Obesity in the transition to adulthood: predictions across race/ethnicity, immigrant generation, and sex

The physiological toll of arrests: An examination of arrest history on midlife allostatic load

PURPOSE

To understand how allostatic load - cumulative physiologic burden of stress - varies by amount and timing of arrests stratified by race/ethnicity and by sex.

METHODS

Using The National Longitudinal Study of Adolescent to Adult Health, we calculated descriptive statistics and mean differences in bio-marker measured allostatic load by arrest history stratified by race/ethnicity and sex.

RESULTS

One-third of participants experienced at least one arrest, and most experienced arrests only as adults. Allostatic load scores were higher for those that had ever experienced an arrest compared to never (mean difference: 0.58 (0.33, 0.84)). Similar results held for men and women and across race/ethnicity, but Black non-Hispanic individuals had higher allostatic load at all levels compared to other individuals.

CONCLUSIONS

Experiencing both any arrest and multiple arrests were associated with higher allostatic load. The stress of arrests may contribute to physiological maladaptations and poor health. The public health and law enforcement fields must recognize the detrimental consequences of arrests on physiological stress and search for non-carceral solutions.

Long-term air pollution exposure and markers of cardiometabolic health in the National Longitudinal Study of Adolescent to Adult Health (Add Health)

BACKGROUND

Air pollution exposure is associated with cardiovascular morbidity and mortality. Although exposure to air pollution early in life may represent a critical window for development of cardiovascular disease risk factors, few studies have examined associations of long-term air pollution exposure with markers of cardiovascular and metabolic health in young adults.

OBJECTIVES

By combining health data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) with air pollution data from the Fused Air Quality Surface using Downscaling (FAQSD) archive, we: (1) calculated multi-year estimates of exposure to ozone (O3) and particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) for Add Health participants; and (2) estimated associations between air pollution exposures and multiple markers of cardiometabolic health.

METHODS

Add Health is a nationally representative longitudinal cohort study of over 20,000 adolescents aged 12-19 in the United States (US) in 1994-95 (Wave I). Participants have been followed through adolescence and into adulthood with five in-home interviews. Estimated daily concentrations of O3 and PM2.5 at census tracts were obtained from the FAQSD archive and used to generate tract-level annual averages of O3 and PM2.5 concentrations. We estimated associations between average O3 and PM2.5 exposures from 2002 to 2007 and markers of cardiometabolic health measured at Wave IV (2008-09), including hypertension, hyperlipidemia, body mass index (BMI), diabetes, C-reactive protein, and metabolic syndrome.

RESULTS

The final sample size was 11,259 individual participants. The average age of participants at Wave IV was 28.4 years (range: 24-34 years). In models adjusting for age, race/ethnicity, and sex, long-term O3 exposure (2002-07) was associated with elevated odds of hypertension, with an odds ratio (OR) of 1.015 (95% confidence interval [CI]: 1.011, 1.029); obesity (1.022 [1.004, 1.040]); diabetes (1.032 [1.009,1.054]); and metabolic syndrome (1.028 [1.014, 1.041]); PM2.5 exposure (2002-07) was associated with elevated odds of hypertension (1.022 [1.001, 1.045]).

CONCLUSION

Findings suggest that long-term ambient air pollution exposure, particularly O3 exposure, is associated with cardiometabolic health in early adulthood.

Associations of peer generational status on adolescent weight across Hispanic immigrant generations: A social network analysis

BACKGROUND

Childhood obesity disproportionately impacts Hispanics in the United States (US), the nation's largest ethnic minority population. However, even among Hispanic children, those born in the US are at increased risk of developing obesity than those not born in the US (i.e. first-generation Hispanics). The objective of this study is to assess whether ethnic and generational differences in the friend networks of Hispanic adolescents moderate the association between immigrant generation and weight.

METHODS

We analyzed data from first-generation, second-generation, and third-generation Hispanic 12 to 19 year-old participants in Wave 1 of the Longitudinal Study of Adolescent to Adult Health (Add Health). Using multivariable linear regression, we examined the association between generational status and body mass index (BMI), and whether the ethnic and generational composition of friends moderated that association.

RESULTS

Higher generational status was associated with higher BMI. The ethnic and generational composition of friends was not independently associated with BMI among Hispanic adolescents. However, a social network with a greater proportion of second-generation Hispanics was positively associated with BMI among first-generation Hispanics, and negatively associated with BMI among second-generation Hispanics.

CONCLUSIONS

The generational status of peers in Hispanic adolescents' social networks, particularly the proportion that are second-generation Hispanic, moderates the positive association between immigrant generation and BMI. Moreover, this moderation effect is different across immigrant generations so that the proportion of second-generation adolescents within a social network is associated with higher BMI in first-generation Hispanic adolescents, but with lower BMI among those who are second-generation. These results were confirmed in sensitivity analyses. Our findings suggest that the generational composition of social networks alters the association between the generational status and weight of Hispanic adolescents, and thus that social factors within those networks may contribute to those associations.

Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife

This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.

Longitudinal change in physical activity and adiposity in the transition from adolescence to early adulthood: the 1993 Pelotas cohort study

Background

In the current Physical Activity Guidelines (PAG) for moderate- and vigorous-intensity physical activity (MVPA), abrupt transition from ≥ 60 min/day [youth PAG] to ≥ 150 min/week (≥ 22 min/day on average) [adult PAG] during emerging adulthood is poorly justified. The aim of this study was to examine body fat mass changes according to whether meeting the youth and adult PAGs in late adolescence (age 18 years) to early adulthood (age 22 years).

Methods

The study sample included 2,099 participants (1,113 females) from the 1993 Pelotas (Brazil) Study. At ages 18 and 22 years, MVPA was measured using wrist-worn accelerometry and fat mass was measured using dual-energy X-ray absorptiometry. MVPA at age 18 was categorized into two groups: 0–59 or ≥ 60 min/day (no [N] or yes [Y] for meeting the youth recommendation, respectively). MVPA at age 22 was categorized into three groups: 0–21, 22–59, or ≥ 60 min/day (N, Y22, or Y60 for not meeting the adult recommendation, meeting the adult recommendation, or meeting the youth recommendation, respectively). The combination of these groups created six MVPA groups (N&N, N&Y22, N&Y60, Y&N, Y&Y22, and Y&Y60). Sex-specific multivariable linear regression analyses were conducted to estimate change in fat mass index (FMI) from age 18 to 22 years in the six MVPA groups.

Results

Among males, compared to Y&Y60 (FMI increase = 1.2 kg/m² [95% CI = 1.0, 1.4]), Y&Y22 and Y&N had larger FMI increases (1.9 [1.6, 2.1] and 1.9 [1.2, 2.5], respectively). Among females, Y&Y60 and Y&Y22 had an equal FMI increase (1.6 [1.4, 1.9] for both groups), while Y&N had a larger FMI increase (2.4 [1.8, 3.0]).

Conclusions

These findings suggest that among those who were active in late adolescence, engaging in ≥ 22 min/day of MVPA in adulthood is associated with lower body fat gain for females, but not for males.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01321-0.

Demographic and sociocultural risk factors for adulthood weight gain in Hispanic/Latinos: results from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL)

BACKGROUND

United States (US) Hispanic/Latinos experience a disproportionate burden of obesity, which may in part be related to demographic or sociocultural factors, including acculturation to an US diet or inactive lifestyle. Therefore, we sought to describe the association between adulthood weight histories and demographic and sociocultural factors in a large diverse community-based cohort of US Hispanic/Latinos.

METHODS

We estimated the effect of several factors on weight gain across adulthood, using multivariable linear mixed models to leverage 38,759 self-reported current body weights and weight histories recalled for 21, 45 and 65 years of age, from 15,203 adults at least 21 years of age at the baseline visit of the Hispanic Community Health Study/Study of Latinos (2008-2011).

RESULTS

The average rate of weight gain was nearly 10 kg per decade in early adulthood, but slowed to < 5 kg a decade among individuals 60+ years of age. Birth cohort, gender, nativity or age at immigration, Hispanic/Latino background, and study site each significantly modified the form of the predicted adulthood weight trajectory. Among immigrants, weight gain during the 5 years post-migration was on average 0.88 kg (95% CI: 0.04, 1.72) greater than the weight gain during the 5 years prior. The rate of weight gain appeared to slow after 15 years post-migration.

CONCLUSIONS

Using self-reported and weight history data in a diverse sample of US Hispanic/Latinos, we revealed that both demographic and sociocultural factors were associated with the patterning of adulthood weight gain in this sample. Given the steep rate of weight gain in this population and the fact that many Hispanic/Latinos living in the US immigrated as adults, efforts to promote weight maintenance across the life course, including after immigration, should be a top priority for promoting Hispanic/Latino health and addressing US health disparities more broadly.

Cohabitation and marriage during the transition between adolescence and emerging adulthood: A systematic review of changes in weight-related outcomes, diet and physical activity

•

Starting cohabitation and getting married were associated with increased BMI.

•

Findings were mixed for the effect of starting cohabitation/marriage on PA.

•

Limited evidence for the effect of starting cohabitation/marriage on diet.

Our aim was to systematically review the effect of cohabitation and marriage on physical activity, diet and weight-related outcomes during emerging adulthood. A systematic search of six electronic databases was conducted until July 2019 (PROSPERO:CRD42018106943). Prospective studies were included if data were presented for a weight-related outcome, physical activity, and/or diet among 15–35 years-old participants assessed pre- and post-cohabitation or marriage and compared to a consistently non-cohabiting/non-married (single) reference group. Following title/abstract screening, two reviewers independently screened full-text and assessed risk of bias. There were 11 studies that met inclusion criteria. Outcomes included: body mass index (BMI) only (n = 3), physical activity only (n = 4), diet only (n = 2), BMI and physical activity (n = 1), and all outcomes (n = 1). Cohabitation or marriage was associated with greater BMI increases compared to remaining single among both men and women. Three studies analysed separately cohabitation and marriage and 3 of 4 found that only marriage was associated with higher BMI. Compared to being consistently single, starting cohabitation or getting married were associated with decreased physical activity in 2 of 4 studies among men and 4 of 6 studies among women, with no differences between marriage and cohabitation. Of the three studies examining change in diet, two showed no difference between individuals beginning to cohabit compared to those remaining single; without gender differences. Starting cohabitation and getting married may be valuable targets for weight management interventions, but more studies are needed to investigate the effect of cohabitation and marriage on health behaviours.

Childhood factors related to diverging body mass index trajectories from childhood into mid-adulthood: A mixed methods study

Body mass index (BMI) trajectories that improve over the lifecourse result in better cardiometabolic profiles, but only a small proportion of children of an unhealthy weight show improving BMI trajectories. This study aimed to examine the childhood factors related to diverging BMI trajectories from childhood into adulthood using data from the Childhood Determinants of Adult Health study. A convergent parallel mixed methods design was used. Quantitative data (n = 2206) came from the first (2004-06) and second (2009-11) adult follow-ups of 8498 Australian children (7-15 years) assessed in 1985. Using BMI z-scores, group-based trajectory modelling identified five trajectory groups: Persistently Low, Persistently Average, High Decreasing, Average Increasing and High Increasing. Qualitative data (n = 50) were collected from a sub-group (2016; 38-46 years). Semi-structured interviews with 6-12 participants from each BMI trajectory group focused on individual, social and environmental influences on weight, diet and physical activity across the lifecourse. Log multinomial regression modelling estimated relative risks of trajectory group membership across childhood demographic, behavioural, health, parental and school factors. Qualitative data were thematically analysed using a constant comparative approach. Childhood factors influenced BMI trajectories. Paternal education, main language spoken, alcohol and self-rated health were significant quantitative childhood predictors of BMI trajectory. A distinct 'legacy effect' of parental lifestyle influences during childhood was apparent among interview participants in the Stable and High Decreasing groups, a strong and mostly positive concept discussed by both men and women in these groups and persisting despite phases of unhealthy behaviours. In contrast, the 'legacy effect' was much weaker in the two Increasing BMI groups. This study is the first to simultaneously identify important quantitative and qualitative childhood factors related to divergent BMI trajectories, and to observe a legacy effect of parents' lifestyle behaviours on divergent BMI trajectories. This work provides direction for further exploration of the factors driving divergent BMI trajectories.

Thirty-Day Outcomes of Bariatric Surgery in Adolescents: a First Look at the MBSAQIP Database

INTRODUCTION

Bariatric surgery is the only effective treatment of severe obesity. The number of adolescents undergoing bariatric surgery is increasing. However, bariatric surgery in adolescents is controversial.

OBJECTIVE

The purpose of this study is to evaluate the outcomes of bariatric surgery in adolescents based on the MBSAQIP database (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project).

METHODS

We analyzed the 2015-2017 MBSAQIP database; patients ≤ 19 years of age were included in our analysis. Primary outcomes were 30-day serious adverse events (SAEs), organ space infection (OSI), re-intervention, and re-operation rates. Secondary outcomes included operation length, hospital stay, and re-admission rates. We conducted separate Mann-Whitney rank sums tests, chi-square, or Fisher's exact tests as appropriate, with p < .05 denoting statistical significance.

RESULTS

A total of 1983 adolescent patients were included in our analysis. The average age and BMI were 18.1 and 47.5, respectively. Of adolescent patients, 21.7% underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and 78.3% underwent laparoscopic sleeve gastrectomy (LSG). The 30-day SAE and readmission rates were significantly lower for LSG compared with LRYGB (2.9% and 2.6% vs 6.5% and 5.6%, respectively; p < 0.05). The 30-day reoperation rate was also lower for LSG compared with LRYGB albeit not significant (1.1% and vs 2.3%; p = 0.05). The 30-day intervention rate for LSG was significantly lower, however, compared with LRYGB (1.2% vs 3%; p < 0.05). Compared with adult patients, > 19 years old (n = 353,726), we found no difference in our outcomes. However, adolescents had significantly shorter operation length.

CONCLUSION

In adolescents, LSG had fewer SAE, re-intervention, and readmission rates compared with LRYGB. There was no difference in outcomes between adolescents and adults.

Becoming obese in young adulthood: the role of career-family pathways in the transition to adulthood for men and women

BACKGROUND

During the transition to adulthood many young adults become obese for the first time in their lives, yet relatively little research has examined why people in this life phase become obese. This study examines what career and family life-course pathways during the transition to adulthood are related to developing obesity in young adulthood.

METHODS

We use data from the NLSY97, a U.S. nationally representative panel survey conducted by the Bureau of Labor Statistics between 1997 to 2013 (N = 4688), and apply multichannel sequence analysis in order to identify clusters of typical career-family pathways during the transition to adulthood (age 17 to 27), and subsequently investigate whether these pathways are associated with becoming obese at the end of young adulthood (age 28), using logistic regression. We control for obesity at age 17 and family background factors (race, parental education, parental income, and family structure). To take into account the fact that the transition to adulthood has a different meaning for men and for women, we also interact career-family clusters with gender.

RESULTS

For women, pathways characterized by college education, early home leaving, and postponement of family formation decrease the probability of becoming obese. For men, pathways characterized by early marriage increase the probability of becoming obese.

CONCLUSIONS

The results highlight the importance of gender differences in how career and family pathways are related to becoming obese in young adulthood.

Maltreatment experience in childhood and average excess body mass from adolescence to young adulthood

BACKGROUND

Prior studies have suggested maltreatment is a strong predictor of later weight outcomes, such that maltreatment experiences in childhood increase the likelihood of being overweight or obese in adulthood. Estimates of this relationship may be biased due to: 1) inadequate selection of covariates; 2) improper operationalization of child maltreatment; and 3) restricting analyses to cross-sectional outcomes.

OBJECTIVES

Evaluate how latent classes of child maltreatment experiences are associated with a longitudinal BMI measure from adolescence to adulthood.

PARTICIPANTS

Data from the National Longitudinal Study of Adolescent to Adult Health.

METHODS

We evaluated how previously developed latent classes of child maltreatment experiences were associated with average excess BMI from adolescence to adulthood using multivariate linear regression.

RESULTS

In the unadjusted model, individuals in the poly-maltreatment class (b = 0.46, s.e. = 0.20) and individuals who experienced adolescent-onset maltreatment (b = 0.36, s.e. = 0.11) had higher average excess BMI compared to individuals in the no maltreatment class. After adjusting for confounders, the relationship between poly-maltreatment and average excess BMI abated, whereas the relationship between adolescent-onset maltreatment and average excess BMI sustained (b = 0.28, s.e. = 0.11).

CONCLUSIONS

Contrary to previous findings, our analyses suggest the association between maltreatment experiences and longitudinal weight outcomes dissipates after controlling for relevant confounders. We did find a relationship, however, between adolescent-onset maltreatment and average excess BMI from adolescence to adulthood. This suggests the importance of maltreatment timing in the relationship between maltreatment and weight.

Sensitive Periods for the Association Between Childhood Maltreatment and BMI

INTRODUCTION

Although previous research has suggested a positive association between child maltreatment and BMI over the life course, it is unclear when this develops.

METHODS

The authors used time-varying effect models and data from a nationally representative, longitudinal, cohort study (Add Health), to test how childhood physical, sexual, and emotional abuse uniquely varied in associations with BMI from age 13 to 28 years, and whether different patterns existed for male and female participants. Add Health collected data from 1994 to 2008, and the present analyses took place in 2018.

RESULTS

Age 18 years was the earliest that a relationship between maltreatment and BMI emerged for either sex. Child sexual abuse was negatively associated with BMI among male participants from 18.5 to 20 years, but positively associated with BMI among female participants from 19 to 24.5 years, and childhood emotional abuse was positively associated with BMI among female participants from 18 to 28 years.

CONCLUSIONS

The relationship between child maltreatment and BMI varies as a function of type of maltreatment, sex, and time. Notably, associations between maltreatment and BMI did not emerge until young adulthood. Future research should investigate mechanisms by which the association between maltreatment and BMI changes over time to identify trauma-informed intervention targets for improving weight outcomes.

Life Course Patterns of Concurrent Trajectories of BMI and Affective Symptoms of Rural Mothers: Socioeconomic Antecedents and Disease Outcomes in Later Life

OBJECTIVES

The current study, using prospective data over 25 years (1991-2015), concurrently investigates patterns of body mass index (BMI) and affective symptom trajectories in middle-aged mothers and the socioeconomic antecedents and disease outcomes of these patterns.

METHOD

Growth mixture modeling was used to identify latent classes of conjoint health risk trajectories (BMI, depressive symptoms, and anxiety symptoms) from 1991 to 2001. For each latent class, we identified mean trajectories of each health risk. Then, analyses were conducted identifying how these conjoint health risk classes were associated with respondents' socioeconomic background profiles in 1991 and subsequent chronic health problems in 2015.

RESULTS

Socioeconomic background profiles were significantly associated with initially high-risk trajectories. There was a statistically significant association between membership in certain classes of conjoint trajectories and physical health outcomes in later years. Consistent patterns of association with changes in different health outcomes including onset of diseases were observed when classes of conjoint risk trajectories are examined.

DISCUSSION

The identification of members of various conjoint risk trajectory groups provides a potentially useful prognostic tool for early preventive intervention efforts, treatment, and policy formation. Such interventions should promote and develop resiliency factors, thereby aiding in the redirection of middle-aged women's adverse risk trajectories.

Obesity risk factors in American Indians and Alaska Natives: a systematic review

OBJECTIVES

We systematically reviewed the literature on risk factors for obesity in American Indians (AIs) and Alaska Natives (ANs) of all ages.

STUDY DESIGN

We searched titles and abstracts in PubMed with combinations of the following terms: obesity, body mass index (BMI), American Indian, Alaska Native, and Native American.

METHODS

We limited our review to articles that provided an empirically testable claim about a variable associated with obesity, measured obesity as a dependent variable, and provided data specific to AI/ANs.

RESULTS

Our final sample included 31 articles; 20 examined AI/AN youth (<18 years), and 11 examined AI/AN adults (≥18 years). Risk factors for obesity varied by age. In infants, low birth weight, early termination of breastfeeding, and high maternal BMI, and maternal diabetes increased the risk of childhood obesity. In children and adolescents, parental obesity, sedentary behaviors, and limited access to fruits and vegetables were associated with obesity. In adulthood, sedentary behaviors, diets high in fats and carbohydrates, stress, verbal abuse in childhood, and the belief that health cannot be controlled were associated with obesity.

CONCLUSIONS

Extant studies have three limitations: they do not apply a life course perspective, they lack nationally representative data and have limited knowledge of the resilience, resistance and resourcefulness of AI/ANs. Future studies that avoid these shortcomings are needed to inform interventions to reduce the prevalence of obesity in AI/ANs across the life course.

Evaluating Potential Behavioral Mediators for Increasing Similarity in Friends' Body Size among College Students

College students and their friends become more similar in weight status over time. However, it is unclear which mediators explain this relationship. Using validated survey measures of diet, physical activity, alcohol intake, sleep behaviors, mental health, and food security status, we take a comprehensive look at possible factors associated with excess weight gain that may explain friends’ convergence on body mass index (BMI), waist circumference, waist to hip ratio, and waist to height ratio over time. We use linear mixed models applied to a longitudinal dataset of first-year college students to examine whether these variables satisfy two criteria for potential candidate mediators of friends’ influence on anthropometrics—cross-sectional similarity among friends (n = 509) and longitudinal associations with increasing anthropometrics (n = 428). While friends were similar on some survey measures (such as dining hall use, home cooked meal consumption, fruit intake, alcohol intake, hours of sleep, and stress). Only dining hall use and stress emerged as potential explanations for why friends’ BMI and anthropometric change may be similar. Given that only a few variables satisfied the two criteria as potential mediators, future research may need to consider alternative measurement approaches, including real-time assessments, objective measurements, and alternative factors causing the convergence of friends’ and college students’ body size over time.

Child Maltreatment and Body Mass Index over Time: The Roles of Social Support and Stress Responses

An unhealthy body mass index (BMI) trajectory can exacerbate the burdens associated with child maltreatment. However, we have yet to explain why the relationship between maltreatment and BMI trajectories exists and what allows individuals to attain healthy BMI trajectories despite adversity. Guided by the Transactional Model of Stress and Coping, we evaluated (1) if peer friendship and adult mentors moderate, and (2) if impulsivity and depressive symptoms mediate, the relationship between maltreatment experiences and average excess BMI. We used data from four waves of the National Longitudinal Study of Adolescent to Adult Health (n = 17,696), following adolescents from ages 13-21 (Wave I) to 24-31 years (Wave IV). We did not find evidence of significant moderation or mediation of the maltreatment experience to average excess BMI relationship. However, models did demonstrate a relationship between peer friendship quality and average excess BMI, such that higher quality protected against higher average excess BMI (B = -0.073, s.e. = 0.02, p < 0.001). Age of maltreatment onset was also associated with average excess BMI, such that maltreatment onset in adolescence was associated with a higher average excess BMI (B = 0.275-0.284, s.e. = 0.11, p = 0.01). Although we found no evidence of moderation by social support or mediation by stress responses of the relationship between maltreatment experiences and average excess BMI, peer friendship appears to protect against higher average excess BMI from adolescence to young adulthood for all adolescents. Future public health interventions should consider how to leverage friendship in obesity prevention efforts.

Does a parsimonious measure of complex body mass index trajectories exist?

BACKGROUND

A single measure that distills complex body mass index (BMI) trajectories into one value could facilitate otherwise complicated analyses. This study creates and assesses the validity of such a measure: average excess BMI.

METHODS

We use data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (n = 17,669). We calculate average excess BMI by integrating to find the area above a healthy BMI trajectory and below each subject-specific trajectory and divide this value by total study time. To assess validity and utility, we (1) evaluate relationships between average excess BMI from adolescence to adulthood and adult chronic conditions, (2) compare associations and fit to models using subject-specific BMI trajectory parameter estimates as predictors, and (3) compare associations to models using BMI trajectory parameter estimates as outcomes.

RESULTS

Average excess BMI from adolescence to adulthood is associated with increased odds of hypertension (OR = 1.56; 95% CI: 1.47, 1.67), hyperlipidemia (OR = 1.36; 95% CI: 1.26, 1.47), and diabetes (OR = 1.57; 95% CI: 1.47, 1.67). The odds associated with average excess BMI are higher than the odds associated with the BMI intercept, linear, or quadratic slope. Correlations between observed and predicted health outcomes are slightly lower for some models using average excess BMI as the focal predictor compared to those using BMI intercept, linear, and quadratic slope. When using trajectory parameters as outcomes, some co-variates associate with the intercept, linear, and quadratic slope in contradicting directions.

CONCLUSIONS

This study supports the utility of average excess BMI as an outcome. The higher an individual's average excess BMI from adolescence to adulthood, the greater their odds of chronic conditions. Future studies investigating longitudinal BMI as an outcome should consider using average excess BMI, whereas studies that conceptualize longitudinal BMI as the predictor should continue using traditional latent growth methods.

Neighborhood disadvantage across the transition from adolescence to adulthood and risk of metabolic syndrome

This study investigates the association between neighborhood disadvantage from adolescence to young adulthood and metabolic syndrome using a life course epidemiology framework. Data from the United States-based National Longitudinal Study of Adolescent to Adult Health (n = 9500) and a structural equation modeling approach were used to test neighborhood disadvantage across adolescence, emerging adulthood, and young adulthood in relation to metabolic syndrome. Adolescent neighborhood disadvantage was directly associated with metabolic syndrome in young adulthood. Evidence supporting an indirect association between adolescent neighborhood disadvantage and adult metabolic syndrome was not supported. Efforts to improve cardiometabolic health may benefit from strategies earlier in life.

Relationship between Child Maltreatment and Adolescent Body Mass Index Trajectories

This study examines the relationship between childhood maltreatment experiences and body mass index (BMI) over time. Using data from the National Longitudinal Study of Adolescent to Adult Health, we use latent profile analysis to create child maltreatment experience classes and latent growth modeling to understand how classes relate to BMI trajectories from adolescence to early adulthood. The best-fitting model suggests four child maltreatment experience classes: 1) poly-maltreatment (n=607); 2) physical abuse (n=1,578); 3) physical abuse and neglect (n=345); and 4) no childhood maltreatment (n=4,188). Class membership differentially predicts BMI trajectories, such that individuals in the no maltreatment, physical abuse, and physical abuse plus neglect classes exhibit the most stable BMI, and individuals in the poly-maltreatment class increase most rapidly (Χ2[9]=149.9, p < 0.001). Individuals in the poly-maltreatment class experience significantly higher BMI over time compared to the other three classes. In addition to overall growth differing between classes, there is substantial inter-individual variability in BMI trajectories within each class. Because BMI trajectories differ across different childhood maltreatment experiences-and substantial variability in BMI trajectories exists within these different experiences-future analyses should investigate mediators and moderators of this relationship to inform trauma-based therapies and interventions.

Health of Philippine Emigrants Study (HoPES): study design and rationale

BACKGROUND

Immigrants to the United States are usually healthier than their U.S.-born counterparts, yet the health of immigrants declines with duration of stay in the U.S. This pattern is often seen for numerous health problems such as obesity, and is usually attributed to acculturation (the adoption of "American" behaviors and norms). However, an alternative explanation is secular trends, given that rates of obesity have been rising globally. Few studies of immigrants are designed to distinguish the effects of acculturation versus secular trends, in part because most studies of immigrants are cross-sectional, lack baseline data prior to migration, and do not have a comparison group of non-migrants in the country of origin. This paper describes the Health of Philippine Emigrants Study (HoPES), a study designed to address many of these limitations.

METHODS

HoPES is a dual-cohort, longitudinal, transnational study. The first cohort consisted of Filipinos migrating to the United States (n = 832). The second cohort consisted of non-migrant Filipinos who planned to remain in the Philippines (n = 805). Baseline data were collected from both cohorts in 2017 in the Philippines, with follow-up data collection planned over 3 years in either the U.S. for the migrant cohort or the Philippines for the non-migrant cohort. At baseline, interviewers administered semi-structured questionnaires that assessed demographic characteristics, diet, physical activity, stress, and immigration experiences. Interviewers also measured weight, height, waist and hip circumferences, blood pressure, and collected dried blood spot samples.

DISCUSSION

Migrants enrolled in the study appear to be representative of recent Filipino migrants to the U.S. Additionally, migrant and non-migrant study participants are comparable on several characteristics that we attempted to balance at baseline, including age, gender, and education. HoPES is a unique study that approximates a natural experiment from which to study the effects of immigration on obesity and other health problems. A number of innovative methodological strategies were pursued to expand the boundaries of current immigrant health research. Key to accomplishing this research was investment in building collaborative relationships with stakeholders across the U.S. and the Philippines with shared interest in the health of migrants.

Intersecting Social Inequalities and Body Mass Index Trajectories from Adolescence to Early Adulthood

This study combines multiple-hierarchy stratification and life course perspectives to address two research questions critical to understanding U.S. young adult health. First, to what extent are racial-ethnic inequalities in body mass index (BMI) gendered and/or classed? Second, do racial-ethnic, gender, and socioeconomic inequalities in BMI widen or persist between adolescence and early adulthood? Using data from the National Longitudinal Survey of Youth 1997 cohort and growth curve models, results suggest that among white, black, and Hispanic American men and women ages 13 to 31, racial-ethnic inequality in BMI is greatest among women. Black women experience the highest adolescent BMI and the greatest increases in BMI with age. Furthermore, socioeconomic resources are less protective against weight gain for blacks and Hispanics, with the nature of these relationships varying by gender. Findings present a more nuanced picture of health inequality that renders visible the disproportionate burden of poor health experienced by marginalized groups.

Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population

Immigrants experience an escalation of negative health behaviors after arrival to the United States. Negative mood is associated with poorer health behaviors in the general population; however, this relationship is understudied in immigrant populations. Adolescent (n = 81) and adult (n = 70) participants completed a health behavior survey for immigrant families using a community-based participatory research approach. Data was collected for mood, nutrition, and physical activity. Adolescents with positive mood drank less regular soda, and demonstrated more minutes, higher levels, and greater social support for physical activity (all ps < .05). Adults with positive mood reported more snacking on fruits/vegetables, greater self-efficacy for physical activity, and better physical well-being (all ps < .05). Negative mood was associated with low physical activity level and poor nutritional habits in adolescent and adult immigrants. Designing community-based programs offering strategies for mood management and healthy lifestyle change may be efficacious for immigrant populations.

Health Disparities in Adolescent Bariatric Surgery: Nationwide Outcomes and Utilization

PURPOSE

Bariatric surgery represents an appropriate treatment for adolescent severe obesity, but its utilization remains low in this patient population. We studied the impact of race and sex on preoperative characteristics, outcomes, and utilization of adolescent bariatric surgery.

METHODS

Retrospective analysis (2007-2014) of adolescent bariatric surgery using the Bariatric Outcomes Longitudinal Database, a national database that collects bariatric surgical care data. We assessed the relationships between baseline characteristics and outcomes (weight loss and remission of obesity-related conditions [ORCs]). Using the National Health and Nutrition Examination Survey and U.S. census data, we calculated the ratio of severe obesity and bariatric procedures among races and determined the ratio of ratios to assess for disparities.

RESULTS

About 1,539 adolescents underwent bariatric surgery. Males had higher preoperative body mass index (BMI; 51.8 ± 10.5 vs. 47.1 ± 8.7, p < .001) and higher rates of obstructive sleep apnea and dyslipidemia. Blacks had higher preoperative BMI (52.4 ± 10.6 vs. 47.3 ± 8.3; 48.7 ± 8.8; 48.2 ± 12.1 kg/m2; whites, Hispanics, and others, respectively p < .001) and higher rates of hypertension, obstructive sleep apnea, and asthma. Weight loss and ORCs remission rates did not differ between sexes or races after accounting for the rate of severe obesity in each racial group. White adolescents underwent bariatric surgery at a higher proportion than blacks and Hispanics (2.5 and 2.3 times higher, respectively).

CONCLUSIONS

Preoperative characteristics vary according to race and sex. Race and sex do not impact 12-month weight loss or ORC's remission rates. Minority adolescents undergo bariatric surgery at lower-than-expected rates.

Emerging Adulthood, Emergent Health Lifestyles: Sociodemographic Determinants of Trajectories of Smoking, Binge Drinking, Obesity, and Sedentary Behavior

During the transition to adulthood, many unhealthy behaviors are developed that in turn shape behaviors, health, and mortality in later life. However, research on unhealthy behaviors and risky transitions has mostly focused on one health problem at a time. In this article, we examine variation in health behavior trajectories, how trajectories cluster together, and how the likelihood of experiencing different behavior trajectories varies by sociodemographic characteristics. We use the National Longitudinal Study of Adolescent Health (Add Health) Waves I to IV to chart the most common health behavior trajectories over the transition to adulthood for cigarette smoking, alcohol consumption, obesity, and sedentary behavior. We find that health behavior trajectories cluster together in seven joint classes and that sociodemographic factors (including gender, parental education, and race-ethnicity) significantly predict membership in these joint trajectories.

Breastfeeding, overweight status, and inflammation

Research documents a host of health benefits of breastfeeding for infants and children, including long-term health conditions arising from inflammation. Here, we provide new evidence about this association, focusing on the link between breastfeeding in infancy and inflammation in early adulthood. Our study is based on the National Longitudinal Study of Adolescent to Adult Health (Add Health) which allows us investigate a potentially important mediating pathway - overweight status from early adolescence into young adulthood. Results from pathway analyses in a structural equation modeling framework indicate that, in addition to a direct pathway linking breastfeeding and inflammation, an indirect pathway through overweight status across adolescence into young adulthood partially explains the association between breastfeeding and inflammation. Overweight status, moreover, links breastfeeding to inflammation not only through proximal timing of overweight status, but also through an indirect cascading process of overweight status over the life course that is evident in adolescence. Overall, this study highlights the importance of considering breastfeeding, overweight status and inflammation as dynamic life course processes that contribute to development of health inequalities.

Age at migration, family instability, and timing of sexual onset

This study builds on and extends previous research on nativity variations in adolescent health and risk behavior by addressing three questions: (1) whether and how generational status and age at migration are associated with timing of sexual onset among U.S. adolescents; (2) whether and how family instability mediates associations between nativity and sexual debut; and (3) whether and how these associations vary by gender. We find that first- and second-generation immigrant youth initiate sexual activity later than native youth. Foreign-born youth who migrate after the start of adolescence exhibit the latest sexual onset; boys' sexual behavior is particularly sensitive to age at migration. Parental union stability is protective for first- and second-generation youth, especially boys; however, instability in co-residence with parents accelerates sexual debut for foreign-born girls, and dilutes protections from parental marital stability. Use of a non-English language at home delays sexual onset for immigrant girls, but not boys.

BMI loci and longitudinal BMI from adolescence to young adulthood in an ethnically diverse cohort

Objective

The association of obesity susceptibility variants with change in body mass index (BMI) across the life course is not well understood.

Subjects

In ancestry stratified models of 5,962 European American (EA), 2,080 African American (AA), and 1,582 Hispanic American (HA) individuals from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined associations between 34 obesity SNPs with per year change in BMI, measured by the slope from a growth-curve analysis of two or more BMI measurements between adolescence and young adulthood. For SNPs nominally associated with BMI change (p<0.05), we interrogated age differences within data collection Wave and time differences between age categories that overlapped between Waves.

Results

We found SNPs in/near FTO, MC4R, MTCH2, TFAP2B, SEC16B, and TMEM18 were significantly associated (p<0.0015 ≈ 0.05/34) with BMI change in EA and the ancestry-combined meta-analysis. Rs9939609 in FTO met genome-wide significance at p<5e-08 in the EA and ancestry combined analysis, respectively [Beta(se)=0.025(0.004);Beta(se)=0.021(0.003)]. No SNPs were significant after Bonferroni correction in AA or HA, although 5 SNPs in AA and 4 SNPs in HA were nominally significant (p<0.05). In EA and the ancestry-combined meta-analysis, rs3817334 near MTCH2 showed larger effects in younger respondents, while rs987237 near TFAP2B, showed larger effects in older respondents across all Waves. Differences in effect estimates across time for MTCH2 and TFAP2B are suggestive of either era or cohort effects.

Conclusion

The observed association between variants in/near FTO, MC4R, MTCH2, TFAP2B, SEC16B, and TMEM18 with change in BMI from adolescence to young adulthood suggest that the genetic effect of BMI loci varies over time in a complex manner, highlighting the importance of investigating loci influencing obesity risk across the life course.

Feasibility of conducting a longitudinal, transnational study of filipino migrants to the United States: a dual-cohort design

Most studies of immigrant health are cross-sectional and fail to collect information prior to migration, leading to potential bias and confounding. The present pilot study examines the feasibility of studying migrants prospectively, with baseline data collected before migration. The study followed two cohorts of Filipinos for one year, a migrant cohort (n=27) that emigrated to the U.S. and a second non-migrant cohort (n=26) that remained in the Philippines. The one-year retention rate was 96%. The migrant cohort arrived in the U.S. within two months of their baseline assessment. Migrants and non-migrants did not differ with regard to body mass index, waist circumference, or waist to hip ratio at baseline or at follow-up. It is feasible to conduct a transnational, longitudinal study of two cohorts of Filipinos. This design provides important pre-migration information, is analogous to a natural experiment, can be upscaled, and allows for a rigorous examination of immigrant health.

Diet misreporting can be corrected: confirmation of the association between energy intake and fat-free mass in adolescents

Subjective energy intake (sEI) is often misreported, providing unreliable estimates of energy consumed. Therefore, relating sEI data to health outcomes is difficult. Recently, Börnhorst et al. compared various methods to correct sEI-based energy intake estimates. They criticised approaches that categorise participants as under-reporters, plausible reporters and over-reporters based on the sEI:total energy expenditure (TEE) ratio, and thereafter use these categories as statistical covariates or exclusion criteria. Instead, they recommended using external predictors of sEI misreporting as statistical covariates. We sought to confirm and extend these findings. Using a sample of 190 adolescent boys (mean age=14), we demonstrated that dual-energy X-ray absorptiometry-measured fat-free mass is strongly associated with objective energy intake data (onsite weighted breakfast), but the association with sEI (previous 3-d dietary interview) is weak. Comparing sEI with TEE revealed that sEI was mostly under-reported (74 %). Interestingly, statistically controlling for dietary reporting groups or restricting samples to plausible reporters created a stronger-than-expected association between fat-free mass and sEI. However, the association was an artifact caused by selection bias – that is, data re-sampling and simulations showed that these methods overestimated the effect size because fat-free mass was related to sEI both directly and indirectly via TEE. A more realistic association between sEI and fat-free mass was obtained when the model included common predictors of misreporting (e.g. BMI, restraint). To conclude, restricting sEI data only to plausible reporters can cause selection bias and inflated associations in later analyses. Therefore, we further support statistically correcting sEI data in nutritional analyses. The script for running simulations is provided.

Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

Latino suicidal adolescent psychosocial service utilization: The role of mood fluctuations and inattention

BACKGROUND

Little is known about the specific factors related to whether or not Latino adolescents with suicide ideation (SI) will seek services. Utilizing Andersen's Behavior Model of Health Services Use (2008) the goal of this study is to identify the factors related to utilization of mental health services by Latino adolescents with SI to inform and improve suicide prevention efforts.

METHOD

Data from Wave 1 of the National Longitudinal Study of Adolescent Health was examined. Predispositional (gender, age), enabling/disabling (income, lack of insurance, difficulty obtaining medical care), and need (depressed mood, suicide attempt, perceived health, impulsivity, mood fluctuations, difficulties with attention, etc.) variables were examined via logistic regression as potential correlates of mental health service utilization.

RESULTS

Twenty-eight percent of the Latino adolescents with suicidal ideation (SI) in our sample received mental health services. Need factors such as daily mood fluctuations within the past 12 months (OR=4.78) and frequent difficulty focusing attention within the past week (OR=4.96), but not impulsivity, were associated with an increased likelihood of receiving mental health services. No additional associations were observed.

LIMITATIONS

The current study is based on cross-sectional data. Therefore, statements about causality cannot be made.

CONCLUSIONS

These findings suggest that emotion regulation (e.g., daily mood fluctuations) and neurocognitive factors (e.g., difficulty with focusing attention) may be important factors to consider in the clinical assessment of Latino adolescents with SI.

Capitalizing on mobile technology to support healthy eating in ethnic minority college students

OBJECTIVE

To evaluate the capacity of a mobile technology-based intervention to support healthy eating among ethnic minority female students.

PARTICIPANTS

Forty-three African American and Hispanic female students participated in a 3-week intervention between January and May 2013.

METHODS

Participants photographed their meals using their smart phone camera and received motivational text messages 3 times a day. At baseline, postintervention, and 10 weeks after the intervention, participants reported on fruit, vegetable, and sugar-sweetened beverage consumption. Participants were also weighed at baseline.

RESULTS

Among participants with body mass index (BMI) ≥25, fruit and vegetable consumption increased with time (p < .01). Among participants with BMI <21, consumption of fruit decreased (p < .05), whereas the consumption of vegetables remained stable. No effects were found for sugar-sweetened beverage consumption.

CONCLUSION

Mobile technology-based interventions could facilitate healthy eating among female ethnic minority college students, particularly those with higher BMI.

Preventing Weight Gain in Children Who Are School Age and African-American

PURPOSE

To describe a health and weight management intervention for children who are African American.

METHODS

Body mass index (BMI), blood pressure, and fitness levels were measured in 222 students (kindergarten-eighth grade) from 2 schools (control and intervention). Baseline and outcome data were collected over the course of 2 academic years. The intervention group received education on good nutrition and active lifestyle. Intervention students were also given the Body Figure Perception Questionnaire.

RESULTS

Students in the intervention group who were obese/overweight were more likely to be less physically fit. The greater the intervention students' BMI, the larger the difference between their ideal and real body images. Intervention students' BMIs were maintained. The intervention group's posttest scores of knowledge about active lifestyle and good nutrition were significantly higher than their pretest scores and higher than the control group's scores.

CONCLUSIONS

Weight gain prevention holds promise for reducing risk of overweight/obesity in the African-American population.

Change in waist circumference with longer time in the United States among Hispanic and Chinese immigrants: the modifying role of the neighborhood built environment

PURPOSE

We examined whether living in neighborhoods supportive of healthier diets and more active lifestyles may buffer immigrants against the unhealthy weight gain that is purported to occur with longer length of US residence.

METHODS

Neighborhood data referring to a 1-mile buffer around participants' baseline home addresses were linked to longitudinal data from 877 Hispanic and 684 Chinese immigrants aged 45 to 84 years in the Multi-Ethnic Study of Atherosclerosis. We used ethnicity-stratified linear mixed models to examine whether food and activity-based neighborhood measures (healthy food stores, walkability, and recreational facilities) were associated with change in waist circumference (WC) over a 9-year follow-up.

RESULTS

Among Hispanics, living in neighborhoods with more resources for healthy food and recreational activity was related to lower baseline WC. However, there was no association with change in WC over time. Among Chinese, living in more walkable neighborhoods was associated with lower baseline WC and with slower increases in WC over time, especially among the most recent immigrant arrivals.

CONCLUSIONS

Where immigrants reside may have implications for health patterns that emerge with longer time in the United States.

Content and perception of weight-related maternal messages communicated to adult daughters

PURPOSE

This study examined communication between mothers and overweight daughters on weight or weight-related behaviors through the perspective of adult daughters.

METHODS

Qualitative thematic analysis was used to analyze in-depth individual interviews conducted with 15 adult daughters.

RESULTS

Mothers who actively engaged in weight management behaviors, such as dieting and exercising regularly, transmitted these behaviors through modeling and served as continuous sources of verbal guidance on the topic. Weight management was discussed frequently and explicitly. Daughters relied on mothers for motivation in the form of supportive statements consisting of specific recommendations on weight management practices, encouragement to attempt or continue weight management practices, empathy with the struggle of managing weight, and affirmation of practices conducive to weight management. Mothers who did not engage in weight management behaviors were not viewed as credible sources for advice on diet and exercise. Daughters did most of the advice giving and modeling on weight management behaviors. Weight management was discussed infrequently and cautiously. Daughters perceived weight-related messages from mothers as unsolicited and critical.

CONCLUSION

The results suggest that shared lifestyle goals among family members are important for facilitating supportive communication and engagement in health-promoting behaviors and have implications for family-based weight management interventions.

Sex, Socioeconomic and Regional Disparities in Age Trajectories of Childhood BMI, Underweight and Overweight in China

Using a longitudinal dataset from the China Health and Nutrition Survey (CHNS), growth curve models were employed to examine age trajectories of BMI for 1,694 subjects who were aged 2-11 in 1993 and followed in four waves (1997, 2000, 2004 and 2006). Based on age- and sex-specific BMI cut-points recommended for international use, the prevalence rates of overweight and underweight in the transition from childhood to adulthood (age 6-18) were also predicted. Sex, family income, rural-urban residency and geographical location were found to be significantly associated with the onsets, slopes, and acceleration of age trajectories in BMI, overweight, and underweight (P<0.01). Children who had lower prevalence of underweight in the transition from childhood to adulthood exhibited higher prevalence of overweight than their counterparts did. Moreover, the age interval during which children were more vulnerable to an increase in underweight was different from that for overweight. There were substantial regional disparities in the age trajectories of childhood overweight and underweight. Whereas the analyses suggest that the dual burden of nutritional problems (the coexistence of overweight and underweight) in China is more like two sides of a coin than two separate health issues, the critical age period for intervening in childhood overweight is different from that of childhood underweight. Geographical indicators of childhood obesity in China deserve further attention.

Racial and Ethnic Disparities in Early Childhood Obesity: Growth Trajectories in Body Mass Index

OBJECTIVE

The aims of this study are to describe growth trajectories in the body mass index (BMI) among the major racial and ethnic groups of US children and to identify predictors of children's BMI trajectories.

METHODS

The Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) was used to identify predictors of BMI growth trajectories, including child characteristics, maternal attributes, home practices related to diet and social behaviors, and family sociodemographic factors. Growth models, spanning 48 to 72 months of age, were estimated with hierarchical linear modeling via STATA/Xtmixed methods.

RESULTS

Approximately one-third of 4-year-old females and males were overweight and/or obese. African-American and Latino children displayed higher predicted mean BMI scores and differing mean BMI trajectories, compared with White children, adjusting for time-independent and time-dependent predictors. Several factors were significantly associated with lower mean BMI trajectories, including very low birth weight, higher maternal education level, residing in a two-parent household, and breastfeeding during infancy. Greater consumption of soda and fast food was associated with higher mean BMI growth. Soda consumption was a particularly strong predictor of mean BMI growth trajectory for young Black children. Neither the child's inactivity linked to television viewing nor fruit nor vegetable consumption was predictive of BMI growth for any racial/ethnic group.

CONCLUSION

Significant racial and ethnic differences are discernible in BMI trajectories among young children. Raising parents' and health practitioners' awareness of how fast food and sweetened-beverage consumption contributes to early obesity and growth in BMI-especially for Blacks and Latinos-could improve the health status of young children.

The association between personality traits and body mass index varies with nativity among individuals of Mexican origin

Personality traits have been associated consistently with health-related outcomes, but less is known about how aspects of the sociocultural environment modify these associations. This study uses a sample of participants of Mexican origin (N = 1013) to test whether exposure to the United States, indexed by nativity (Mexicans living in Mexico, foreign-born Mexican Americans, and U.S.-born Mexican Americans), moderates the association between personality traits and body mass index (BMI). Higher Conscientiousness was associated with lower BMI, regardless of nativity. In contrast, the association between Neuroticism and BMI was moderated by exposure to the U.S.: Neuroticism was associated with higher BMI among U.S.-born Mexican Americans (partial r = .15) but not among Mexican participants (partial r = .00), an effect strongest and most robust for the impulsivity facet of Neuroticism. This finding suggests that with more exposure to the United States, those who are more emotionally impulsive are at greater risk for obesity. More broadly, these findings suggest that social and psychological vulnerabilities interact to contribute to health outcomes.

Exploring healthy eating among ethnic minority students using mobile technology: Feasibility and adherence

Interventions aiming to help ethnically diverse emerging adults engage in healthy eating have had limited success. The aim of this study was to assess the feasibility of and adherence to an intervention capitalizing on mobile technology to improve healthy eating. Participants created an online photo food journal and received motivational text messages three times a day. Satisfaction with the intervention was assessed, as were control variables including depression and body dissatisfaction. In addition, weight and height were measured. Levels of adherence to the photo food journal were high with approximately two photos posted a day at baseline. However, adherence rates decreased over the course of the study. Body dissatisfaction positively predicted adherence, while body mass index negatively predicted study satisfaction. Mobile technology provides innovative avenues for healthy eating interventions. Such interventions appear acceptable and feasible for a short period; however, more work is required to evaluate their viability regarding long-term engagement.

Socioeconomic gradients in body mass index (BMI) in US immigrants during the transition to adulthood: examining the roles of parental education and intergenerational educational mobility

BACKGROUND

Despite comparatively lower socioeconomic status (SES), immigrants tend to have lower body weight and weaker SES gradients relative to US-born individuals. Yet, it is unknown how changes in SES over the life-course relate to body weight in immigrants versus US-born individuals.

METHODS

We used longitudinal data from a nationally representative, diverse sample of 13 701 adolescents followed into adulthood to investigate whether associations between SES mobility categories (educational attainment reported by individuals as adults and by their parents during adolescence) and body mass index (BMI) measured in adulthood varied by immigrant generation. Weighted multivariable linear regression models were adjusted for age, sex, race/ethnicity and immigrant generation.

RESULTS

Among first-generation immigrants, although parental education was not associated with adult BMI, an immigrant's own education attainment was inversely associated with BMI (β=-2.6 kg/m(2); SE=0.9, p<0.01). In addition, upward educational mobility was associated with lower adult mean BMI than remaining low SES (β=-2.5 kg/m(2); SE=1.2, p<0.05). In contrast, among US-born respondents, college education in adulthood did not attenuate the negative association between parental education and adult BMI. Although an SES gradient emerged in adulthood for immigrants, remaining low SES from adolescence to adulthood was not associated with loss of health advantage relative to US-born respondents of US-born parents of similar SES.

CONCLUSIONS

Immigrants were able to translate higher SES in adulthood into a lower adult mean BMI regardless of childhood SES, whereas the consequences of lower childhood SES had a longer reach even among the upwardly mobile US born.

Does adolescent weight status predict problematic substance use patterns?

OBJECTIVES

To identify underlying patterns of cigarette smoking, alcohol use, and marijuana use in young adulthood, and ascertain whether adolescent overweight or obesity status predicts problematic substance use patterns.

METHODS

The study included 15,119 participants from the National Longitudinal Study of Adolescent Health (Add Health) at Wave 1 (11-19 years) and Wave 3 (18-26 years). Latent class analysis was conducted.

RESULTS

Participants were classified into a Low Substance Use (35%), Regular Smokers (12%), High-risk Alcohol use (33%), or High Substance Use (20%) class. Overweight/obese adolescents had a greater likelihood of belonging to the Regular Smokers class.

CONCLUSIONS

Overweight/obese adolescents are at higher risk of engaging in regular cigarette smoking without problematic alcohol or marijuana use.

The longer you stay, the worse your health? A critical review of the negative acculturation theory among Asian immigrants

Researchers have become increasingly interested in the health patterns of immigrants with longer residence in the United States, as this reveals the health consequences of integration processes. The negative acculturation effect has been the dominant interpretation of duration patterns, despite empirical and theoretical uncertainties about this assumption. This theory assumes that immigrant health declines with longer residence in the United States because of poorer health behaviors and health risks that reflect Americanized lifestyles. This paper reviews the empirical support for the negative acculturation theory among Asian immigrants to determine if and when it is an appropriate interpretation for duration patterns. I conclude that empirical inconsistencies and methodological issues limit the negative acculturation theory as the primary interpretation for duration patterns. First, there is no consistent evidence that health behaviors decline with time. There is also substantial group heterogeneity in duration patterns as well as heterogeneity across health outcomes. The literature has not adequately addressed methodological shortcomings, such as confounding by cohort effects or non-linear duration patterns. Length of residence in the United States is still an important aspect of Asian immigrant health, but the mechanisms of this relationship are still understudied. I propose alternative frameworks between duration and health that consider environmental influences and end with future research directions to explore research gaps.

Influence of country of birth and ethnicity on body mass index among Canadian youth: a national survey

BACKGROUND

The body mass index (BMI) of youth often changes when they immigrate to a new country as a result of the adoption of new behaviours, a process called acculturation. We investigated whether BMI differs by country of birth (Canada v. other countries) and ethnicity, both individually and together. We also examined whether time since immigration and health-related behaviour explain any observed BMI differences.

METHODS

Data sources were the Canadian Health Behaviour in School-Aged Children study and the Canada Census of Population. Participants were youth in grades 6-10 (weighted sample n = 19 272). A questionnaire was used to assess participants' sociodemographic characteristics, height, weight and health-related behaviour. We calculated BMIs from participants' self-reported heights and weights and used World Health Organization growth references to determine BMI percentiles.

RESULTS

Based on self-reported heights and weights, BMI percentiles for foreign-born youth were lower than those of youth born in Canada (-4, 95% confidence interval [CI] -6 to -2). This difference did not decrease with time since immigration. Similarly, BMI percentiles were lower among East and Southeast Asian youth than their peers from the Canadian host culture (-4, 95% CI -6 to -2). Finally, BMI percentiles for foreign-born Arab and West Asian youth and East Indian and South Asian youth were lower than their Canadian-born peers of the same ethnicity (-14, 95% CI -22 to -7; -8, 95% CI -14 to -3).

INTERPRETATION

Immigrant generation and ethnicity were related to BMI among Canadian youth, both independently and together. Some ethnic groups showed differences by country of birth, i.e., East Indian and South Asian, while others showed no such difference, i.e., East and Southeast Asian. There was no association with time since immigration. Our findings reinforce the need to investigate country of birth and ethnicity when considering the determinants of childhood BMI.

Challenges in modelling the random structure correctly in growth mixture models and the impact this has on model mixtures

Lifecourse trajectories of clinical or anthropological attributes are useful for identifying how our early-life experiences influence later-life morbidity and mortality. Researchers often use growth mixture models (GMMs) to estimate such phenomena. It is common to place constrains on the random part of the GMM to improve parsimony or to aid convergence, but this can lead to an autoregressive structure that distorts the nature of the mixtures and subsequent model interpretation. This is especially true if changes in the outcome within individuals are gradual compared with the magnitude of differences between individuals. This is not widely appreciated, nor is its impact well understood. Using repeat measures of body mass index (BMI) for 1528 US adolescents, we estimated GMMs that required variance-covariance constraints to attain convergence. We contrasted constrained models with and without an autocorrelation structure to assess the impact this had on the ideal number of latent classes, their size and composition. We also contrasted model options using simulations. When the GMM variance-covariance structure was constrained, a within-class autocorrelation structure emerged. When not modelled explicitly, this led to poorer model fit and models that differed substantially in the ideal number of latent classes, as well as class size and composition. Failure to carefully consider the random structure of data within a GMM framework may lead to erroneous model inferences, especially for outcomes with greater within-person than between-person homogeneity, such as BMI. It is crucial to reflect on the underlying data generation processes when building such models.

Meal skipping linked to increased visceral adipose tissue and triglycerides in overweight minority youth

OBJECTIVE

To investigate the impact of eating frequency on dietary intake, physical activity (PA), metabolic, and adiposity measures in minority youth.

METHODS

This analysis included 185 overweight (≥85th BMI percentile) Hispanic and African-American youth (8-18 years) with the following cross-sectional measures: height, weight, BMI, dietary intake, body composition, metabolic parameters, PA, visceral adipose tissue (VAT), and subcutaneous adipose tissue. Each eating occasion (EO) was defined as ≥50 calories and ≥15 minutes from any previous EO. Participants were dichotomized based on EOs per 24-h into meal skippers <3 EO (MS; n = 27) or normal/frequent eaters ≥3 EO (NFE; n = 158). ANCOVAs were used to assess dietary intakes, metabolic outcomes, adiposity, and PA between eating frequency groups.

RESULTS

MS compared to NFE consumed 24% fewer calories per 24-h (P ≤ 0.01), 21% more calories per EO (P ≤ 0.01), ate 40% less often (P ≤ 0.01), had 18% higher triglycerides (P = 0.03), and 26% more VAT (P = 0.03), with no differences in PA.

CONCLUSIONS

Although meal skipping was associated with decreased energy intake, it was linked to increased calories per EO and higher triglycerides and VAT, which are strong indicators of deleterious metabolic profiles. These findings elucidate that meal skipping may be associated with increased VAT and related metabolic diseases in high-risk minority youth.

The immigration effect on obesity and overweight in Israeli Jewish male adolescents born 1970-1993

PURPOSE

The aim of the study was to assess the relationship between age of arrival of male pediatric immigrant populations in Israel and their risk for subsequent high-weight morbidity at adolescence.

METHODS

The study analyzed a pooled cross section of 89,744 foreign-born male Jewish study participants, who were born in the former Soviet Union or Ethiopia (1970-1993) and immigrated in childhood to Israel. Each participant's body mass index was measured at approximately 17 years of age. Odds ratios were calculated for obesity and overweight according to age on arrival to Israel. A total of 52,503 Israel-born participants with origins in those same countries were measured at the same age and used as references. A total of 52,258 native Israelis without known immigrating ancestry were also used for comparison. The risk stratification accounted for possible socio-demographic confounders and birth year.

RESULTS

Foreign-born immigrants had decreased risk for obesity and overweight relative to Israeli-born immigrants when measured at the age of 17 years. However, those who arrived in Israel during infancy and early childhood (before the age of 3 years) had greater risk for high weight compared with those immigrating during late childhood and adolescence.

CONCLUSIONS

Although generally protective against obesity and overweight relative to native, these beneficial effects of immigration are diminished for those arriving in early childhood rather than later in adolescence.

Child and adolescent psychopathology predicts increased adult body mass index: results from a prospective community sample

OBJECTIVE

To examine the relationship between childhood and adolescent symptoms of (1) depression, (2) attention-deficit hyperactivity disorder (ADHD), and (3) conduct disorder (CD) with adult body mass index (BMI) in a prospective longitudinal study of 3294 community participants in the Ontario Child Health Survey.

METHODS

One thousand nine hundred ninety-two children aged 4 to 11 years and 1302 adolescents aged 12 to 16 years at study entry in 1983 underwent follow-up in 2000. Body mass index data were available for 1886 adult participants in the year 2000, which comprised the final study sample. Data were collected from youth, parents, and teachers using a combination of parental, youth, and teacher self-report and semistructured interview. Body mass index is a derived variable determined from the self-reported height and weight in 2000.

RESULTS

Adults with depression, ADHD, or CD identified in childhood had increased body weight (BMI = 27.2 kg/m, 27.7 kg/m, and 27.9 kg/m, respectively) compared with their nonaffected peers (BMI = 24.8 kg/m; p < .001). Greater depressive symptoms in childhood were associated with increased adult BMI among boys (p = .02). Among adolescents, depression and sex interact in the association with adult BMI (p = .01). The association of childhood ADHD with adult overweight was completely accounted for by the effect of comorbid child conduct disturbance (p < .001) for both girls and boys. Greater conduct symptoms were associated with increased adult BMI (p = .04) among adolescent girls.

CONCLUSION

This epidemiologic study suggests that psychopathology in childhood is associated with increased adult BMI. Early identification of psychiatric illness may present key opportunities for targeted prevention of obesity.

Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk

PURPOSE

This article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children.

METHODS

Public health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs.

RESULTS

The Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on children's risk for obesity consistent with Socio-Ecological Framework.

CONCLUSIONS

Much research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.

Insulin resistance and impaired mitochondrial function in obese adolescent girls

BACKGROUND

Mitochondrial dysfunction plays a role in the development of muscle insulin resistance (IR) and the accumulation of intramyocellular lipid (IMCL) in skeletal muscle that can, in turn, interfere with insulin signaling. The purpose of this study was to assess mitochondrial function (MF) and IMCL in obese adolescent girls with and without IR to determine whether: (1) Girls with IR have impaired MF, and (2) impaired MF in girls with IR is related to higher IMCL.

METHODS

We examined 22 obese girls aged 13-21 years old for IR [defined as a homeostasis model assessment of insulin resistance (HOMA-IR) value >4. Phosphorus magnetic resonance spectroscopy (31P-MRS) and proton magnetic resonance spectroscopy (1H-MRS), respectively, were used to determine MF and IMCL of the soleus muscle along with magnetic resonance imaging (MRI) measures of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) in girls with HOMA-IR >4 (insulin-resistant group) versus HOMA-IR ≤ 4 (insulin-sensitive group). Serum lipids and waist-to-hip ratio (W/H) were also measured.

RESULTS

Girls with IR (n=8) did not differ from the insulin-sensitive group (n=14) for age, bone age, weight, VAT, SAT, TAT, or IMCL. However, the insulin-resistant group had higher W/H. Additionally the insulin-resistance group had a lower log rate of postexercise phosphocreatine (PCr) recovery (ViPCr) and a higher log PCr recovery constant (tau), indicative of impaired MF.

CONCLUSIONS

Obese girls with increased IR have impaired mitochondrial function. This association is not mediated by alterations in IMCL or adipose tissue. Further studies are necessary to determine whether there is a causal relation between impaired mitochondrial function and IR in obesity and mediators of such a relationship.