Physical activity and overweight among adolescents on the Texas-Mexico border

The potential epidemiologic, clinical, and economic impact of requiring schools to offer Physical Education (PE) classes in Mexico City

Background

Many schools have been cutting physical education (PE) classes due to budget constraints, which raises the question of whether policymakers should require schools to offer PE classes. Evidence suggests that PE classes can help address rising physical inactivity and obesity prevalence. However, it would be helpful to determine if requiring PE is cost-effective.

Methods

We developed an agent-based model of youth in Mexico City and the impact of all schools offering PE classes on changes in weight, weight-associated health conditions and the corresponding direct and indirect costs over their lifetime.

Results

If schools offer PE without meeting guidelines and instead followed currently observed class length and time active during class, overweight and obesity prevalence decreased by 1.3% (95% CI: 1.0%-1.6%) and was cost-effective from the third-party payer and societal perspectives ($5,058 per disability-adjusted life year [DALY] averted and $5,786/DALY averted, respectively, assuming PE cost $50.3 million). When all schools offered PE classes meeting international guidelines for PE classes, overweight and obesity prevalence decreased by 3.9% (95% CI: 3.7%-4.3%) in the cohort at the end of five years compared to no PE. Long-term, this averted 3,183 and 1,081 obesity-related health conditions and deaths, respectively and averted ≥$31.5 million in direct medical costs and ≥$39.7 million in societal costs, assuming PE classes cost ≤$50.3 million over the five-year period. PE classes could cost up to $185.5 million and $89.9 million over the course of five years and still remain cost-effective and cost saving respectively, from the societal perspective.

Conclusion

Requiring PE in all schools could be cost-effective when PE class costs, on average, up to $10,340 per school annually. Further, the amount of time students are active during class is a driver of PE classes’ value (e.g., it is cost saving when PE classes meet international guidelines) suggesting the need for specific recommendations.

Breast Cancer Epidemiology, Prevention, and Screening

Globally, breast cancer is both the most commonly occurring cancer and the commonest cause of cancer death among women. Available data suggest that incidence and mortality in high-resource countries has been declining whereas incidence and mortality in low-resource countries has been increasing. This pattern is likely to be due to changing risk factor profiles and differences in access to breast cancer early detection and treatment. Risk factors for breast cancer include increasing age, race, menarche history, breast characteristics, reproductive patterns, hormone use, alcohol use, tobacco use, diet, physical activity, and body habitus. Mutations in the BRCA 1 and BRCA 2 tumor suppressor genes are significantly associated with the development of breast and ovarian cancer by the age of 70. Survival depends on both stage and molecular subtype. As there are few signs and symptoms early on, early detection is an important strategy to improve outcomes. Major professional organizations in the United States and elsewhere recommend screening with mammography with appropriate follow up for an abnormal screening test, although they differ somewhat by recommended ages and frequency of screening. Studies suggest a 15%-40% mortality reduction secondary to screening, however, there are also concerns about harms, such as overdiagnosis (5%-54%) and overtreatment leading to long term complications, and false negatives (6%-46%). Identification of women at risk for BRCA1 and BRCA 2 mutations is also recommended with referral for genetic testing. Preventive interventions, such as lifestyle, medical, and surgical options are available for women testing positive for BRCA mutations.

Neglect: failure to thrive and obesity

Medical providers need to monitor growth at every visit. Weight status is influenced by genetics, medical conditions, socioeconomic status, and family environment. Screening for food security and psychosocial risk factors is an integral tool to identify families at risk for nutritional deficits and child maltreatment. Nutritional rehabilitation is best accomplished in an outpatient, multidisciplinary setting. Medical neglect should be considered in failure to thrive and obesity when there is a serious risk of harm from identified medical complications, additional or worsening medical complications occurring despite a multidisciplinary approach, and/or non-adherence with the treatment plan.

Perceptions of social support, empowerment and youth risk behaviors

This study examined the association of perceived social support and community empowerment among urban middle-school students living in Matamoros, Mexico and the risk behaviors of fighting, alcohol and tobacco use, and sexual activity. Middle school students (n = 1,181) from 32 public and private Mexican schools were surveyed. Weighted multiple logistic regression analyses were conducted. Among girls, lack of parent/teacher interactions regarding school increased odds for fighting, alcohol and tobacco use. Among boys, lack of empowerment increased odds of alcohol and tobacco use and lack of parent/teacher interactions regarding school increased odds for sexual activity. Community empowerment and perceived social support are uniquely associated with risk behaviors for girls and boys. Additionally, perceived social support from individuals most immediate to the youth are associated with protection against risk for some behaviors, while perceived social support from individuals more removed from youth have mixed association with risk behaviors.

It's all about the children: a participant-driven photo-elicitation study of Mexican-origin mothers' food choices

BACKGROUND

There is a desperate need to address diet-related chronic diseases in Mexican-origin women, particularly for those in border region colonias (Mexican settlements) and other new destination communities in rural and non-rural areas of the U.S. Understanding the food choices of mothers, who lead food and health activities in their families, provides one way to improve health outcomes in Mexican-origin women and their children. This study used a visual method, participant-driven photo-elicitation, and grounded theory in a contextual study of food choices from the perspectives of Mexican-origin mothers.

METHODS

Teams of trained promotoras (female community health workers from the area) collected all data in Spanish. Ten Mexican-origin mothers living in colonias in Hidalgo County, TX completed a creative photography assignment and an in-depth interview using their photographs as visual prompts and examples. English transcripts were coded inductively by hand, and initial observations emphasized the salience of mothers' food practices in their routine care-giving. This was explored further by coding transcripts in the qualitative data analysis software Atlas.ti.

RESULTS

An inductive conceptual framework was created to provide context for understanding mothers' daily practices and their food practices in particular. Three themes emerged from the data: 1) a mother's primary orientation was toward her children; 2) leveraging resources to provide the best for her children; and 3) a mother's daily food practices kept her children happy, healthy, and well-fed. Results offer insight into the intricate meanings embedded in Mexican-origin mothers' routine food choices.

CONCLUSIONS

This paper provides a new perspective for understanding food choice through the eyes of mothers living in the colonias of South Texas -- one that emphasizes the importance of children in their routine food practices and the resilience of the mothers themselves. Additional research is needed to better understand mothers' perspectives and food practices with larger samples of women and among other socioeconomic groups.

Correlates of physical activity and inactivity in urban Mexican youth

OBJECTIVES

To evaluate correlates of physical activity in Mexico City school youth.

METHODS

A cross-sectional survey was conducted with 1,004 school youth (490 males and 514 females), 9-18 years of age resident in Mexico City. Age, height, body mass index (BMI), socioeconomic status (SES), time viewing television and playing video games (physical inactivity), and perceived sport/physical activity status of mother and father were evaluated as potential correlates of physical activity [Physical Activity Questionnaire (PAQ)]. Multiple linear regression analyses (backward elimination) by age group and sex were used.

RESULTS

Physical activity declined in older adolescents, while differences between the two younger age groups were minimal. Television time showed a similar tendency. Overall, fathers were perceived as being active in sport/physical activity more frequently than mothers. Significant predictors of activity differed by age group and sex. For the total sample, age (negative) and perceived sport/activity status of the mother (positive) were significant predictors of the PAQ in boys, and age and the BMI (negative) and height and perceived sport/activity status of both parents (positive) were significant predictors for girls. Age (negative) was the main predictor for inactivity in both males and females.

CONCLUSIONS

Potential correlates of physical activity and inactivity considered in this analysis were limited and accounted for relatively little of the variance in physical activity. The role of perceived sport/activity of the parents, especially among younger boys and girls, is particularly of interest and merits more detailed study. Nevertheless, many other variables also need to be considered.

Obese adolescents are less active than their normal-weight peers, but wherein lies the difference?

BACKGROUND

Obese adolescents achieve less moderate to vigorous physical activity (MVPA) than normal-weight adolescents, but the nature and extent of the deficit is unclear. This study aimed to describe differences in MVPA across weight status categories by domain of activity (sport, play, and active transport) and specific activity-sets (e.g. team sports, playground games, and chores) using minutes of activity, estimated intensity, and estimated energy expenditure as metrics of MVPA.

METHOD

Anthropometric, use-of-time, and pedometer data were collected on a random sample of 2,200 Australian children aged 9-16 years. Minutes of activity, intensity metabolic equivalents of tasks (METs), and energy expenditure (MET.min) within each domain were estimated using an energy cost compendium.

RESULTS

Obese adolescents reported 174 MET.min/d lower MVPA energy expenditure than normal-weight peers (p < .0001), more than accounting for the entire difference in total daily energy expenditure (154 MET.min/d). Of this difference, 121 MET.min/d was associated with lower sports participation (p < .0001) and 45 MET.min/d with less free play (p = .03). There were no differences in minutes of active transport or in reported activity intensity across weight status categories in sport, free play, or active transport. The differences in MVPA participation between obese and normal-weight adolescents were largely because of different levels of participation in team sports, cycling, partner sports (boys), and dancing (girls).

CONCLUSION

More than two-thirds of the difference in energy expenditure between obese and normal-weight Australian adolescents was because of lower participation in sport. Strategies for engaging obese adolescents in sport may help to redress deficits in energy expenditure.

Disturbed sleep among adolescents living in 2 communities on the Texas-Mexico border, 2000-2003

INTRODUCTION

Disturbed sleep is a public health problem, but few studies describe the prevalence of sleep problems among Hispanic adolescents. We estimated the prevalence of disturbed sleep and associated factors among ninth graders living on the Texas-Mexico border.

METHODS

We used probabilistic sampling to conduct 2 cross-sectional, school-based surveys: 1 during the 2000-2001 school year in the Lower Rio Grande Valley, Texas (n = 4,901), and 1 during the 2002-2003 school year in Matamoros, Tamaulipas, Mexico (n = 669). We assessed disturbed sleep during the 4 weeks before the survey.

RESULTS

The prevalence of disturbed sleep in Matamoros was 36% and in the Lower Rio Grande Valley was 28%. Factors associated with disturbed sleep in both populations were smoking cigarettes, having ever used cocaine, having been forced to have sex, considering attempting suicide, feeling sad, and going without eating for 24 hours or more.

CONCLUSION

This study revealed a high prevalence of disturbed sleep in high school students living on the Texas-Mexico border. This public health issue should be further investigated in both communities.

Fatores socioeconômicos, demográficos, ambientais e comportamentais associados ao excesso de peso em adolescentes: uma revisão sistemática da literatura

OBJETIVO: Identificar fatores socioeconômicos, ambientais e comportamentais associados ao excesso de peso (EP) em adolescentes por meio de uma revisão sistemática da literatura. MÉTODOS: Foram consultadas seis bases de dados (Lilacs, Adolec, SciELO, Medline via Pubmed, ISI Web of Knowlwdge e Cochrane Library) entre os dias 3 e 13 de janeiro de 2008. Os descritores e respectivos termos MeSH utilizados foram: "sobrepeso", "obesidade", "adolescência", "adolescentes", "fatores de risco", "fatores associados". Foram avaliados artigos em inglês, espanhol e português publicados entre 1997 e 2007, e incluídos estudos observacionais que estudaram adolescentes com idades entre 10 e 19 anos, cujo desfecho era o EP diagnosticado por critérios internacionalmente utilizados. Foram excluídos estudos com base em amostras de conveniência ou que não investigavam fatores sociais, ambientais e psicocomportamentais entre as variáveis independentes. RESULTADOS: Da leitura dos títulos e resumos, e da aplicação inicial dos critérios de elegibilidade, resultaram 202 artigos. A revisão das publicações completas permitiu a inclusão e análise de 56 artigos. Observou-se que o nível socioeconômico associou-se inversamente com o EP em países desenvolvidos e de forma direta em países em desenvolvimento. Dieta para emagrecer, número de horas alocadas em TV/vídeo por dia, mãe e/ou pais obesos e ocorrência de EP na infância associaram-se diretamente com o EP. Foram identificados como fatores protetores o hábito de consumir desjejum e a prática de atividade física. CONCLUSÃO: Variáveis socioeconômicas, comportamentais, familiares e do início da vida associaram-se com EP e estas devem ser consideradas nas intervenções dirigidas para este agravo entre adolescentes.

Health disparities among Mexican American women aged 15-44 years: National Health and Nutrition Examination Survey, 1999-2004

OBJECTIVES

We analyzed the health of Mexican American women aged 15 to 44 years, by generation and language preference, to guide planning for reproductive health services in this growing population.

METHODS

We used personal interview and medical examination data from the 1999 to 2004 National Health and Nutrition Examination Surveys. We used SUDAAN for calculating age-adjusted prevalence estimates of demographic and health characteristics. The Satterthwaite adjusted F test and Student t test were used for subgroup comparisons.

RESULTS

The women had different health profiles (P < .05) by generation and language preference. Second- and later-generation women and women who used more English were more likely to be sexually active, to have been younger at first intercourse, and to have had more male sexual partners than were first-generation women and women who used more Spanish. Compared with their first-generation counterparts, second- and later-generation women drank more alcohol, were better educated, had higher incomes, and were more likely to have health insurance. Third-generation women were more likely to have delivered a low-birthweight baby than were first-generation women.

CONCLUSIONS

Differences by generation and language preference suggest that acculturation should be considered when planning interventions to promote healthy reproductive behaviors among Mexican American women.

Physical activity participation by parental language use in 4th, 8th, and 11th grade students in Texas, USA

Research on physical activity (PA) by level of acculturation in Hispanic children is limited and findings have been mixed. We examined PA participation by primary language used with parents in a representative sample of 4th, 8th, and 11th grade Texas public school students. Mixed-effects regression models were conducted using cross-sectional data from the 2004-2005 School Physical Activity and Nutrition Study (n = 22,049). Self-reported PA was compared among three language-ethnic groups: Spanish-Hispanic (SH) (referent); English-Hispanic (EH); and English-Other (EO). EH and/or EO girls were generally between 1.25 and 2.58 [OR] times more likely to participate in PA across grade levels, with the largest differences found for school sports in 8th grade girls. EH and EO 8th grade boys were 1.71 (CI: 1.40, 2.10) and 2.06 (CI: 1.68, 2.51) times, respectively, more likely to participate in school sports. Findings indicate important disparities in Spanish-speaking Hispanic children's PA participation.

Associações entre atividade física, índice de massa corporal e comportamentos sedentários em adolescentes

OBJETIVO: Este estudo teve como objetivo determinar a associação do índice de massa corporal (IMC) com os níveis de atividade física (AF) e comportamentos sedentários (assistir TV, usar computador ou jogar videogames) em adolescentes de escolas públicas do Estado de Santa Catarina (15-19 anos; n = 5.028). MÉTODOS: As informações foram coletadas por meio de questionário desenvolvido e validado para adolescentes. Foram considerados insuficientemente ativos, os jovens que não acumulavam pelo menos 300 minutos/semana de atividades físicas moderadas ou vigorosas. Considerou-se para o uso excessivo de TV e computador/games um tempo > 2 horas/dia; para excesso de peso corporal, utilizou-se a tabela internacional de IMC para adolescentes. RESULTADOS: O excesso de peso corporal foi mais prevalente entre os rapazes (12,7% vs 7,9%, p<0,001), e houve uma maior proporção de moças insuficientemente ativas (37,0% vs 21,0%, p<0,001). A chance de ter excesso de peso corporal foi 74% maior entre os rapazes pouco ativos em comparação com os ativos, e entre as moças de menor renda familiar (OR=1,85) e as que residiam na zona urbana (OR=2,22). A chance de serem menos ativos foi 43% maior entre os rapazes que assistiam mais TV e 73% maior para aqueles com excesso de peso corporal. Nas moças, a chance de pouca atividade física foi 54% maior entre as que trabalhavam. CONCLUSÕES: a prevalência de excesso de peso corporal foi maior entre os rapazes, mesmo sendo mais ativos do que as moças. Nos rapazes, o excesso de peso estava significativamente associado à menor prática de atividade física e, nas moças, à menor renda familiar e local de moradia.

Prevalence and associated factors of overweight among Mexican-American adolescents

The purpose of this study is to evaluate the prevalence of overweight and obesity and associated factors among Mexican-American adolescents, because obesity is more common among this ethnic group. The National Health and Nutrition Examination Survey 1999-2002 data were analyzed for Mexican-American adolescents aged 12 to 19 years (n=4,109). Weight status was determined by sex-specific body mass index for age, and evaluated in relationship to demographic characteristics, participation in physical activities, dietary intake, and general health status. Overall, 40.9% of the adolescents were overweight and 22.9% were obese. Males had a higher prevalence of overweight and obesity than females. Factors associated with overweight included being from a low-income family, perceiving oneself as less physically active compared to others of the same age, having a history of asthma, and having considerably higher blood pressure. However, overweight adolescents reported a substantially lower intake for calories and all evaluated nutrients compared to nonoverweight adolescents. It is important to be aware of the high prevalence of overweight among Mexican-American adolescents, as chronic diseases such as hypertension start early among overweight adolescents. Culturally appropriate programs should be created for this ethnic group aimed at obesity prevention and weight management, including nutrition education and individual dietary counseling, with the ultimate goal of lifelong healthful eating habits.