OBJECTIVE To evaluate the long-term impact of adolescent dating violence (ADV) on behavioral and psychological health. STUDY DESIGN From a diverse sample of older adolescents who completed Project EAT in 1999 (wave 1) and 2004 (wave 2; mean age 20.4), 23 male and 102 female adolescents reporting ADV were compared with 671 male and 720 female adolescents reporting no ADV. RESULTS ADV was positively associated with cigarette smoking and suicide attempts for both sexes, binge-eating and suicidal ideation in male adolescents, and smoking marijuana and high depressive symptoms in female adolescents in analyses unadjusted for wave 1 outcomes. In analyses adjusted for wave 1, in female adolescents, ADV was significantly associated with smoking cigarettes, marijuana use, and high depressive symptoms and marginally associated with suicide attempts; in male adolescents, ADV was significantly associated with smoking cigarettes and marginally associated with binge-eating and suicidal ideation. ADV was significantly associated with an overall high-risk profile (presence > or = 3 health outcomes) for both sexes; results remained significant in female adolescents after adjusting for wave 1. CONCLUSIONS ADV is associated with greater likelihood of problematic health factors and increases nonspecific risk toward behavioral and psychological impairment in youth, particularly female adolescents.

OBJECTIVE To determine whether adolescents who participate in a weight-related sport are at increased risk for unhealthful weight-control behaviors and steroid use. DESIGN This was a population-based study (Project EAT [Eating Among Teens]). SUBJECTS/SETTING Subjects were 4,746 adolescents (50.2% males, 49.8% females) from 31 public middle and high schools in the Minneapolis/St Paul area of Minnesota. STATISTICAL ANALYSIS PERFORMED Descriptive statistics, χ2 analyses, and multiple logistic regression were used. Data were adjusted for sociodemographic variables and body mass index. MAIN OUTCOME VARIABLES Unhealthful weight-control behaviors and steroid use. RESULTS More males (20.4%) than females (16.2%) reported participation in a weight-related sport. Males who reported participation in a weight-related sport had an increased risk of past-week vomiting (odds ratio [OR]=5.7), laxative use (OR=6.8), as well as past-year vomiting (OR=4.9), laxative use (OR=3.4), diuretic use (OR=6.0), and steroid use (OR=3.7), compared with those males who did not report participation. Females who reported participation in a weight-related sport had an increased risk of past week vomiting (OR=2.1), as well as past year vomiting (OR=2.0), laxative use (OR=2.6), and steroid use (OR=2.6), compared with those who did not report participation in a weight-related sport. CONCLUSIONS The current study shows that participation in a sport that adolescents perceive as emphasizing weight is strongly associated with unhealthful weight-control behaviors and steroid use. Preventive efforts, targeting parents, coaches, and adolescents are needed to decrease this risk.

BACKGROUND University students represent an important population in which to study access to mental health care. Understanding their unmet needs will enhance efforts to prevent and treat mental disorders during a pivotal period in life. OBJECTIVE To quantify mental health service use and estimate how various factors are associated with help-seeking and access in a university student population. DESIGN A Web-based survey was administered to a random sample of 2785 students attending a large, public university with a demographic profile similar to the national student population. Nonresponse bias was accounted for using administrative data and a nonrespondent survey. MEASURES Mental health was measured using the Patient Health Questionnaire screens for depressive and anxiety disorders. Mental health service utilization was measured as having received psychotropic medication or psychotherapy in the past year. RESULTS Of students with positive screens for depression or anxiety, the proportion who did not receive any services ranged from 37% to 84%, depending on the disorder. Predictors of not receiving services included a lack of perceived need, being unaware of services or insurance coverage, skepticism about treatment effectiveness, low socioeconomic background, and being Asian or Pacific Islander. CONCLUSIONS Even in an environment with universal access to free short-term psychotherapy and basic health services, most students with apparent mental disorders did not receive treatment. Initiatives to improve access to mental health care for students have the potential to produce substantial benefits in terms of mental health and related outcomes.

Mental health among university students represents an important and growing public health concern for which epidemiological data are needed. A Web-based survey was administered to a random sample at a large public university with a demographic profile similar to the national student population. Depressive and anxiety disorders were assessed with the Patient Health Questionnaire (R. L. Spitzer, K. Kroenke, J. B. W. Williams, & the Patient Health Questionnaire Primary Care Study Group, 1999). Nonresponse weights were constructed with administrative data and a brief non-respondent survey. The response rate was 56.6% (N = 2,843). The estimated prevalence of any depressive or anxiety disorder was 15.6% for undergraduates and 13.0% for graduate students. Suicidal ideation in the past 4 weeks was reported by 2% of students. Students reporting financial struggles were at higher risk for mental health problems (odds ratios = 1.6-9.0). These findings highlight the need to address mental health in young adult populations, particularly among those of lower socioeconomic status. Campus communities reach over half of young adults and thus represent unique opportunities to address mental health issues in this important age group.

This research examined whether body dissatisfaction prospectively predicted depressive mood and low self-esteem in adolescent girls and boys 5 years later. Participants were early-adolescent girls (n = 440, Time 1 M age = 12.7 years) and boys (n = 366, Time 1 M age = 12.8 years) and midadolescent girls (n = 946, Time 1 M age = 15.8 years) and boys (n = 764, Time 1 M age = 15.9 years). After controlling for Time 1 of the relevant dependent variable, ethnicity, socioeconomic status, and body mass index, Time 1 body dissatisfaction was a unique predictor of Time 2 depressive mood and low self-esteem in early-adolescent girls (depressive mood: F = 4.80, p < .05; self-esteem: F = 9.64, p < .01) and midadolescent boys (depressive mood: F = 12.27, p < .001; self-esteem: F = 9.38, p < .01) but not in early-adolescent boys or midadolescent girls. These findings are consistent with the hypothesis that body dissatisfaction is a risk factor for depressive mood and low self-esteem in both girls and boys but in differe...

OBJECTIVE The present study uses longitudinal data to examine changes in body satisfaction among male and female adolescents from baseline to 5 years. METHODS A diverse sample of 2516 adolescents completed surveys in 1999 and 2004, reporting satisfaction with 10 body parts or attributes, height/weight, and other characteristics. Multivariable general linear modeling was used to estimate change in body satisfaction from Time 1 to Time 2, by age group, race, and change in body mass index (BMI) category. RESULTS Body satisfaction decreased over 5 years (mean satisfaction change=−0.79) in all groups except older adolescent females. Scores decreased significantly more among younger adolescents than older adolescents, among some racial/ethnic groups of males, and among those whose BMI increased. However, among males, change in body satisfaction depended on BMI category at baseline. CONCLUSIONS Different types of prevention programs addressing body image may be needed for males and females at different developmental stages and may need to address changes in BMI.

OBJECTIVE To describe adolescent involvement in preparing and shopping for food and examine if extent of involvement is related to diet quality. DESIGN Cross-sectional study design. Past week frequency of involvement in preparing and shopping for food was self-reported on the Project EAT (Eating Among Teens) survey. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire. SUBJECTS/SETTING Middle school and high school students from Minneapolis/St Paul, MN, public schools. STATISTICAL ANALYSES PERFORMED Associations between involvement and sociodemographic characteristics were examined using cross tabulations. General linear modeling was used to compare dietary intakes of adolescents across different levels of involvement in preparing and shopping for food. RESULTS The majority of adolescents reported helping prepare dinner (68.6%) and nearly half reported shopping for groceries (49.8%) at least once during the past week. Greater involvement in these food tasks was related to sex (female), grade level (middle school), race (Asian American), socioeconomic status (low), family meal frequency (high), and weight status (overweight). Frequency of preparing food was related to lower intakes of fat (P<0.01) and higher intakes of fruits and vegetables, fiber, folate, and vitamin A. Preparing was related to lower intakes of carbonated beverages among female adolescents (P<0.01) and lower intakes of fried foods among male adolescents (P<0.01). In contrast, food shopping frequency was related to greater consumption of fried foods among female adolescents (P<0.01). CONCLUSIONS Adolescents should be encouraged to help with meal preparation and may benefit from interventions and programs that teach skills for cooking and making healthful purchasing decisions.

CONTEXT Social-psychological theories of health behavior suggest that adolescents' sexual behaviors are influenced by the sexual attitudes and behaviors of their friends. METHODS Data on 2,436 participants in the National Longitudinal Study of Adolescent Health (Add Health) who were sexually inexperienced at Wave 1 (1994-1995) were analyzed to examine whether friend-related variables predicted initiation of vaginal intercourse by Wave 2 (1996). Analyses also assessed whether predictive relationships varied by level of involvement with friends. Odds ratios were generated by logistic regression analysis. RESULTS In the 9-18 months between Waves 1 and 2, 18% of participants initiated intercourse. In analyses controlling for gender, family structure and romantic relationships, the higher the proportion of a youth's friends who were sexually experienced, the greater the odds of sexual debut (odds ratio, 1.01); the odds also were elevated among youth who believed that they would gain their friends' respect by having sex (1.2). Relationships between friend variables and sexual initiation did not vary by level of involvement with friends. CONCLUSIONS To maximize the likelihood of success, programs focused on delaying teenage sexual intercourse should address norms for sexual behavior among adolescents' close friends as well as the perceptions, skills and behaviors of individual youth.

OBJECTIVE To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. DESIGN Population-based 5-year longitudinal study. PARTICIPANTS Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). MAIN OUTCOME MEASURES Weight status, binge eating, extreme weight control, and self-reported eating disorder. STATISTICAL ANALYSIS Multiple linear and logistic regressions. RESULTS Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. CONCLUSIONS Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

BACKGROUND This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents. METHODS Project EAT-II followed 2516 adolescents from Minnesota longitudinally from 1999 to 2004. The population included two cohorts allowing for the observation of transitions from early to middle adolescence (junior high school to high school) and from middle to late adolescence (high school to post-high school). RESULTS The prevalence of overweight (females: 28.7%; males: 28.0%) was high in early adolescence and remained high throughout adolescence. In females, between early and middle adolescence, there were steep longitudinal increases in the use of unhealthy weight control behaviors (48.6% to 58.8%, P = 0.001) and extreme weight control behaviors (9.4% to 17.9%, P < 0.001), and between middle and late adolescence, extreme weight control behaviors increased from 14.5% to 23.9% (P < 0.001). In males, extreme weight control behaviors doubled from middle to late adolescence (3.4% to 6.3%, P = 0.023). Use of diet pills doubled from 7.5% to 14.2% from 1999 to 2004 (P = 0.004) in high school females. One fifth (19.9%) of females in late adolescence reported taking diet pills. CONCLUSIONS Overweight status and unhealthy weight control behaviors in adolescents are major public health concerns that warrant interventions addressing both problems.

PURPOSE To examine correlates of dieting behavior in overweight and non-overweight youth. METHODS Data came from Project EAT (Eating Among Teens), a study of eating and weight-related attitudes, behaviors, and psychosocial variables among 4746 adolescents in public schools. Logistic regression was used to compare dieters and non-dieters, and to examine interactions of dieting and overweight status. RESULTS Approximately one third (31.8%) of the sample was overweight. Dieting in the previous year was reported by 55.2% of girls and 25.9% of boys. Dieting was associated with similarly elevated rates of extreme weight control behaviors, body dissatisfaction, and depression in both the non-overweight and overweight groups for both boys and girls. Girls reporting dieting behavior in both the non-overweight and overweight groups had similarly elevated risk for cigarette use, alcohol use, and marijuana use. CONCLUSIONS The negative correlates of dieting are similarly common among teens of varying weight status. These data suggest that dieting may not be a preferred method of weight management, even for overweight adolescents. Regardless of weight status, dieting may be a marker for other unhealthy behaviors and depressed mood in adolescents.

OBJECTIVE The purpose of this study was to explore the relationship between maternal and adolescent weight-related behaviors and concerns in a population-based sample. METHODS Participants were 810 adolescents (n=429 girls and n=381 boys) and their mothers/guardians. Adolescents were part of the Project EAT (Eating Among Teens) study, which was a comprehensive study of eating patterns and weight concerns among adolescents in Minnesota. Outcome variables included child's body dissatisfaction, weight concerns, dieting, and use of healthy and unhealthy weight control behaviors. RESULTS Adolescents reported lower rates of maternal dieting than mothers. Maternal self-report of dieting was not significantly associated with children's weight-related concerns. Children's perceptions of their mothers' behaviors were significantly related to their level of weight concerns and use of weight control behaviors. CONCLUSION Adolescents' perceptions of maternal behavior affect their weight-related concerns and behaviors. This suggests that mothers who choose to diet should model healthy choices in the areas of nutrition and physical activity.

PURPOSE Many reports have indicated that gay, lesbian and bisexual (GLB) youth are particularly vulnerable to poor outcomes, including suicide. Certain protective factors are likely to reduce this risk. The present study examines four protective factors (family connectedness, teacher caring, other adult caring, and school safety) and their association with suicidal ideation and attempts among adolescents with same-gender experience. METHODS Data come from the 2004 Minnesota Student Survey of 9th and 12th grade students; 21,927 sexually active youth were grouped according to the gender of their sex partner(s) into GLB and non-GLB groups. Four protective factors and suicidal ideation and attempts were compared across groups. Logistic regression was used to examine the influence of protective factors on suicide, and predicted probabilities of suicidal ideation and attempts were estimated using general linear modeling. RESULTS There were 2,255 respondents who reported same-gender experience. Over half of GLB students had thought about suicide and 37.4% reported a suicide attempt. GLB youth reported significantly lower levels of each protective factor than their non-GLB peers. Family connectedness, adult caring, and school safety were significantly protective against suicidal ideation and attempts. Risk associated with a GLB sexual orientation is largely mediated through protective factors. CONCLUSIONS Sexual orientation alone accounts for only a small portion of variability in suicidal ideation and attempts. If protective factors were enhanced among GLB youth, suicide in this population is expected to be considerably lower. Protective factors examined here are amenable to change and should be targeted in interventions.

OBJECTIVE To assess whether weight-related teasing predicts the development of binge eating, unhealthy weight control behaviors, and frequent dieting among male and female adolescents. METHODS A prospective study was conducted with an ethnically and socioeconomically diverse sample of 2516 adolescents who completed surveys at both time 1 (1998-1999) and time 2 (2003-2004) of the Project EAT (Eating Among Teens) study. RESULTS In 1998-1999, approximately one fourth of participants reported being teased about their weight at least a few times a year. After adjustment for age, race/ethnicity, socioeconomic status (SES), and BMI, boys who were teased about their weight were more likely than their peers to initiate binge eating with loss of control and unhealthy weight control behaviors 5 years later. The predicted prevalence for incident binge eating behaviors with loss of control among boys who were teased was 4.1% as compared with 1.4% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. For unhealthy weight control behaviors at time 2, the predicted prevalence was 27.5% among boys who were teased and 19.3% for boys who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. Girls who were teased were more likely than their peers to become frequent dieters. The predicted prevalence for incident frequent dieting among girls who were teased was 18.2% as compared with 11.0% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. CONCLUSIONS Weight teasing in adolescence predicts disordered eating behaviors at 5-year follow-up. The patterns of these associations differ by gender. Reducing teasing through educational interventions and policies may reduce the level of disordered eating behaviors among youths.

PURPOSE To determine if weight-teasing predicts subsequent low self-esteem, poor body image, and depressive symptoms; and to examine two mechanisms through which early teasing may influence later emotional health. METHODS A racially and socio-economically diverse sample of 2516 adolescents completed surveys for both Wave 1 (1998–99) and Wave 2 (2003–04) of the Project EAT study. Approximately one third of these were early adolescents who transitioned into middle adolescence, and two thirds were middle adolescents who transitioned into young adulthood. Multiple linear regression analysis was conducted in three stages to test Model A: the total effect of Time 1 teasing on Time 2 emotional health; Model B: Model A, mediated by Time 2 teasing and body mass index (BMI); and Model C: Model B, also mediated by Time 1 emotional health. RESULTS Approximately one third of males and slightly under half of females reported that they had been teased about their weight at Time 1. Time 1 teasing predicted lower self-esteem, lower body image, and higher depressive symptoms at Time 2 for males and females in the older and younger age groups. This relationship was fully mediated, however, by Time 2 teasing and BMI, and by Time 1 emotional health. Adjusted R2 statistics for the final models ranged from .11 to .36. CONCLUSIONS Weight-teasing in adolescence affects emotional well-being at 5-year follow-up, and appears to function through two mechanisms. Reducing early teasing and its concurrent damages to emotional health may prevent longer-term emotional health consequences.

PURPOSE The purpose of this study was 2-fold: (1) to determine the prevalence of high body satisfaction in a multi-ethnic, urban population of adolescent females, and (2) to examine the demographic, socioenvironmental, personal, and behavioral factors associated with high body satisfaction among adolescent girls. METHODS The study population included 2,357 female middle and high school students who completed surveys in 1998–1999. High body satisfaction and its association with a range of socioenvironmental, personal, and behavioral factors were assessed. Associations were examined through comparisons of means (unadjusted and adjusted for grade level, race, socioeconomic status, and body mass index [BMI]) for continuous variables, and percentages and odds ratios for dichotomized variables. RESULTS Over a quarter (26.7%) of adolescent girls reported high body satisfaction. High body satisfaction was most common among African-American (40.1%) and underweight girls (39.0%). In adjusted analyses, girls with high body satisfaction were more likely to report parental and peer attitudes that encouraged healthy eating and exercising to be fit (p < .001) versus dieting, and less likely to report personal weight-related concerns and behaviors (p < .001). CONCLUSIONS The immediate subculture in which adolescent girls exist may play an important role in fostering high body satisfaction. Parents and health care providers often struggle with how to address the topic of weight management in teens without causing further injury to body image. Findings from the present study suggest the importance of providing a social environment that focuses on health and fitness, rather than on weight control, to increase adolescent girls’ likelihood of being satisfied with their bodies.

OBJECTIVE This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods. DESIGN Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes. SUBJECTS/SETTING The study sample included 902 adolescents and their parent or guardian. RESULTS Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P<0.01) and soft drink availability was inversely associated with dairy intake (ttrend=2.08, P=0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend=3.65, P<0.01). Parental intakes were positively associated with dairy intake for boys (ttrend=2.04, P=0.04), and with dairy (ttrend=2.43, P=0.01), vegetable (ttrend=3.72, P<0.01) and fruit (ttrend=3.17, P<0.01) intakes for girls. CONCLUSIONS/APPLICATIONS Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.

<h3>Background</h3><p>Recent years have seen new challenges to laws protecting minors’ confidential access to reproductive health services. Little research has explored parental views on the issue.</p><h3>Objective</h3><p>To examine parents’ views about laws requiring parental notification (PNLs) when minor children seek to obtain prescription contraceptives, the exceptions parents would endorse, and the consequences they would expect.</p><h3>Design</h3><p>Fifteen-minute telephone surveys conducted in 2002.</p><h3>Setting</h3><p>Minnesota and Wisconsin.</p><h3>Participants</h3><p>Population-based sample of 1069 parents of adolescents aged 13 to 17 years with a working telephone number. An additional 1095 eligible parents declined and 360 were not available to participate.</p><h3>Main Outcome Measures</h3><p>Views about PNLs (“Do you think a law requiring notification of parents when a teen requests birth control from a clinic is a good idea, a bad idea, or neither a good nor a bad idea?”).</p><h3>Results</h3><p>Of the eligible parents, 42.4% completed the survey. More than half (55.1%) of participants thought PNLs were a good idea. However, 96.1% of parents expected at least 1 negative consequence and 47.6% expected 5 or more negative consequences to result with the enactment of PNLs. For exceptions to PNLs, 85.5% of parents endorsed at least 1, and 29.7% endorsed 5 to 6. Each additional anticipated positive consequence of enacting PNLs was significantly associated with more than twice the odds of favoring PNLs (odds ratio [OR], 2.28), and each additional negative consequence was associated with lower odds of supporting PNLs (OR, 0.87). Likewise, each additional exception endorsed was associated with lower odds of supporting PNLs (OR, 0.71).</p><h3>Conclusions</h3><p>Many parents hold complex views on the need for confidentiality and the appropriate involvement of parents in adolescent health care services. Educating parents about the potential negative consequences of parental notification could change their support of PNLs.</p>