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>

Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends’ dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends’ involvement with dieting, using χ2 analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends’ dieting behavior was significantly associated with UWCBs for average weight girls (OR=1.57, CI=1.40–1.77) and moderately overweight girls (OR=1.47, CI=1.19–1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th–85th percentile; OR=1.17, CI=1.01–1.36), and marginally associated for modestly overweight girls (85th–95th percentile; OR=1.21, CI=.97–1.50), even after controlling for friends’ dieting behaviors. The social influences examined here were not associated with UWCBs among underweight (<15th percentile) or overweight (>95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.

Individuals with high body mass index (BMI), negative body image, and unhealthy weight control behaviors may be more likely to engage in high-risk sexual behaviors than others. Researchers have not fully investigated these relationships in a sample of college students. The authors collected data regarding several weight-related issues and high-risk sexual behaviors (response rate = 39%) from 1,168 college students. Over half reported at least 1 high-risk sexual behavior. After the authors controlled for several demographic characteristics, they found that higher BMIs were associated with increased odds of having a casual sexual partner (odds ratio [OR] = 2.70) and being intoxicated at last intercourse (OR = 2.25). Among women, unhealthy weight control behaviors were associated with having a casual partner (OR = 2.12), using no or unreliable contraception (OR = 1.98), and being intoxicated at last intercourse (OR = 2.31). Weight-related issues were not associated with sexual behaviors among college men. Th...

<h3>Objective</h3><p>To determine the association between frequency of family meals and multiple indicators of adolescent health and well-being (tobacco, alcohol, and marijuana use; academic performance; self-esteem; depressive symptoms; and suicide involvement) after controlling for family connectedness.</p><h3>Methods</h3><p>Data come from a 1998-1999 school-based survey of 4746 adolescents from ethnically and socioeconomically diverse communities in the Minneapolis/St Paul, Minn, metropolitan area. Logistic regression, controlling for family connectedness and sociodemographic variables, was used to identify relationships between family meals and adolescent health behaviors.</p><h3>Results</h3><p>Approximately one quarter (26.8%) of respondents ate 7 or more family meals in the past week, and approximately one quarter (23.1%) ate family meals 2 times or less. Frequency of family meals was inversely associated with tobacco, alcohol, and marijuana use; low grade point average; depressive symptoms; and suicide involvement after controlling for family connectedness (odds ratios, 0.76-0.93).</p><h3>Conclusions</h3><p>Findings suggest that eating family meals may enhance the health and well-being of adolescents. Public education on the benefits of family mealtime is recommended.</p>

Purpose.Few studies have investigated the efficacy of e-mail for promoting behavior change. This study evaluates the participation in and outcomes associated with an e-mail-based health promotion program.Methods.Adolescent girls aged 15 to 17 years were recruited at a shopping mall. Participants with an e-mail address were assigned to the interactive e-mail magazine (Ezine) group (n = 37), whereas those not reporting an e-mail address were assigned to the non-Ezine group (n = 33). Participants in the Ezine group received the health Ezine, which included a quiz and an advice column, on a weekly basis.Results.Results indicate that among the Ezine group, there was a high recall of the Ezine (81.1%), and more than one third of the participants replied to Ezine volumes with quiz answers or an advice question (36.6%). Differences in health behavior change between the Ezine and non-Ezine groups were not significant.Conclusions.E-mails on health-related matters can generate moderate levels of involvement in adole...

BACKGROUND Relatively little research has focused on the social norms of teen smoking. This study examined social norms regarding adolescent smoking and their relationship with smoking behavior. METHODS Data were collected in 1998 as part of the follow-up for a randomized trial in 14 rural Minnesota communities. Four aspects of perceived social norms of smoking were measured, and students were classified as nonsmokers, daily smokers, past-week smokers, or past-month smokers. Social norms were compared across four levels of smoking behavior, and multivariate models controlled for personal characteristics and family and peer smoking. RESULTS The sample comprised a total of 3128 girls and 3146 boys in grades 8 to 10. For all four measures, nonsmokers had the most antismoking perceptions of social norms around smoking (p <0.001). In multivariate models, noticing other teens smoking and the perception that adults care about and disapprove of teen smoking remained significantly related to past-month smoking. Using more frequent smoking as the dependent variable, noticing smoking remained significantly associated with smoking in the anticipated direction. Perceived prevalence of smoking did not perform consistently across models. CONCLUSIONS Noticing teens smoking is associated with smoking behavior across three different levels of smoking frequency. The perception that adults care about and disapprove of teen smoking was associated with past-month and past-week smoking. Although perceived prevalence is often used to measure social norms of teen smoking, this measure may have limited utility. Strategies for health promotion and intervention on the issue of youth smoking are discussed.

<h3>Background</h3><p>Verbal harassment, such as bullying and hate speech, has received considerable attention recently, but less is known about weight-based teasing and its potential harmful effects on young people's psychosocial well-being.</p><h3>Objective</h3><p>To determine the associations of weight-based teasing and body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts using a large sample of adolescents.</p><h3>Design</h3><p>Secondary analysis of survey and anthropometric data.</p><h3>Setting</h3><p>Ethnically and socioeconomically diverse communities in the urban and suburban school districts of the Minneapolis/St Paul metropolitan area.</p><h3>Participants</h3><p>A school-based sample of 4746 adolescents in grades 7 to 12 at 31 public middle schools and high schools.</p><h3>Main Outcome Measures</h3><p>Weight-based teasing from peers or family members, body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts.</p><h3>Results</h3><p>Of the eligible students, 81.5% participated; 30.0% of adolescent girls and 24.7% of adolescent boys were teased by peers, and 28.7% of adolescent girls and 16.1% of adolescent boys were teased by family members. Approximately 14.6% of adolescent girls and 9.6% of adolescent boys reported teasing from both of these sources. Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms, and thinking about and attempting suicide, even after controlling for actual body weight. These associations held for adolescent boys and girls, across racial, ethnic, and weight groups. Furthermore, teasing from 2 sources was associated with a higher prevalence of emotional health problems than either teasing from a single source or no teasing.</p><h3>Conclusions</h3><p>Physicians and other health care providers should recognize the importance of weight-based teasing for young patients. Policy, programs, and education should focus on increasing awareness of what constitutes weight-based teasing, its potentially harmful effects on adolescents' emotional well-being, and reduction of this behavior.</p>

This paper examines self-efficacy to avoid cigarette smoking and its association with smoking and quitting behavior, peer and worksite influences, nicotine dependence, and socio-demographic variables among employed adolescents. A cross-sectional survey was used to collect data from employed adolescents ages 15–18 who worked in 10 participating grocery stores in Massachusetts. Eighty-three percent of workers (n=379) completed the survey. Results from the multivariate model indicate that daily smokers were less confident in their ability to avoid smoking than those who smoked less frequently. As nicotine dependence increased, self-efficacy beliefs decreased. In addition, as friends' encouragement to quit increased, self-efficacy beliefs also increased. Work-related variables were not associated with self-efficacy beliefs among smokers. This study suggests that smoking frequency, nicotine dependence, and friends' encouragement to quit are associated with self-efficacy to avoid smoking. Researchers may tailor interventions for daily and less-than-daily smokers, build on peer networks that encourage quitting and help smokers resist pressures to smoke, and enhance strategies for coping with nicotine dependence in high-risk situations.

A variety of social factors are expected to contribute to health behaviors among college students. The goal of this paper is to describe the relationships of two different aspects of the campus social environment, namely the campus resources for gay, lesbian, and bisexual (GLB) students and the campus-wide behavioral norms of substance use, to the individual substance-use behaviors of college students with same-sex experiences. Individual-level data come from 630 college students reporting same-sex experience, who were part of a national random sample returning questionnaires. Current cigarette smoking and binge drinking were examined. College-level data regarding the campus resources designed for GLB students were collected and used with campus-wide substance-use norms to predict individual substance use in logistic regression analyses. One-third to one-half of students reported current smoking and binge drinking, by sex and sex-partner category. The presence of GLB resources was inversely associated with women's smoking and directly associated with men's binge drinking behaviors. The proportion of students reporting same-sex behavior on campus was directly associated with these same outcomes, and behavioral norms were not associated with either outcome. Findings provide a glimpse into the influence of the social environment on the use of two of the most widely used substances at American colleges, and suggest that contextual approaches to explaining and controlling substance use may be important.