Associations between use of specific social media sites and electronic cigarette use among college students

OBJECTIVE

To examine dose-response associations between use of specific social media sites and the use of electronic cigarettes (e-cigarettes) and traditional cigarettes.

METHODS

This was a cross-sectional study of 298 first-year college students enrolled in the fall 2019 semester at a large state university. Heckman selection and Probit model were used to estimate associations between use of specific social media sites and e-cigarette/traditional cigarette use.

RESULTS

Each additional hour per day spent on Snapchat was associated with a 4.61% increase in the probability of lifetime e-cigarette use. In addition, among current e-cigarette users, more time spent on Snapchat was associated with more frequent e-cigarette use (marginal effects: 0.13, p = 0.001). Facebook, Twitter, Snapchat and Instagram were not associated with traditional cigarette smoking.

CONCLUSION

Snapchat was the only major social media platform associated with both lifetime and current e-cigarette use.

Patterns and Predictors of Elevated Blood Pressure Among Primary School Children in Two Urban Settings in Kenya

Objectives

We conducted a cross-sectional study to examine the prevalence of elevated blood pressure (BP) among primary school children of different socio-economic status in two urban settings in Kenya and explored the association between elevated BP and children's dietary behaviors and overweight/obesity status.

Methods

The research study was conducted in Nairobi and Kisumu cities in Kenya. Three public schools, catering to children from households at low, medium and high socio-economic status were purposively selected to participate in the study in each city. Data was collected among children within the ages of 10–12 years enrolled in grades 4–6 at each school. Certified clinicians read children's BP readings using an aneroid sphygmomanometer and age-appropriate child BP cuffs. Trained enumerators measured children's weights, heights, waist circumferences and skinfolds. We calculated children's BP percentiles, BMI-for-age percentiles, waist circumference-for-height ratio (WHtR) and total skinfold values as recommended. Parents, with the help of their respective children, completed questionnaires on children's consumption of fruits, vegetables, red meats and processed meats, fries/crisps, fried/baked wheat products, confectioneries and beverages. Complete data were available for 390 children. We utilized prevalence ratio regression analysis to examine the association between children's BP and dietary practices and obesity.

Results

Over, 20% of the school children had pre-hypertension and 14% had hypertension, giving an overall elevated BP prevalence of 34%. Overweight and obese children were significantly more likely to have elevated BP and hypertension compared to children with healthy BMI-for-age percentiles. Children with WHtR > 0.5 and children with high total skinfold values were significantly more likely to have elevated BP and hypertension compared to children with lower waist circumference and skinfold values. Children who consumed high amounts of fries/crisps were significantly more likely to have elevated BP compared to children who consumed lower amounts.

Conclusions

This study increases our understanding BP patterns and determinants among school children in Kenya, and informs non-communicable disease prevention efforts.

Funding Sources

Saff Family.

Perceptions and Impact of a Youth-led Childhood Obesity Prevention Intervention among Youth-leaders

Objective

To evaluate the impact of a youth-led nutrition intervention on youth-leaders themselves.

Design

Mixed methods, including: in-depth interviews and a quasi-experimental quantitative study comparing youth-leaders and nonparticipant comparison youth.

Analysis

Qualitative analysis using direct content analysis. Difference-in-differences analyses assessing quantitative program impact.

Results

Youth-leaders perceived that the intervention impacted themselves, the youth-participants, and their respective social networks. Youth-leaders experienced greater increases in intentions to eat healthfully (p=0.04), and greater decreases in support for healthy eating from their friends (p=0.01), than the comparison group.

Conclusions/Implications

Youth-leaders reported multiple levels of intervention impact, and increased intentions for healthy eating; however, additional research is needed to enhance impact on behavioral outcomes.

Associations of Intensive Lifestyle Intervention in Type 2 Diabetes With Health Care Use, Spending, and Disability: An Ancillary Study of the Look AHEAD Study

IMPORTANCE

Intensive lifestyle interventions focused on diet and exercise can reduce weight and improve diabetes management. However, the long-term effects on health care use and spending are unclear, especially for public payers.

OBJECTIVE

To estimate the association of effective intensive lifestyle intervention for weight loss with long-term health care use and Medicare spending.

DESIGN, SETTING, AND PARTICIPANTS

This ancillary study used data from the Look AHEAD randomized clinical trial, which randomized participants with type 2 diabetes to an intensive lifestyle intervention or control group (ie, diabetes support and education), provided ongoing intervention from 2001 to 2012, and demonstrated improved diabetes management and reduced health care costs during the intervention. This study compared Medicare data between study arms from 2012 to 2015 to determine whether the intervention was associated with persistent reductions in health care spending.

EXPOSURE

Starting in 2001, Look AHEAD's intervention group participated in sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists with the goal of reducing weight 7% in the first year. Sessions occurred weekly in the first 6 months of the intervention and decreased over the intervention period. The controls participated in periodic group education sessions that occurred 3 times per year in the first year and decreased to 1 time per year later in the trial.

MAIN OUTCOMES AND MEASURES

Outcomes included total Medicare spending, Part D prescription drug costs, Part A and Part B Medicare spending, hospital admissions, emergency department visits, and disability-related Medicare eligibility.

RESULTS

This study matched Medicare administrative records for 2796 Look AHEAD study participants (54% of 5145 participants initially randomized and 86% of 3246 participants consenting to linkages). Linked intervention and control participants were of a similar age (mean [SD] age, 59.6 [5.4] years vs 59.6 [5.5] years at randomization) and sex (818 [58.1%] women vs 822 [59.3%] women). There was no statistically significant difference in total Medicare spending between groups (difference, -$133 [95% CI, -$1946 to $1681]; P = .89). In the intervention group, compared with the control group, there was statistically significantly higher Part B spending (difference, $513 [95% CI, $70 to $955]; P = .02) but lower prescription drug costs (difference, -$803 [95% CI, -$1522 to -$83]; P = .03).

CONCLUSIONS AND RELEVANCE

This ancillary study of a randomized clinical trial found that reductions in health care use and spending associated with an intensive lifestyle intervention for type 2 diabetes diminished as participants aged. Intensive lifestyle interventions may need to be sustained to reduce long-term health care spending.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03952728.

Building an endobariatric program: lessons learned

The emphasis on treating obesity has never been more critical, yet the complexity of delivering care has become more intricate due to new procedures, variable insurance coverage, and inconsistent reimbursement. This is our experience building an endobariatric program and treating overweight and obese patients with endobariatric therapies (EBTs) over 3 years. The primary intention of this manuscript was to educate the reader on how to build an endobariatric program, identify barriers, and provide succinct solutions to establish a successful program. The secondary aim was weight loss outcomes of procedures offered at our institution. We compiled a list of lessons learned, based on the difficulties we experienced to make it easy for others embarking on this journey. Herein, we present a business development strategy to overcome impediments, whilst offering high quality service. The high cost and lack of insurance coverage are significant barriers. Marketing can be costly and is often a factor that is ignored particularly early on, when finances are limited. However, it is an integral component of growing the program. The percentage total body weight loss (%TBWL) at 6 and 12 months post ESG was 17.8 ± 6.48 and 20.6 ± 8.3 ( P  < 0.001), respectively. The %TBWL at 6 months post IGB was 14.9 ± 9.8 for the Orbera IGB and 12.6 ± 7.4 for the Reshape IGB. There was a trend of preference for ESG compared to IGB placement over the 3 years. The key to building a successful endobariatric program is a motivated physician leader, collaborative bariatric surgeons, institutional support, and marketing. Insurance coverage will likely occur in the near future and programs must be prepared to manage the massive influx of patients that will likely request these procedures.

Schoolchildren's Body Mass Index and Dietary Practices Vary Across Socio-Economic Status in Kenya

Objectives

We conducted a cross-sectional study to examine the prevalence and determinants of overweight and obesity among schoolchildren at different levels of socio-economic status in Kenya. We explore children's weight status and dietary practices in the current analysis.

Methods

The research study was conducted in Nairobi and Kisumu, the largest and the third-largest cities in Kenya. Three public schools, catering to children from households at low, medium and high socio-economic status were purposively selected to participate in the study in each city. Data was collected among children within the ages of 10–12 years enrolled in grades 4–6 at each school. Trained enumerators measured children's weights and heights. Parents, with the help of their respective schoolchildren, completed questionnaires on schoolchildren's dietary practices including consumption of fruits, vegetables, snacks foods, confectioneries, beverages and restaurant foods. Completed sets of body measurements and dietary practices data were available for 390 children. We used Wilcoxon-Mann Whitney, Kruskal Wallis and chi-square tests to compare schoolchildren's weight status and dietary practices across cities and school income status.

Results

Over 15% of the schoolchildren were overweight, 5.5% were obese and 3% were stunted. Schoolchildren's weight status did not significantly differ across cities. However, % of overweight or obese children were significantly higher among children attending high-income schools compared to those in middle- and low-income schools. Frequency of consumption of red meats, fries and take-away foods, and amount of fruit juice consumed per week were significantly higher among children enrolled in high-income schools. Frequency of consumption of breakfast, eating meals in front of a screen and amount of milk consumed per week were significantly lower among children enrolled in low-income schools.

Conclusions

This study increases our understanding of dietary practices and overweight and obesity patterns among schoolchildren, and contributes to obesity prevention efforts in Kenya. Additional analysis will explore the relationship between dietary practices, and overweight and obesity.

Funding Sources

John Hopkins University.

Resiliency and Obesity: What Factors Promote Healthy Weight? (P12-011-19)

Objectives

Emotional distress can trigger maladaptive coping strategies, such as eating to suppress negative emotions, and this in turn, can lead to weight gain. This study reviews the literature for factors (personal, familial, or environmental) that help individuals maintain healthy weight in obesogenic environments.

Methods

We conducted a narrative review, in both adults and children, of resiliency strategies. A PubMed search was conducted using the term “resil* AND obesity” (as well as “resiliency AND obesity,” and “resilience AND obesity”). 47 articles that were relevant to the objectives of this study had their full-text reviewed. The eight which described types of resiliency were included in this study.

Results

Personal resilience strategies include ‘shift-and-persist’ mindsets which help individuals reframe stressors more positively while at the same time maintaining an optimistic outlook about the future. 'Shift' consists of cognitive restructuring, positive thinking, and emotion regulation. 'Persist' consists of optimism and purpose. Resilient families with a strong sense of coherence and regular family meals together also helped individuals maintain healthy weight.

Conclusions

Resiliency training and family meals may be strategies worth exploring for the prevention and/or intervention against obesity.

Funding Sources

None.

Perspectives on obesity and its treatment: health care providers and the general public in rural West Virginia and urban Baltimore

OBJECTIVE

To determine and compare the perspectives of the general public and health care providers (HCPs) on obesity and its treatment in rural West Virginia (WV) and Baltimore, MD.

METHOD

Surveys were completed in both locations by the general public (WV: n = 200; Baltimore: n = 171) and HCPs (WV: n = 25; Baltimore: n = 15).

RESULTS

BMI (body mass index) ≥ 30 (WV: n = 94; Baltimore: n = 58) was associated with a stronger belief in the heritability of obesity and with the ability to control obesity by controlling food cost, compared with those with normal BMI (WV: n = 42; Baltimore: n = 57). Those with a high school education (WV: n = 112; Baltimore: n = 113) were less likely to agree that obesity is a problem in the community and that proper diet and exercise are realistic expectations, compared with those with at least some higher education. Perspectives of HCPs differed significantly from the general public in both locations.

CONCLUSION

Many differences in perspective on obesity exist between WV and Baltimore, within both populations, and between HCPs and the general public in both settings. A better understanding of patient views is important for effective obesity management. HCPs must consider each patient's level of understanding when discussing management and consequences of obesity. More time spent with patients who have less insight into their obesity may improve patient adherence with treatment and overall patient outcomes.

Olestra Postmarketing Surveillance Study: design and baseline results from the sentinel site

OBJECTIVE

To describe the design of the Olestra Postmarketing Surveillance Study (OPMSS) and to present baseline results from the sentinel site. The purpose of the OPMSS is to monitor consumption patterns of olestra-containing snacks and to determine whether consumption affects nutritional status.

DESIGN

The OPMSS combines repeated cross-section, random-digit dial telephone surveys before and after the market release of olestra-containing foods as well as intensive dietary and clinical assessments on a subsample of survey participants.

SUBJECTS

Data are from baseline telephone (n = 1,962) and clinical (n = 1,069) assessment of participants (aged 18 to 74 years) in the Marion County, Indiana, sentinel site. Mean age of participants in the telephone survey was 43.2 years; 19% of respondents were black and 29% had completed college.

STATISTICAL ANALYSIS

Analyses examined associations among savory snack use, fruit and vegetable consumption, and demographic and health-related characteristics. Data from the telephone survey were adjusted to be representative of the Marion County population.

RESULTS

Almost 96% of the population surveyed had eaten savory snacks in the month before the survey: 74% had eaten regular-fat, 26% fat-reduced, and 78% nonfat types. Total snack consumption did not differ by gender, education, or race. Residents younger than 35 years ate snacks 16 times a month compared with 12 times a month among older residents. Types of snacks consumed differed markedly by demographic characteristics. Male, younger, and less educated residents ate more regular-fat snacks; female, white, and college-educated residents ate more nonfat snacks. In general, residents practicing healthful behaviors, including not smoking, eating fruits and vegetables, and exercising, also ate fewer regular-fat and more nonfat snacks. Fat intake was also related linearly to use of snack foods, ranging from 33.2% of energy among those consuming 1 serving per month or less to 36.8% among those consuming 20 or more servings per month.

APPLICATIONS/CONCLUSIONS

Procedures for recruitment and nutrition assessment appear adequate for evaluating the impact of olestra consumption on nutritional status. Nutritionists should be aware that there is potential for relatively high olestra consumption, given that almost 35% of Marion County residents eat snack foods at least 20 times a month. Consumers eating at least 20 servings of snacks per month derived more than 12% of their total energy and fat from snack foods, which suggests that substituting olestra snacks could substantially reduce intakes of fat and energy.