Associations between the home food environment and obesity-promoting eating behaviors in adolescence

Objective: This study examines relationships between multiple aspects of the home food environment and obesity-promoting characteristics of 12- to 13-year-old adolescents' diets, specifically frequency of consumption of high-energy fluids, sweet snacks, savory snacks, and take-out foods.

Research Methods: This was a cross-sectional study including 347 adolescents 12 to 13 years of age and their parents. Data were collected via self-completed surveys. The adolescents' diets were assessed using a Food Frequency Questionnaire derived from existing age-appropriate National Nutrition Survey data. An extensive range of domains within the home food environment were assessed. Bivariate linear regression analyses were run split by gender. Forced entry multiple linear regression analyses (adjusting for all variables significant in bivariate analyses as well as for maternal education) were also performed, stratified by the sex of the child.

Results: The influence of mothers, either as models for eating behaviors or as the providers of food, was pervasive. Mothers' intake of high-energy fluids (p = 0.003), sweet snacks (p = 0.010), savory snacks (p = 0.008), and take-out food (p = 0.007) was positively associated with boys' intake of all these foods. In addition, mothers' intake of high-energy fluids was positively associated with daughters' consumption of these drinks (p = 0.025). Furthermore, availability of unhealthy foods at home was positively associated with girls' sweet snack (p = 0.001), girls' savory snack (p < 0.001), boys' savory snack (p = 0.002), and, in the bivariate analyses, girls' high-energy fluid consumption (p = 0.002).

Discussion: This study of home food environment influences on adolescent diet highlights the pervasive influence of mothers in determining adolescents' obesity-promoting eating, providing direction for obesity prevention strategies and future research.

The pursuit of muscularity among adolescent boys in Fiji and Tonga

The desire for muscularity is tied to Western views of the male gender role, which prescribe that men be strong, physically fit and athletically successful. Although, these ideals have been primarily studied among Western adolescent boys, there is emerging evidence that the same ideals are valued and promoted among males from the Pacific Islands. The aim of the present study was to examine body image concerns associated with muscularity and the reasons for these concerns among Fijian and Tongan adolescent boys. Semi-structured interviews were conducted with 24 Indigenous Fijian, 24 Indo-Fijian, and 24 Tongan boys aged between 13 and 20 years. A thematic analysis of boys’ narratives showed that the pursuit of muscularity was a dominant theme for many boys. Boys’ reasons for pursing muscularity included the attainment of strength and fitness, sporting performance, physical work, dominance, and health. These findings are examined in relation to previous research with Western adolescent boys.

Comparison of the structure of adolescent problem behavior in the United States and Australia

Some extant theory and empirical research suggests that youth problem behaviors, such as substance abuse and delinquency, reflect a single underlying dimension of behavior, whereas others suggest there are several different dimensions. Few studies have examined potential international differences in the structure of problem behavior, where cultural and policy differences may create more variation in behavior and different structures. This study explored the structure of problem behavior in two representative samples of youth (ages 12-17) from Maine and Oregon in the United States (N = 33,066) and Victoria, Australia (N = 8,500). The authors examined the degree to which data from the two countries produce similar model structures using indicators of problem behavior. Results show that the data are best represented by two factors, substance use and delinquency, and there appear to be more similarities than differences in the models across countries. Implications for understanding problem behavior across cultural and developmental groups and practical and policy implications are discussed.

Does interpersonal psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial

Background: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial.

Methods/design: The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate.  Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive  symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method.

Discussion: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services.

Citizenship for the future - educating the adolescent in 1960s Australia

This paper explores the planning of adolescent subjectivity in Australian education during the 1960s and 70s in relation to citizenship formation. Citizenship encompasses questions about social values and subjectivity - the kind of people adolescents will become. Debates in Australian education during this time convey ambivalence towards modernity and change, with adolescents both exhorted to abide by existing social values, and to embrace the future of changed values. The paper first maps some of the dominant concerns about managing adolescents and their (desirable or lacking) capacities, set against a claimed collapse in social and personal values and the responsibility of schools to prepare adolescents for future citizenship. Second, key ideas that underpinned these debates - notably the future, role and socialization, and forms of reasoning derived from social psychology – are examined from a genealogical or Foucauldian perspective. Finally, the paper, as a part of an attempt to understand the history of the present, briefly raises some questions in relation to contemporary initiatives and concerns about citizenship and social values education.

Being normal is the only way to be : adolescent perspectives on gender and school

A book for teachers and parents of adolescents. Draws on the writings of teenage boys and girls and uses these to build specific knowledge about what it means to be an adolescent at school, what it means to be Cool and Normal, and the effects of these social constructions on learning and relationships.

Evidence-based nutrition and cardiovascular disease in the Asia-Pacific region

The Asia-Pacific region is undergoing a major change in both food and health patterns, with a connection between the two more than likely. Evidence for certain traditional Asia-Pacific foods as protective agents against chronic non-communicable disease and cardiovascular disease (CVD), in particular, is growing at a time when their usage diminishes. The nature of the evidence to establish relevant Asia-Pacific food-health linkages will include randomised placebo-controlled clinical trials, but is much more extensive and meaningful. Okinawans have probably achieved one of the most successful food cultures from a health point of view and serve as a reference point for the Asia-Pacific region. The expert working party has produced, in November 2000, the 'Okinawan Recommendations on Nutrition and CVD in the Asia-Pacific region'.

Dietary patterns of Australian adults and their association with socio-economic status: results from the 1995 national nutrition survey

Objective: To describe dietary patterns among men and women in the Australian population, and to explore how these varied according to socioeconomic status (SES).

Design: A cross-sectional self-report population survey, the 1995 Australian National Nutrition Survey (NNS), was used.

Setting: Private dwelling sample, covering urban and rural areas across Australia.

Subjects: Data provided by 6680 adults aged 18-64 who participated in the NNS were used in the analyses.

Methods: Factor analyses were used to analyse data from a Food Frequency Questionnaire (FFQ) completed by participants. Associations between SES and dietary pattens were assessed using ANOVA.

Results: Separate factor analyses of the FFQ data for men and women revealed 15 factors, accounting for approximately 50% of the variance in both men's and women's dietary patterns. Several gender and SES differences in food patterns were observed. Lower SES males more frequently consumed 'tropical fruits', 'protein foods', and 'offal and canned fish', while high SES males more often ate 'breakfast cereals' and 'wholemeal bread'. Lower SES females more often ate 'traditional vegetables', 'meat dishes' and 'pasta, rice and other mixed foods', while high SES females more frequently ate 'ethnic vegetables' and 'breakfast cereal/muesli'.

Conclusions: These findings contribute to a better understanding of the dietary patterns that underscore gender-specific SES differences in nutrient intakes. Analyses of the type employed in this study will facilitate the development of interventions aimed at modifying overall eating patterns, rather than specific components of the diet.

Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the third national health and nutrition examination survey

OBJECTIVE— To determine the association between serum 25-hydroxyvitamin D (25OHD) and diabetes risk and whether it varies by ethnicity.
RESEARCH DESIGN AND METHODS— We performed an analysis of data from participants who attended the morning examination of the Third National Health and Nutrition Examination Survey (1988–1994), a cross-sectional survey of a nationally representative sample of the U.S. population. Serum levels of 25OHD, which reflect vitamin D status, were available from 6,228 people (2,766 non-Hispanic whites, 1,736 non-Hispanic blacks, and 1,726 Mexican Americans) aged ≥20 years with fasting and/or 2-h plasma glucose and serum insulin measurements.
RESULTS— Adjusting for sex, age, BMI, leisure activity, and quarter of year, ethnicityspecific odds ratios (ORs) for diabetes (fasting glucose ≥7.0 mmol/l) varied inversely across quartiles of 25OHD in a dose-dependent pattern (OR 0.25 [95% CI 0.11– 0.60] for non-Hispanic whites and 0.17 [0.08–0.37] for Mexican Americans) in the highest vitamin D quartile (25OHD ≥81.0 nmol/l) compared with the lowest 25OHD (≥43.9 nmol/l). This inverse association
was not observed in non-Hispanic blacks. Homeostasis model assessment of insulin resistance (loge) was inversely associated with serum 25OHD in Mexican Americans (P ≥ 0.0024) and non-Hispanic whites (P≥0.058) but not non-Hispanic blacks (P≥0.93), adjusting for confounders.
CONCLUSIONS— These results show an inverse association between vitamin D status and diabetes, possibly involving insulin resistance, in non-Hispanic whites and Mexican Americans. The lack of an inverse association in non-Hispanic blacks may reflect decreased sensitivity to vitamin D and/or related hormones such as the parathyroid hormone.

Under-reporting of energy intake in the 1997 national nutrition survey

Aims To estimate the level of under-reporting of energy intake by gender, age, ethnicity and body size (normal, overweight, obese) in the 1997 National Nutrition Survey (NNS97) in New Zealand.
Methods Data were from 4,258 participants (1,808 men and 2,450 women aged 15 years and over) who completed the 24-hour diet recall; the primary methodology used in the NNS97. Under-reporting was assessed using the ratio of reported energy intake to estimated resting metabolic rate (EI: RMRest). Cut-off limits were used to identify percentages of under-reporters in the various subgroups.
Results Mean EI: RMRest was 1.40 for all participants (1.51 for men, 1.30 for women, p<0.001) with older age being associated with lower EI: RMRest (p<0.001). There were no significant differences in mean EI: RMRest between ethnic groups for men.
Mean EI: RMRest for women were: Maori 1.46, European 1.29, and Pacific 1.37 (p<0.01). A larger body size was associated with a significantly lower EI: RMRest especially for women.
Percentages of ‘definite’ under-reporters (individual EI: RMRest <0.9) were as follows: men 12%, women 21%; Europeans 16%, Maori 23% and Pacific 26%; normal weight (11%), overweight (19%) and obese (27%) participants; and from 10% in the youngest to 23% in the oldest age group (p<0.001 for all results).
Conclusion In this study, in agreement with the literature, women, older people and obese people under-reported more than men, younger people and non-obese people. Possible ethnic differences in under-reporting rates need further study. Care is needed in interpreting the energy intake data from the NNS97.

Developmental language disorders and adolescent risk: a public-health advocacy role for speech pathologists?

Within the multi-disciplinary team concerned with child and adolescent development, speech pathologists are uniquely positioned to understand the nature and overall developmental significance of language acquisition in childhood and adolescence. Other disciplines contribute valuable insights about psychosocial development during the childhood and adolescent years. The field of developmental psychology, for example provides a large and convincing body of evidence about the role of academic success as a protective factor against a range of psychosocial harms, in particular substance misuse, truancy, early school leaving, and juvenile offending. In this paper, we argue that juvenile offending embodies the notion of "adolescent risk", but in Australia in particular, has been under-investigated with respect to possible associations with developmental language disorders and subsequent academic failure. We present findings pertaining to a sample of 30 male juvenile offenders completing community based orders. Performance on a range of oral language processing and production skills was poorer than that of a demographically similar comparison group. Our results confirm the need to conceptualize language within a broader risk and protective framework. We therefore emphasize the public health importance of early language competence, by virtue of the psychosocial protection it confers on young people with respect to the development of prosocial skills, transition to literacy and overall academic achievement. We argue that speech pathologists are best positioned to advocate at a policy level about the broader public health importance of oral language competence.

A cross-national comparison of risk and protective factors for adolescent substance use : the United States and Australia

Purpose
To compare risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused polices.

Methods
Cross-sectional survey data were collected from independent samples of adolescents in the states of Maine (N = 16,861; 53% female, 7% Non-white) and Oregon (N = 15,542; 51% female, 24% Non-white) in the United States and Victoria in Australia (N = 8442; 54% Female, 11% Non-white) in 1998 (Maine and Oregon) and 1999 (Victoria). Chi-square tests, t-tests, effect size comparisons, and logistic regression analyses that accounted for age and gender were used to investigate cross-national similarities and differences in: (a) rates of cigarette, alcohol, and marijuana use; (b) levels of risk and protective factors; and (c) magnitudes of associations between risk and protective factors and substance use.

Results
More adolescents in Victoria reported using cigarettes and alcohol, whereas more of the U.S. adolescents reported using marijuana. Exposure to risk and protective factors was generally similar in the cross-national samples. However, adolescents in Maine and Oregon perceived handguns to be more readily available, reported more participation in religious activities, and were higher in sensation-seeking and social skills; and adolescents in Victoria had more favorable attitudes toward drug use and reported community norms and parental attitudes more favorable to drug use. Most of the risk and protective factors were strongly associated with substance use to a similar degree in Victoria, Maine, and Oregon. However, among adolescents in Maine and Oregon peer/individual risk and protective factors associated with social detachment were more strongly related to substance use, and among adolescents in Victoria, family protective factors were less strongly related to alcohol use.

Conclusions
Inter-country influences on youth substance use are generally similar despite different policy directions. Existing differences suggest that the abstinence policy context is associated with higher levels of illicit drug use and stronger relations between individual indicators of social detachment and substance use, whereas the harm reduction policy context is related to more cigarette and alcohol use, possibly from exposure to normative influences that are more tolerant of youth drug use.

Levels and family correlates of positive adolescent development: A cross national comparison

The article examines the levels of positive school engagement, and family characteristics associated with engagement, in adolescents in Australia and the United States. There are several modifiable family characteristics related to positive behavior. These include parents boosting both rewards for and opportunities to participate in prosocial activities, and the importance of expressing clear disapproval of antisocial behavior and drug use. Family management practices and family conflict influence adolescents' views about school and home and need to be addressed. There is evidence of the validity of ecological approaches to development, which underscores the inter-relationships between young people's developmental contexts.

The effect of school suspensions and arrests on subsequent adolescent antisocial behavior in Australia and the United States

Purpose: To examine the effect of school suspensions and arrests (i.e., being taken into police custody) on subsequent adolescent antisocial behavior such as violence and crime, after controlling for established risk and protective factors in Victoria, Australia and Washington State, United States (U.S.). Methods: This article reports on analyses of two points of data collected 1 year apart within a cross-national longitudinal study of the development of antisocial behavior, substance use, and related behaviors in approximately 4000 students aged 12 to 16 years in Victoria, Australia and Washington State, U.S. Students completed a modified version of the Communities That Care self-report survey of behavior, as well as risk and protective factors across five domains (individual, family, peer, school, and community). Multivariate logistic regression analyses investigate the effect of school suspensions and arrests on subsequent antisocial behavior, holding constant individual, family, peer, school, and community level influences such as being female, student belief in the moral order, emotional control, and attachment to mother. Results: At the first assessment, school suspensions and arrests were more commonly reported in Washington, and school suspensions significantly increased the likelihood of antisocial behavior 12 months later, after holding constant established risk and protective factors (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.1, _p < .05). Predictors of antisocial behavior spanned risk and protective factors across five individual and ecological areas of risk. Risk factors in this study were pre-existing antisocial behavior (OR 3.6, CI 2.7–4.7, _p < .001), association with antisocial peers (OR 1.8, CI 1.4–2.4, _p < .001), academic failure (OR 1.3, CI 1.1–1.5, _p < .01), and perceived availability of drugs in the community (OR 1.3, CI 1.1–1.5, _p < .001). Protective factors included being female (OR 0.7, CI 0.5–0.9, _p < .01), student belief in the moral order (OR 0.8, CI 0.6–1.0, p < .05), student emotional control (OR 0.7, CI 0.6–0.8, _p < .001), and attachment to mother (OR 0.8, CI 0.7–1.0, _p < .05). Conclusions:  School suspensions may increase the likelihood of future antisocial behavior. Further research is required to both replicate this finding and establish the mechanisms by which school suspensions exert their effects.