Maternal rotating night shift work before pregnancy and offspring stress markers.

BACKGROUND: Recent studies suggest an intergenerational influence of stress such that maternal exposure even before pregnancy could impact offspring health outcomes later in life. In humans, investigations on the impact of maternal stressors on offspring health outcomes, including stress-sensitive biomarkers, have largely been limited to extreme stressors. Prior studies have not addressed more moderate maternal stressors, such as rotating night shift work, on offspring stress markers in young adulthood. METHODS: We investigated the association between maternal rotating night shift work before conception and offspring salivary cortisol and alpha amylase (sAA) patterns in young adulthood among mothers enrolled in the Nurses' Health Study II (NHSII) and their offspring participating in the Growing Up Today Study 2 (GUTS2). Our sample included over 300 mother-child pairs where, between 2011 and 2014, the children provided 5 saliva samples over the course of one day. We used piecewise linear mixed models to compare awakening responses, overall slopes as well as several other diurnal patterns of cortisol and sAA between offspring born to shift working versus non-shift working mothers. RESULTS: Offspring born to shift working mothers had a flattened late decline in cortisol (percent differences in slope (%D): 2.1%; 95%CI: 0.3, 3.8) and their sAA awakening response was steeper (%D -37.4%; 95%CI: -59.0, -4.4), whereas sAA increase before bedtime appeared less pronounced (%D -35.9%; 95%CI: -55.3, -8.3), compared to offspring born to mothers without shift work. For cortisol, we observed a significant difference in the Area Under the Curve (AUC) (%D 1.5%; 95%CI: 0.3, 2.7) with higher AUC for offspring of mothers who worked rotating night shifts. In offspring-sex-stratified analyses we found differences primarily among males. CONCLUSION: Our results provide some - albeit modest - evidence that maternal rotating night shift work-a moderate stressor-influences offspring stress markers. Future studies with larger samples sizes, more detailed exposure assessment (particularly during maternal pregnancy), and multiple offspring biomarker assessments at different developmental stages are needed to further investigate these associations.

Racial/ethnic differences in accuracy of body mass index reporting in a diverse cohort of young adults.

Surveillance data describing the weight status of the U.S. population often rely on self-reported height and weight, despite likely differences in reporting accuracy by demographics. Our objective was to determine if there were racial/ethnic differences in accuracy of self-reported body mass index (BMI) in a diverse nationally representative sample of young people. Using data from Wave III (data collected in 2001-2002) of the National Longitudinal Study of Adolescent Health when respondents were aged 18-26, we used gender-stratified multivariable linear regression models to examine the association of race/ethnicity and self-reported BMI controlling for measured BMI while also adjusting for factors known to be associated with weight self-perception. Black males and females (b(Female)=0.45, confidence interval (CI): 0.19, 0.71; b(Male)=0.34, CI: 0.17, 0.51) and Hispanic females (b(Female)=0.30, CI: 0.08, 0.52) and Native American males (b(Native) American=0.87, CI: 0.15, 1.58) reported higher BMIs than their similarly weighted White peers, leading to more accurate BMI reporting in these groups at higher BMIs. Caution should be taken in interpreting results from studies relying on self-reported BMI, as they may exaggerate racial/ethnic differences in weight status.

Prevention Across the Spectrum: a randomized controlled trial of three programs to reduce risk factors for both eating disorders and obesity.

BACKGROUND: A randomized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors. METHOD: A total of 1316 grade 7 and 8 girls and boys (mean age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; the Helping, Encouraging, Listening and Protecting Peers (HELPP) initiative; or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at the 6- and 12-month follow-ups. RESULTS: Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys. A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time than controls. CONCLUSIONS: Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems.

Family ties: maternal-offspring attachment and young adult nonmedical prescription opioid use.

BACKGROUND: Nonmedical prescription drug use is prevalent among young adults, yet little is known about modifiable determinants of use. We examined whether maternal-offspring attachment reported at mean age 21 was associated with nonmedical prescription opioid use at mean age 26, and investigated whether a history of depressive symptoms and substance use played a role in associations between maternal-offspring attachment and nonmedical prescription opioid use. METHODS: We used data from the Growing Up Today Study, a longitudinal cohort of United States adolescents followed into young adulthood. Maternal-offspring attachment was reported by young adults and their mothers, and defined as mutual low, mutual medium or high, and dissonant. Analyses were carried out in the full sample using generalized estimating equation models, and in a sibling subsample, using conditional fixed effects models to control for stable aspects of the family environment. RESULTS: Analyses with the full sample and the sibling subsample both showed that mutual medium/high maternal-offspring attachment at age 21 was associated with lower odds of nonmedical prescription opioid use at age 26 (RR=0.74; 95% CI=0.57-0.97 in full sample). The association was partly mediated by mean age 23 offspring smoking, heavy episodic drinking, and illicit drug use. CONCLUSIONS: Promoting reciprocal attachment in the maternal-offspring dyad should be investigated as a strategy to prevent nonmedical prescription opioid use by young adulthood. Even in young adulthood, programs that target both parents and offspring may have greater impact on offspring substance use than programs that target offspring alone.

Body satisfaction, weight gain and binge eating among overweight adolescent girls.

OBJECTIVE: To examine if body satisfaction is associated with body mass index (BMI) change and whether it protects against the development of frequent binge eating among overweight and obese adolescent girls. METHODS: We used prospective data from nine waves of an ongoing cohort study of adolescents, the Growing Up Today Study. At enrollment in 1996, participants were 9-14 years old. Questionnaires were mailed to participants annually until 2001, then biennially through 2007. Girls who were overweight or obese in 1996 were included in the analysis (n = 1559). Our outcomes were annual change in BMI and incident frequent binge eating, defined as binge eating at least weekly and no use of compensatory behaviors. RESULTS: At baseline, 57.2% of the overweight and obese girls were at least somewhat satisfied with their bodies. During 11 years of follow-up, 9.5% (95% confidence interval (CI) (7.8, 10.8)) of the girls started to binge eat frequently. Controlling for BMI and other confounders, overweight and obese girls who reported being at least somewhat satisfied with their bodies made smaller BMI gains (ß = -0.10 kg m(-2), 95% CI (-0.19, -0.02)) and had 61% lower odds of starting to binge eat frequently (odds ratio (OR) = 0.39, 95% CI (0.24, 0.64)) than their less satisfied peers. Compared with girls who were the least satisfied with their bodies, girls who were the most satisfied had 85% lower odds of starting to binge eat frequently (OR = 0.15, 95% CI (0.06, 0.37)). The association between body satisfaction and starting to binge eat frequently was stronger for younger adolescents than older adolescents. CONCLUSIONS: Whereas body dissatisfaction is common among overweight and obese girls, body satisfaction may protect against excessive weight gain and binge eating. Prevention of body dissatisfaction must begin early and should be considered as a component of both obesity and eating disorder prevention programs.

Snack food intake does not predict weight change among children and adolescents.

OBJECTIVE: To assess whether intake of snack foods was associated with weight change among children and adolescents. METHODS: Prospective study of 8,203 girls and 6,774 boys, 9-14 y of age in 1996, in an ongoing cohort study who completed at least two questionnaires between 1996 and 1999. Intake of snack foods was assessed in 1996-1998 with a validated food frequency questionnaire designed specifically for children and adolescents. The outcome measure was change in age- and gender-specific z-score of body mass index (BMI). RESULTS: Boys consumed more snack foods than girls during the entire study period. After controlling for Tanner stage of development, age, height change, activity, and inactivity, there was no relation between intake of snack foods and subsequent changes in BMI z-score among the boys (beta=-0.004), but snack foods had a weak inverse association (beta=-0.007, P<0.05) with weight change among the girls. However, the results were confounded by dieting status, which had a significant positive independent association with BMI change. After controlling for dieting status and whether the mother was overweight, the association between servings per day of snack foods and subsequent changes in BMI z-score were not significant in either gender. DISCUSSION: Our results suggest that although snack foods may have low nutritional value, they were not an important independent determinant of weight gain among children and adolescents.

Relation between dieting and weight change among preadolescents and adolescents.

OBJECTIVE: To assess whether dieting to control weight was associated with weight change among children and adolescents. METHODS: A prospective study was conducted of 8203 girls and 6769 boys who were 9 to 14 years of age in 1996, were in an ongoing cohort study, and completed at least 2 annual questionnaires between 1996 and 1999. Dieting to control weight, binge eating, and dietary intake were assessed annually from 1996 through 1998 with instruments designed specifically for children and adolescents. The outcome measure was age- and sex-specific z score of body mass index (BMI). RESULTS: In 1996, 25.0% of the girls and 13.8% of the boys were infrequent dieters and 4.5% of the girls and 2.2% of the boys were frequent dieters. Among the girls, the percentage of dieters increased over the following 2 years. Binge eating was more common among the girls, but in both sexes, it was associated with dieting to control weight (girls: infrequent dieters, odds ratio [OR]: 5.10; frequent dieters, OR: 12.4; boys: infrequent dieters, OR: 3.49; frequent dieters, OR: 7.30). During 3 years of follow-up, dieters gained more weight than nondieters. Among the girls, frequency of dieting was positively associated with increases in age- and sex-specific z scores of BMI (beta = 0.05 and beta = 0.04 for frequent and infrequent dieters vs nondieters). Among the boys, both frequent and infrequent dieters gained 0.07 z scores of BMI more than nondieters. In addition, boys who engaged in binge eating gained significantly more weight than nondieters. CONCLUSIONS: Although medically supervised weight control may be beneficial for overweight youths, our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain.

Consumerism: its impact on the health of adolescents.

Marketplace practices are integral to the larger economic and social context of adolescent health risk behaviors. To corporations and marketers, adolescents represent a gold mine of current and future profits. Adolescent incomes increased by almost a third in the 1990s. The annual spending of the U.S. adolescent population is estimated now to have reached 155 billion US dollars. The sheer size of the adolescent population and its spending power are of keen interest to corporations and marketers. This chapter presents a brief history of youth-targeted marketing and examines the major avenues in the media and inside schools that marketers and corporations use today to reach adolescents with their messages and products. It outlines the impact of consumerism and marketing on adolescent health using five case examples: tobacco, alcohol, cosmetic surgery, laxatives, and diet pills. It then concludes with a discussion of resistance efforts, led by health advocates, policy makers, parents, and youth themselves to restrict sales of harmful products to youth and curtail advertisers' access to adolescents in schools. A critical role for adolescent health researchers and advocates is to contribute a public health perspective into ongoing debates over regulating business practices that negatively affect the health of young people.

U.S. federally funded television public service announcements (PSAs) to prevent HIV/AIDS: a content analysis.

This article reports a content analysis of 56 English-language public service announcements (PSAs) for HIV/AIDS prevention produced since 1987 by the U.S. federal government for television broadcast. These PSAs do not lead target audiences through a logical sequence from awareness to motivation, skill building, and maintenance. The PSAs underutilize a strategy of "strategic ambiguity" to craft individual PSAs that can address the needs of and appeal to multiple target audiences, thereby directing information not only to heterosexuals, the primary target of these PSAs, but also to homosexuals and bisexuals. The PSAs largely ignore issues related to injection drug use and needle sharing. What drug-related portrayals there are focus on African American street junkies, which perpetuates racial stereotypes and fails to address occasional injection drug use. The PSAs exploit fear of HIV/AIDS to discourage drug use but do not offer drug treatment or counseling information. PSAs produced by the Clinton administration to promote condom use do not fully address key reasons why people fail to use condoms: concern about sexual pleasure, embarrassment about obtaining condoms, and lack of skills to negotiate condom use with sexual partners. Implications of these conclusions for the future of U.S. HIV/AIDS prevention are discussed.

Population-based prevention of eating disorders: an application of the Rose prevention model.

BACKGROUND: Several decades of concerted research on eating disorders have generated a broad range of proposed causal influences, but much of this etiologic research does not elucidate practical avenues for preventive interventions. Translating etiologic theory into community health interventions depends on the identification of key leverage points, factors that are amenable to public health intervention and provide an opportunity to maximize impact on the outcome of interest. Population-based preventive strategies, elaborated by epidemiologist Geoffrey Rose, can maximize the impact of public health interventions. In the case of eating disorders, Rose's model is instructive: Dieting stands out as risk behavior that may both fit Rose's model well and be a key leverage point for preventive intervention. METHODS: Grounded in Rose's work, this article lodges a theoretical argument for the population-based prevention of eating disorders. In the introductory section, existing research on the epidemiology of dieting is reviewed, showing that it is extremely common among adolescent girls and women and that the behavior has been implicated as a causal factor for disordered eating. Next, new evidence is offered to build a case for how a population-wide reduction in dieting may be an effective strategy for prevention of eating pathology. Finally Rose's prevention framework is used to introduce a unique and provocative perspective on the prevention of eating disorders. RESULTS: Dieting is a normative behavior in our culture with psychological and physiological effects in the causal chain leading to eating pathology. This behavior may represent an ideal target for population-based prevention. CONCLUSIONS: Theoretical and empirical evidence suggests that a population-wide reduction in dieting may be a justifiable and effective strategy for prevention of eating pathology.

Dieting and smoking initiation in early adolescent girls and boys: a prospective study.

OBJECTIVES: This analysis tested the relation between dieting frequency and risk of smoking initiation in a longitudinal sample of adolescents. METHODS: From 1995 to 1997, 1295 middle school girls and boys participated in a nutrition and physical activity intervention study. The prospective association between dieting frequency at baseline and smoking initiation 2 years later was tested. RESULTS: Compared with girls who reported no dieting at baseline, girls who dieted up to once per week had 2 times the adjusted odds of becoming smokers (odds ratio = 2.0; 95% confidence interval = 1.1, 3.5), and girls who dieted more often had 4 times the adjusted odds of becoming smokers (odds ratio = 3.9; 95% confidence interval = 1.5, 10.4). CONCLUSIONS: Dieting among girls may exacerbate risk of initiating smoking, with increasing risk with greater dieting frequency.

Prevention research in eating disorders: theory and new directions.

BACKGROUND: Over the past two decades, scores of articles and several books have been published calling for more attention to the prevention of eating disorders, but less than two dozen prevention intervention studies have been conducted to date. METHODS: This paper reports the results of a systematic review of 20 empirical intervention studies on eating disorders prevention, discussing the data accumulated on what has and has not been effective. Beyond a description of study design and findings, this paper devotes special attention to the theoretical orientations of the studies and their implied assumptions about preventive strategies. RESULTS: Though there has been a compelling interest in social, political and economic factors influencing the incidence of disordered eating, little of this interest has been carried over into the prevention end of eating disorders research. Most studies reported thus far have been designed to target and measure change principally on the individual level, to the exclusion of considering leverage points for intervention in the larger social environment. CONCLUSIONS: This paper concludes with a recommendation for new attention to a model of proactive primary prevention targeted at environmental change and cross-disciplinary collaboration to achieve a reduction in the incidence of eating disorders.