There is a paucity of research regarding the contextual factors that influence health behaviors to inform the development of programs and services for youth during the transition from adolescence to young adulthood. Researchers are thus in need of efficient strategies for surveying diverse populations of young adults. This study among a population-based sample of young adults aimed to 1) examine response to a mixed-mode survey design (web and mailed surveys) and 2) identify demographic correlates of response mode. Young adults who participated in previous study waves were invited to participate in the third wave of a 10-year longitudinal study (Project EAT-III: 2008-2009) examining factors associated with weight-related behaviors. Participants were mailed invitation letters providing the web address and a unique password for completing the survey. Nonresponders were mailed three reminder invitations; the third mailing included the paper form, and all other mailings included a postage-paid card for requesting the paper form. Most completed surveys (82.1% of n=2,287) were returned by respondents within the first four months of fielding prior to the mailing which included the paper form. Nearly all of these early responders (92.6% of n=1,878) and 86.5% of the full respondent sample (n=1,979 of 2,287) completed the web form. Response to the web versus mailed paper form of the survey was associated with age >25 years, higher socioeconomic status, current employment, student status, and having no children. The combination of web and mailed survey modes is an effective strategy for conducting data collection in demographically diverse, young adult populations.

OBJECTIVE To examine associations between watching television during family meals and dietary intake among adolescents. DESIGN Cross-sectional study using survey data from a diverse sample of adolescents. SETTING Data were collected from a school-based survey during the 1998-1999 school year. PARTICIPANTS Middle and high school students (N = 4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%. VARIABLES MEASURED Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals. ANALYSIS General linear modeling comparing dietary intake across 3 groups. RESULTS 33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals. CONCLUSIONS AND IMPLICATIONS Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.

OBJECTIVE Little is known about the food and weight-related behaviors of Hmong adolescents. This study assessed these behaviors in Hmong adolescents and determined if they differed between Hmong and white teens or by country of birth. DESIGN School-based cross-sectional study. SUBJECTS/SETTING Hmong (n=649) and white (n=2,260) adolescents from 31 public middle and high schools in the Minneapolis/St Paul, MN, metropolitan area who participated in Project EAT (Eating Among Teens). MAIN OUTCOME MEASURES Family meals, grocery shopping, and meal preparation; consumption of breakfast, snacks, and fast foods, physical activity and inactivity; body satisfaction, weight concern, body mass index, and weight-control behaviors. STATISTICAL ANALYSES PERFORMED Variables were compared across race/ethnicity and by country of birth using χ2 tests and general linear model regression. RESULTS Hmong students reported greater participation in family meals and more involvement with food purchasing and preparation. Fast-food consumption was similar among groups. Hmong teens reported less frequent breakfast consumption. The prevalence of overweight was higher in Hmong male adolescents than white male adolescents, but similar among female adolescents. Hmong students reported higher levels of weight concern, body dissatisfaction, dieting, unhealthful weight-control behaviors, less physical activity, and more inactivity than white students. Hmong male adolescents participated in extreme unhealthful weight-control behaviors four times more often than white male adolescents. CONCLUSIONS Hmong adolescents appear to be at increased risk for obesity, body dissatisfaction, and unhealthful weight-control behaviors compared to white adolescents. There is a need for culturally tailored interventions to address these nutrition and weight issues among Hmong adolescents.

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.

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.

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.

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.