Perspective: Teaching Kitchens: Conceptual Origins, Applications and Potential for Impact within Food Is Medicine Research.

There is a need to identify innovative strategies whereby individuals, families, and communities can learn to access and prepare affordable and nutritious foods, in combination with evidence-based guidance about diet and lifestyle. These approaches also need to address issues of equity and sustainability. Teaching Kitchens (TKs) are being created as educational classrooms and translational research laboratories to advance such strategies. Moreover, TKs can be used as revenue-generating research sites in universities and hospitals performing sponsored research, and, potentially, as instruments of cost containment when placed in accountable care settings and self-insured companies. Thus, TKs can be considered for inclusion in future health professional training programs, and the recently published Biden-Harris Administration Strategy on Hunger, Nutrition and Health echoes this directive. Recent innovations in the ability to provide TK classes virtually suggest that their impact may be greater than originally envisioned. Although the impact of TK curricula on behaviors, outcomes and costs of health care is preliminary, it warrants the continued attention of medical and public health thought leaders involved with Food Is Medicine initiatives.

Alterations in Fecal Short-Chain Fatty Acids after Bariatric Surgery: Relationship with Dietary Intake and Weight Loss.

Bariatric surgery is associated with weight loss attributed to reduced caloric intake, mechanical changes, and alterations in gut hormones. However, some studies have suggested a heightened incidence of colorectal cancer (CRC) has been associated with bariatric surgery, emphasizing the importance of identifying mechanisms of risk. The objective of this study was to determine if bariatric surgery is associated with decreases in fecal short-chain fatty acids (SCFA), a group of bacterial metabolites of fiber. Fecal samples (n = 22) were collected pre- (~6 weeks) and post-bariatric surgery (~4 months) in patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. SCFA levels were quantified using liquid chromatography/mass spectrometry. Dietary intake was quantified using 24-h dietary recalls. Using an aggregate variable, straight SCFAs significantly decreased by 27% from pre- to post-surgery, specifically acetate, propionate, butyrate, and valerate. Pre-surgery weight was inversely associated with butyrate, with no association remaining post-surgery. Multiple food groups were positively (sugars, milk, and red and orange vegetables) and inversely (animal protein) associated with SCFA levels. Our results suggest a potential mechanism linking dietary intake and SCFA levels with CRC risk post-bariatric surgery with implications for interventions to increase SCFA levels.

A national evaluation of geographic accessibility and provider availability of obesity medicine diplomates in the United States between 2011 and 2019.

BACKGROUND/OBJECTIVES: Obesity is a pressing health concern within the United States (US). Obesity medicine "diplomates" receive specialized training, yet it is unclear if their accessibility and availability adequately serves the need. The purpose of this research was to understand how accessibility has evolved over time and assess the practicality of serving an estimated patient population with the current distribution and quantity of diplomates. METHODS: Population-weighted Census tracts in US counties were mapped to the nearest facility on a road network with at least one diplomate who specialized in adult (including geriatric) care between 2011 and 2019. The median travel time for all Census tracts within a county represented the primary geographic access measure. Availability was assessed by estimating the number of diplomates per 100 000 patients with obesity and the number of facilities able to serve assigned patients under three clinical guidelines. RESULTS: Of the 3371 diplomates certified since 2019, 3036 were included. The median travel time (weighted for county population) fell from 28.5 min [IQR: 13.7, 68.1] in 2011 to 9.95 min [IQR: 7.49, 18.1] in 2019. There were distinct intra- and inter-year travel time variations by race, ethnicity, education, median household income, rurality, and Census region (all P < 0.001). The median number of diplomates per 100 000 with obesity grew from 1 [IQR: 0.39, 1.59] in 2011 to 5 [IQR: 2.74, 11.4] in 2019. In 2019, an estimated 1.7% of facilities could meet the recommended number of visits for all mapped patients with obesity, up from 0% in 2011. CONCLUSIONS: Diplomate geographic access and availability have improved over time, yet there is still not a high enough supply to serve the potential patient demand. Future studies should quantify patient-level associations between travel time and health outcomes, including whether the number of available diplomates impacts utilization.

Willingness to pay for a telemedicine-delivered healthy lifestyle programme.

INTRODUCTION: Effective weight-management interventions require frequent interactions with specialised multidisciplinary teams of medical, nutritional and behavioural experts to enact behavioural change. However, barriers that exist in rural areas, such as transportation and a lack of specialised services, can prevent patients from receiving quality care. METHODS: We recruited patients from the Dartmouth-Hitchcock Weight & Wellness Center into a single-arm, non-randomised study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Every 4 weeks, participants completed surveys that included their willingness to pay for services like those experienced in the intervention. A two-item Willingness-to-Pay survey was administered to participants asking about their willingness to trade their face-to-face visits for videoconference visits based on commute and copay. RESULTS: Overall, those with a travel duration of 31-45 min had a greater willingness to trade in-person visits for telehealth than any other group. Participants who had a travel duration less than 15 min, 16-30 min and 46-60 min experienced a positive trend in willingness to have telehealth visits until Week 8, where there was a general negative trend in willingness to trade in-person visits for virtual. Participants believed that telemedicine was useful and helpful. CONCLUSIONS: In rural areas where patients travel 30-45 min a telemedicine-delivered, intensive weight-loss intervention may be a well-received and cost-effective way for both patients and the clinical care team to connect.

Exposure to Television Alcohol Brand Appearances as Predictor of Adolescent Brand Affiliation and Drinking Behaviors.

Adolescence and the transition to adulthood is an important developmental stage in the emergence of health risk behaviors, specifically underage alcohol use. Adolescents consume a tremendous amount of screened media (primarily streamed television), and media depictions of behaviors is prospectively linked to youth initiation of behaviors. With the arrival of streamed media technology, alcohol advertising can be nested within television content. This study describes alcohol brand depictions in television and evaluates impact of exposure to such depictions on adolescent drinking outcomes. A national sample of 2012 adolescents (Mage = 17.07; SD = 1.60 years, range 15-20; 50.70% female) reported on television viewership, alcohol brand affiliation, and drinking behavior, with follow-up one year later. Ten series (that remain relevant to youth today) across television ratings from a single television season were content coded for presence/salience of alcohol brand appearances. Adjusting for covariates (e.g., peer/parent drinking, youth sensation seeking, movie alcohol brand exposure), higher exposure to brand appearances in the television shows was associated with youth drinking. Aspirational and usual brand to drink corresponded to television alcohol brand prominence, and television brand exposure was independently associated with drinking initiation and hazardous drinking.

Impact of Diet and Exercise on Weight and Cognition in Older Adults: A Rapid Review.

OBJECTIVE: To determine where the current literature stands in regard to diet/exercise interventions on cognition in overweight or obese individuals. DATA SOURCE: A rapid review was conducted of English-language studies published in Medline from January 1965 to January 2020. STUDY INCLUSION AND EXCLUSION CRITERIA: Included studies were intervention studies lasting ≥12 weeks, with participants aged ≥65 years, with a body mass index ≥25 kg/m2. DATA EXTRACTION: Data extracted included study population, duration, intervention design, outcomes, and results. DATA SYNTHESIS: Outcomes were qualitatively measured due to paucity of RTC. RESULTS: 1845 citations were identified, 31 full-text articles were reviewed, and 5 studies were included. Studies had usual care control groups and combined exercise/diet intervention groups with 31-3,526 participants randomized to each arm. Mean age of participants was 69.2-83.4 years. Studies reporting on cognitive changes showed marginally significant positive changes in cognition, and those that reported BMI indicated potential improvements in cognition. CONCLUSIONS: The number of interventions assessing the combined effects of both diet and exercise is low. Future studies should evaluate the impact of combined effects to ascertain whether cognitive decline may be reversed in older adults with a BMI ≥25 kg/m2.

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic.

PURPOSE: Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. METHODS: A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation and exploratory measures of program adoption and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interviews. We evaluated elements of the RE-AIM model (reach, adoption) to assess staff barriers to success for future scalability. FINDINGS: There were 27 patients and 8 staff completing measures. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. CONCLUSIONS: The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity. TRIAL REGISTRATION: Clinicaltrials.gov NCT03309787. Registered on 16 October 2017.

Internet Alcohol Marketing Recall and Drinking in Underage Adolescents.

OBJECTIVE: Evidence suggests that adolescents are exposed to alcohol marketing in digital media. We aimed to assess recall of Internet alcohol marketing and its association with underage drinking. METHODS: New England adolescents age 12 to 17 years (N = 202) were recruited from a pediatric clinic. Subjects completed an online survey assessing: 1) general simple recall of Internet alcohol marketing and 2) image-prompted recall of specific Internet alcohol marketing channels (display ads, commercials, brand websites, and brand social media pages). Cross-sectional associations between recall (simple and image-prompted) and ever-drinking were each assessed in regression analysis adjusting for age, gender, race, parent education, ever-smoking, media use, sensation-seeking, peer/parent drinking, parent monitoring/responsiveness, and parent Internet monitoring. RESULTS: In this sample (Mage = 14.5 years; 55% female; 89% white; high parent education), 20% reported ever-drinking and 87% recalled Internet alcohol marketing. Of the latter, 67% recalled display ads, 67% Internet commercials, 5% websites, and 5% social media pages. In logistic regression, higher simple Internet alcohol advertising recall was independently associated with higher odds of ever-drinking for simple (adjusted odds ratio: 2.66 [1.04,6.83]) but not for image-prompted recall. CONCLUSIONS: Despite controlling for potential confounders, simple recall of Internet alcohol marketing was significantly associated with underage drinking whereas image-prompted recall was significant only in bivariate analysis, likely due to small sample and a more limited range of specific channels assessed than those accessed by adolescents. Further longitudinal studies using image-prompted recall and capturing a broader range of internet platforms could be used to better understand adolescent engagement with alcohol marketing and guide policy and prevention efforts.

A New Recall of Alcohol Marketing Scale for Youth: Measurement Properties and Associations With Youth Drinking Status.

OBJECTIVE: Adolescents are exposed to alcohol marketing through traditional advertising and through newer digital media channels. Cumulative marketing exposure across channels is of concern but has been insufficiently studied. This study explores the measurement of alcohol marketing exposure across channels and whether cumulative recalled exposure is independently associated with underage drinking. METHOD: Two hundred two New England adolescents (ages 12-17 years) were recruited from a general pediatrics clinic and completed an online survey. Recall of alcohol marketing across channels (e.g., Internet, magazines) was assessed, along with drinking behavior and relevant covariates (i.e., demographics, parental/peer drinking, smoking status, sensation seeking, Internet use, social media use, television use, and parental Internet monitoring). Confirmatory factor analysis was used to establish a latent construct of alcohol marketing exposure recall. Logistic regression tested associations between alcohol marketing recall and adolescent drinking, with covariates controlled for. RESULTS: Adolescents reported recall of alcohol marketing across all marketing channels. Alcohol marketing recall items were significantly correlated, with α = .83. The latent measurement model of alcohol marketing recall provided excellent fit to the data, χ2(17, n = 202) = 27.402, p = .052; root mean square error of approximation (.000-.092) = .055; Tucker-Lewis Index = .960; comparative fit index = .976; standardized root mean square residual = .037). Adjusted cross-sectional logistic regression analyses demonstrated that the latent alcohol marketing recall construct was significantly associated with underage drinking (adjusted odds ratio = 4.08, 95% CI [1.15, 14.46]) when relevant covariates were accounted for. CONCLUSIONS: The final measurement model provided support for construct validity of a novel alcohol marketing recall construct assessing cumulative cross-channel marketing exposure. Adolescent recall of alcohol marketing across channels was significantly associated with underage drinking, while associated factors such as peer/parental drinking were accounted for.

Prevalence of Sarcopenia Obesity in Patients Treated at a Rural, Multidisciplinary Weight and Wellness Center.

Sarcopenic obesity portends poor outcomes, yet it is under-recognized in practice. We collected baseline clinical data including data on body composition (total and segmental muscle mass and total body fat), grip strength, and 5-times sit-to-stand. We defined sarcopenia using cut-points for appendicular lean mass (ALM) and obesity using body-fat cut-points. A total of 599 clinic patients (78.5% female; mean age was 51.3 ± 14.2 years) had bioelectrical impedance analysis (BIA) data (83.8%). Mean body mass index (BMI) and waist circumference were 43.1 ± 8.9 kg/m2 and 132.3 ± 70.7 cm, respectively. All patients had elevated body fat. There were 284 (47.4%) individuals fulfilling criteria for ALM-defined sarcopenia. Sarcopenic obese persons had a lower BMI (38.2 ± 6.4 vs 47.6 ± 8.6; P < 0.001), fat-free mass (113.0 kg ± 16.1 vs 152.1 kg ± 29.4; P < 0.001), fat mass (48.4% ± 5.9 vs 49.5% ± 6.2; P = 0.03), and visceral adipose tissue (216.8 ± 106.3 vs 242.7 ± 133.6 cm3; P = 0.009) than those without sarcopenic obesity. Grip strength was lower in those with sarcopenic obesity (25.1 ± 8.0 vs 30.5 ± 11.3 kg; P < 0.001) and sit-to-stand times were longer (12.4 ± 4.4 vs 10.8 second ± 4.6; P = 0.03). Sarcopenic obesity was highly prevalent in a rural, tertiary care weight and wellness center.

A 4-Year Integrated Nutrition Curriculum for Medical Student Education.

While poor diet is the one of the primary contributors to death and disability in the USA, formal nutrition education in medical schools across the nation remains sparse. As it stands, few medical schools have formally incorporated nutrition education, and fewer still have integrated nutrition into the entire length of their 4-year curriculum. We describe how a new, formally integrated, 4-year nutrition curriculum was developed and is being implemented in a US medical school, and how this program will evolve as part of a twenty-first century medical school education.

Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme.

BACKGROUND: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. METHODS: Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. RESULTS: Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 ± 11.6 years (88.9% female), with a mean body mass index of 41.3 ± 7.1 kg/m2 and mean waist circumference of 120.7 ± 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 ± 0.58 on 1-5 Likert scale-low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 ± 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed. CONCLUSION: A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.

Aspirational Brand Choice and Underage Alcohol Use.

OBJECTIVE: Marketing aims to foster brand allegiance, and alcohol is a heavily marketed commodity. We hypothesize that exposed youth who are able to identify an aspirational alcohol brand will be at higher risk for underage drinking. METHOD: U.S. youth ages 15-20 (N = 2,012; 51% female) were surveyed twice in 2011-2013. Aspirational brand was assessed by asking, "If you could drink any brand you want, what is the name of the brand of alcohol you would choose?" Multivariable logistic regression tested associations between having an aspirational brand at baseline and onset of ever, binge (≥6 drinks/occasion), and hazardous drinking (Alcohol Use Disorders Identification Test-Consumption ≥ 4). RESULTS: Baseline ever, binge, and hazardous drinking prevalence was 55%, 26%, and 19%, respectively; 47% reported having an aspirational brand, of whom 20% were nondrinkers. Top five reported brands were Budweiser, Smirnoff, Corona, Jack Daniels, and Bacardi, all heavily advertised brands. Older age, male gender, sensation seeking, and peer/parent drinking were associated with having an aspirational brand. After we controlled for these confounders, having an aspirational brand was independently associated cross-sectionally with greater risk of ever, binge, and hazardous drinking (adjusted odds ratio = 4.47, 95% CI [3.33, 6.00], 4.84 [3.41, 6.86], and 5.46 [3.63, 8.23], respectively) and longitudinally with initiation of binge and hazardous drinking (1.80 [1.19, 2.73] and 2.02 [1.33, 3.06], respectively). CONCLUSIONS: Having an aspirational alcohol brand is both common and independently associated with subsequent underage alcohol use and misuse. Further studies examining how youth interact with and are affected by branded advertising are critical to guide development of effective education and policy interventions.

Internet Alcohol Marketing and Underage Alcohol Use.

BACKGROUND AND OBJECTIVE: Internet alcohol marketing is not well studied despite its prevalence and potential accessibility and attractiveness to youth. The objective was to examine longitudinal associations between self-reported engagement with Internet alcohol marketing and alcohol use transitions in youth. METHODS: A US sample of 2012 youths aged 15 to 20 was surveyed in 2011. An Internet alcohol marketing receptivity score was developed, based on number of positive responses to seeing alcohol advertising on the Internet, visiting alcohol brand Web sites, being an online alcohol brand fan, and cued recall of alcohol brand home page images. We assessed the association between baseline marketing receptivity and both ever drinking and binge drinking (≥6 drinks per occasion) at 1-year follow-up with multiple logistic regression, controlling for baseline drinking status, Internet use, sociodemographics, personality characteristics, and peer or parent drinking. RESULTS: At baseline, ever-drinking and binge-drinking prevalence was 55% and 27%, respectively. Many (59%) reported seeing Internet alcohol advertising, but few reported going to an alcohol Web site (6%) or being an online fan (3%). Higher Internet use, sensation seeking, having family or peers who drank, and past alcohol use were associated with Internet alcohol marketing receptivity, and a score of 1 or 2 was independently associated with greater adjusted odds of initiating binge drinking (odds ratio 1.77; 95% confidence interval, 1.13-2.78 and odds ratio 2.15; 95% confidence interval, 1.06-4.37 respectively) but not with initiation of ever drinking. CONCLUSIONS: Although high levels of engagement with Internet alcohol marketing were uncommon, most underage youths reported seeing it, and we found a prospective association between receptivity to this type of alcohol marketing and future problem drinking, making additional research and ongoing surveillance important.

Cued recall of alcohol advertising on television and underage drinking behavior.

IMPORTANCE: Alcohol is the most common drug among youth and a major contributor to morbidity and mortality worldwide. Billions of dollars are spent annually marketing alcohol. OBJECTIVE: To examine the reach of television alcohol advertising and its effect on drinking among underage youth. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal telephone- and web-based surveys conducted in 2011 and 2013 involving 2541 US adolescents 15 to 23 years of age at baseline, with 1596 of these adolescents completing the follow-up survey. Cued recall of television advertising images for top beer and distilled spirits brands that aired nationally in 2010-2011 (n = 351). Images were digitally edited to remove branding, and the respondents were queried about 20 randomly selected images. An alcohol advertising receptivity score was derived (1 point each for having seen the ad and for liking it, and 2 points for correct brand identification). Fast-food ads that aired nationally in 2010-2011 (n = 535) were similarly queried to evaluate message specificity. MAIN OUTCOMES AND MEASURES: Among the underage youth at baseline, we determined (1) the onset of drinking among those who never drank, (2) the onset of binge drinking among those who were never binge drinkers, and (3) the onset of hazardous drinking among those with an Alcohol Use Disorders Identification Test consumption subscore of less than 4. Multivariate regressions were used to predict each outcome, controlling for covariates (demographics, drinking among friends and parents, and sensation seeking), weighting to the US population, and using multiple imputation to address loss to follow-up. RESULTS: Underage participants were only slightly less likely than participants of legal drinking age to have seen alcohol ads (the mean percentage of ads seen were 23.4%, 22.7%, and 25.6%, respectively, for youth 15-17, 18-20, and 21-23 years of age; P < .005). The transition to binge and hazardous drinking occurred for 29% and 18% of youth 15 to 17 years of age and for 29% and 19% of youth 18 to 20 years years of age, respectively. Among underage participants, the alcohol advertising receptivity score independently predicted the onset of drinking (adjusted odds ratio [AOR], 1.69 [95% CI, 1.17-2.44]), the onset of binge drinking (AOR, 1.38 [95% CI, 1.08-1.77]), and the onset of hazardous drinking (AOR, 1.49 [95% CI, 1.19-1.86]). Fast-food advertising receptivity was not associated with any drinking outcome. CONCLUSIONS AND RELEVANCE: Receptivity to television alcohol advertising predicted the transition to multiple drinking outcomes. The findings are consistent with the idea that marketing self-regulation has failed to keep television alcohol advertising from reaching large numbers of underage persons and affecting their drinking patterns.

Receptivity to and recall of alcohol brand appearances in U.S. popular music and alcohol-related behaviors.

BACKGROUND: The average U.S. adolescent is exposed to about 2.5 hours of popular music and 8 mentions of alcohol brands every day. Alcohol brand mentions may function as advertising whether or not they are sanctioned by the alcohol industry. Our study aimed to determine associations between adolescents' involvement with music containing alcohol brand mentions and alcohol-related behaviors. METHODS: In 2010 to 2011, we conducted a random-digit-dial survey using national U.S. land line and cell phone frames. Through screening interviews, we identified 6,466 eligible households with subjects between 15 and 23 years of age, of whom 3,422 (53%) completed the telephone survey. Of these, 2,541 opted to participate in a subsequent web-based component. Independent variables included a composite score indicating owning and liking popular songs with alcohol brand mentions and correct recall of alcohol brands in songs. Outcome measures included ever having consumed a complete drink, ever bingeing, bingeing at least monthly, and having experienced problems from alcohol use. RESULTS: Among the 2,541 participants, compared with those in the lowest tertile on the receptivity scale, those in the highest tertile had higher odds of having had a complete drink (OR = 3.4; 95% CI = 2.2, 5.2) after adjusting for age, sex, race/ethnicity, socioeconomic status, sensation seeking, friend alcohol use, and parent alcohol use. Compared with those who did not identify at least 1 alcohol brand correctly, those who did had over twice the odds of having had a complete drink (OR = 2.1; 95% CI = 1.2, 3.8) after adjusting for all covariates. Results were also significant for the outcome of ever bingeing, but not for bingeing at least monthly or having had problems due to drinking. CONCLUSIONS: In a national sample of U.S. adolescents and young adults, there were independent associations between involvement with popular music containing alcohol brand mentions and both having ever had a complete drink and having ever binged on alcohol.

Association of a television in the bedroom with increased adiposity gain in a nationally representative sample of children and adolescents.

IMPORTANCE: Obesity affects health in children and adolescents. Television viewing is an established risk factor for obesity in youth. No prospective study has assessed whether a bedroom television confers an additional risk for obesity in youth. OBJECTIVE: To assess the prospective association between the presence of a bedroom television and change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), independent of television viewing, in a nationally representative sample of US children and adolescents. DESIGN, SETTING, AND PARTICIPANTS: We conducted a random-digit prospective telephone survey that captured children and adolescents from across the United States. Participants included 6522 boys and girls aged 10 to 14 years at baseline who were surveyed via telephone about media risk factors for obesity.Weighted regressions assessed adiposity at 2- and 4-year follow-up, controlling for television and movie viewing, video-game playing, parenting, age, sex, race or ethnicity, household income, and parental educational level. EXPOSURE: Report of having a television in the bedroom at baseline. MAIN OUTCOMES AND MEASURES: Age- and sex-adjusted BMI based on self-report and parent report of weight and height at 2- and 4-year follow-up. RESULTS: Distributions for age, sex, race or ethnicity, and socioeconomic status were similar to census estimates for the US population. Sample weighting methods accounted for higher dropout rates among ethnic minorities and those with lower socioeconomic status. Bedroom televisions were reported by 59.1%of participants at baseline, with boys, ethnic minorities, and those of lower socioeconomic status having significantly higher rates. In multivariate analyses, having a bedroom television was associated with an excess BMI of 0.57 (95%CI, 0.31-0.82) and 0.75 (0.38-1.12) at years 2 and 4, respectively, and a BMI gain of 0.24 (0.02-0.45) from years 2 to 4. CONCLUSIONS AND RELEVANCE: Having a bedroom television is associated with weight gain beyond the effect of television viewing time. This association could be the result of uncaptured effects of television viewing or of disrupted sleep patterns. With the high prevalence of bedroom televisions, the effect attributable to this risk factor among US children and adolescents is excess weight of 8.7 million kg/y.

Receptivity to television fast-food restaurant marketing and obesity among U.S. youth.

BACKGROUND: Advertisement of fast food on TV may contribute to youth obesity. PURPOSE: The goal of the study was to use cued recall to determine whether TV fast-food advertising is associated with youth obesity. METHODS: A national sample of 2541 U.S. youth, aged 15-23 years, were surveyed in 2010-2011; data were analyzed in 2012. Respondents viewed a random subset of 20 advertisement frames (with brand names removed) selected from national TV fast-food restaurant advertisements (n=535) aired in the previous year. Respondents were asked if they had seen the advertisement, if they liked it, and if they could name the brand. A TV fast-food advertising receptivity score (a measure of exposure and response) was assigned; a 1-point increase was equivalent to affirmative responses to all three queries for two separate advertisements. Adjusted odds of obesity (based on self-reported height and weight), given higher TV fast-food advertising receptivity, are reported. RESULTS: The prevalence of overweight and obesity, weighted to the U.S. population, was 20% and 16%, respectively. Obesity, sugar-sweetened beverage consumption, fast-food restaurant visit frequency, weekday TV time, and TV alcohol advertising receptivity were associated with higher TV fast-food advertising receptivity (median=3.3 [interquartile range: 2.2-4.2]). Only household income, TV time, and TV fast-food advertising receptivity retained multivariate associations with obesity. For every 1-point increase in TV fast-food advertising receptivity score, the odds of obesity increased by 19% (OR=1.19, 95% CI=1.01, 1.40). There was no association between receptivity to televised alcohol advertisements or fast-food restaurant visit frequency and obesity. CONCLUSIONS: Using a cued-recall assessment, TV fast-food advertising receptivity was found to be associated with youth obesity.

Alcohol marketing receptivity, marketing-specific cognitions, and underage binge drinking.

BACKGROUND: Exposure to alcohol marketing is prevalent and is associated with both initiation and progression of alcohol use in underage youth. The mechanism of influence is not well understood, however. This study tests a model that proposes alcohol-specific cognitions as mediators of the relation between alcohol marketing and problematic drinking among experimental underage drinkers. METHODS: This study describes a cross-sectional analysis of 1,734 U.S. 15- to 20-year-old underage drinkers, recruited for a national study of media and substance use. Subjects were queried about a number of alcohol marketing variables including TV time, Internet time, favorite alcohol ad, ownership of alcohol-branded merchandise (ABM), and exposure to alcohol brands in movies. The relation between these exposures and current (30-day) binge drinking was assessed, as were proposed mediators of this relation, including marketing-specific cognitions (drinker identity and favorite brand to drink), favorable alcohol expectancies, and alcohol norms. Paths were tested in a structural equation model that controlled for sociodemographics, personality, and peer drinking. RESULTS: Almost one-third of this sample of ever drinkers had engaged in 30-day binge drinking. Correlations between mediators were all statistically significant (range 0.16 to 0.47), and all were significantly associated with binge drinking. Statistically significant mediation was found for the association between ABM ownership and binge drinking through both drinker identity and having a favorite brand to drink, which also mediated the path between movie brand exposure and binge drinking. Peer drinking and sensation seeking were associated with binge drinking in paths through all mediators. CONCLUSIONS: Associations between alcohol marketing and binge drinking were mediated through marketing-specific cognitions that assess drinker identity and brand allegiance, cognitions that marketers aim to cultivate in the consumer.

Comparing media and family predictors of alcohol use: a cohort study of US adolescents.

OBJECTIVE: To compare media/marketing exposures and family factors in predicting adolescent alcohol use. DESIGN: Cohort study. SETTING: Confidential telephone survey of adolescents in their homes. PARTICIPANTS: Representative sample of 6522 US adolescents, aged 10-14 years at baseline and surveyed four times over 2 years. PRIMARY OUTCOME MEASURE: Time to alcohol onset and progression to binge drinking were assessed with two survival models. Predictors were movie alcohol exposure (MAE), ownership of alcohol-branded merchandise and characteristics of the family (parental alcohol use, home availability of alcohol and parenting). Covariates included sociodemographics, peer drinking and personality factors. RESULTS: Over the study period, the prevalence of adolescent ever use and binge drinking increased from 11% to 25% and from 4% to 13%, respectively. At baseline, the median estimated MAE from a population of 532 movies was 4.5 h and 11% owned alcohol-branded merchandise at time 2. Parental alcohol use (greater than or equal to weekly) was reported by 23% and 29% of adolescents could obtain alcohol from home. Peer drinking, MAE, alcohol-branded merchandise, age and rebelliousness were associated with both alcohol onset and progression to binge drinking. The adjusted hazard ratios for alcohol onset and binge drinking transition for high versus low MAE exposure were 2.13 (95% CI 1.76 to 2.57) and 1.63 (1.20 to 2.21), respectively, and MAE accounted for 28% and 20% of these transitions, respectively. Characteristics of the family were associated with alcohol onset but not with progression. CONCLUSION: The results suggest that family focused interventions would have a larger impact on alcohol onset while limiting media and marketing exposure could help prevent both onset and progression.