimate adjusted prevalence rate ratios and 95% confidence intervals (CIs).ResultsThere were lower risks of fetal mortality among NHB women (aPRR = 0.76; 95% CI = 0.71–0.81) and Hispanic women (aPRR = 0.89; 95% CI = 0.83–0.96) compared with NHWs at 22–23 weeks’ gestation. For NHB women, the risk was higher starting at 32–33 weeks (aPRR = 1.11; 95% CI = 1.04–1.18) and continued to increase as gestational age increased. Hispanic and AIAN women had lower risks of fetal mortality compared with NHW women until 38–39 weeks.ConclusionsFurther examination is needed to identify causes of fetal death within the later pregnancy period and how those causes and their antecedents might differ by race and ethnicity.     

Recent Changes in the Trends of Teen Birth Rates, 1981–2006

PurposeTo explore trends in teen birth rates by selected demographics.MethodsWe used birth certificate data and joinpoint regression to examine trends in teen birth rates by age (10–14, 15–17, and 18–19 years) and race during 1981–2006 and by age and Hispanic origin during 1990–2006. Joinpoint analysis describes changing trends over successive segments of time and uses annual percentage change (APC) to express the amount of increase or decrease within each segment.ResultsFor teens younger than 18 years, the decline in birth rates began in 1994 and ended in 2003 (APC: ?8.03% per year for ages 10–14 years; APC: ?5.63% per year for ages 15–17 years). The downward trend for 18- and 19-year-old teens began earlier (1991) and ended 1 year later (2004) (APC: ?2.37% per year). For each study population, the trend was approximately level during the most recent time segment, except for continuing declines for 18- and 19-year-old white and Asian/Pacific Islander teens. The only increasing trend in the most recent time segment was for 18- and 19-year-old Hispanic teens. During these declines, the age distribution of teens who gave birth shifted to slightly older ages, and the percentage whose current birth was at least their second birth decreased.ConclusionsTeen birth rates were generally level during 2003/2004–2006 after the long-term declines. Rates increased among older Hispanic teens. These results indicate a need for renewed attention to effective teen pregnancy prevention programs in specific populations.     

Racial Differences in Obesity Risk Knowledge among Low-Income Reproductive-Age Women

Objective: To examine the level of obesity risk knowledge (ORK) among reproductive-age women and racial differences associated with it.

Methods: We conducted this study based on cross-sectional data gathered from 1153 (310 whites, 491 blacks, 335 Hispanics, and 17 others) low-income women (16–40 years old) attending publicly funded reproductive health clinics in Texas during 2010–2011. Data were collected through self-administered questionnaires that assessed sociodemographics and ORK based on ORK-10 scale.

Results: The mean score was 5.9, 5.3, and 5.3 (possible score 0–10) for whites, blacks, and Hispanics, respectively. Acculturated Hispanic women had mean ORK scores (mean score 5.8) similar to scores of whites. Multiple linear regression analysis after adjusting for confounders showed that ORK score was lower among black (β coefficient = ?0.6; p < 0.001) and Hispanic (β coefficient = ?0.4; p = 0.002) women than among white women. Age, high school diploma or college level education, and Internet use, but not obesity status, were associated with higher ORK scores.

Conclusion: In general, obesity risk knowledge was low among low-income reproductive-age women, and knowledge scores were even lower among minority women. Strategies to incorporate ORK into obesity awareness and prevention programs should be formulated.     

Patterns of Current Use of Tobacco Products Among U.S. High School Students for 2000–2012—Findings From the National Youth Tobacco Survey

PurposeThe purpose of this study was to assess patterns and trends of tobacco use among high school students to better understand which products are used individually or concurrently.MethodsData from the National Youth Tobacco Survey from 2000 through 2012 were used to assess patterns and trends of current tobacco use (cigarettes, cigars, smokeless tobacco, and other tobacco products) among U.S. high school students. We assessed use of products individually and concurrently.ResultsDuring 2000–2012, overall linear declines were observed in current use of any tobacco product from 33.6% to 20.4% (p < .05), current use of only 1 tobacco product, from 18.8% to 10.5% (p < .05), and current poly tobacco use, from 14.7% to 9.9% (p < .05), among high school students. Overall current use of only cigarettes had both a linear decline, from 14.0% to 4.7%, as well as a quadratic trend.ConclusionsDuring 2000–2012, the most significant overall decline observed was for students who reported smoking only cigarettes. The results suggest that more data on the use of multiple tobacco products, not just cigarettes, is needed to guide tobacco prevention and control policies and programs.     

Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution

BackgroundDespite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payer source, provider gender) factors accounted for any observed differences by ethnicity/race.MethodsOur retrospective cohort study used logistic regression to evaluate the relationship between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital.ResultsStatistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95% confidence interval, 1.03–6.01) and Black women (adjusted odds ratio, 2.83; 95% confidence interval, 1.67–4.81) had higher odds of RCD than White women.ConclusionsAdjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.     

Differences between Hispanic and non-Hispanic white women with breast cancer for clinical characteristics and their correlates

PurposeBody size and ethnicity may influence breast cancer tumor characteristics at diagnosis. We compared Hispanic and non-Hispanic white (NHW) cases for stage of disease, estrogen receptor (ER) status, tumor size, and lymph node status, and the associations of these with body size in the 4-Corners Breast Cancer Study.MethodsOne thousand five hundred twenty-seven NHW and 798 Hispanic primary incident breast cancer cases diagnosed between October 1999 and May 2004 were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multiple logistic regression.ResultsHispanic women were more likely to have larger (>1 cm) ER? tumors and more than four positive lymph nodes (P < .003). Lymph node status was not associated with body size. However, among NHW women, obesity (body mass index >30) and increased waist circumference (>38.5 inches) were significantly positively associated with ER? tumor status (OR, 1.87; 95% CI, 1.24–2.81 and OR, 2.59; 95% CI, 1.58–4.22, respectively). In contrast, among Hispanic women, obesity and waist circumference had inverse associations with ER? tumor status (OR, 0.49; 95% CI, 0.29–0.84 and OR, 0.56; 95% CI, 0.30–1.05, respectively).ConclusionsHispanic ethnicity may modify the association of body size and composition with ER? breast cancer. This finding could have relevance to clinical treatment and prognosis.