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Purpose: To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents. Methods: From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes-self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days-in four BMI categories-obese, overweight, normal weight, and underweight-of approximately 6,000 US adolescents aged 12-17 years. We also estimated the percentages for boys and girls separately. Results: Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95 % CI 15-22) of obese adolescents reported fair or poor health compared to only 5 % (95 % CI 4-7) of normal-weight adolescents. Thirty-seven percent (95 % CI 33-42) of obese adolescents reported excellent or very good health, compared to 65 % (94 % CI 63-67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls. Conclusions: Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to examine reading and use of calorie information at fast-food/chain restaurants. Methods A cross-sectional analysis was conducted on a sample of 4363 US adults using the 2009 HealthStyles survey. The outcome variable was reading calorie information when available while ordering at fast-food/chain restaurants. Among those who go to fast-food/chain restaurants, we conducted multivariable logistic regression to examine associations between sociodemographic variables and reading calorie information when available. Among those who report reading calorie information when available, we assessed the proportion using calorie information. Results Among those who reported eating at fast-food/chain restaurants, 36.4% reported reading calorie information when available. Reading calorie information was not related to race/ethnicity, income or education. Compared with men, women had higher odds [adjusted odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5–2.1] of reading calorie information when available while those who frequented fast-food/chain restaurants ≥3 times/week (aOR = 0.6; 95% CI = 0.4–0.8) had lower odds compared with those going <4 times/month. Of those who reported reading calorie information when available, 95.4% reported using calorie information at least sometimes. Conclusions Almost all who read calorie information when available use the information at least sometimes. Research is needed on how calorie information is being used. [ABSTRACT FROM AUTHOR]

Background As a first step to determining the public availability of drinking water, self-reported access to water fountains in parks and playgrounds was examined. Methods A cross-sectional analysis was conducted on a convenience sample of 4163 US adults (aged ≥18 years) using the 2009 HealthStyles Survey. The outcome measure was reported access to water fountains in parks/playgrounds. Among those who reported using parks/playgrounds, multivariable logistic regression was used to examine the associations between sociodemographic variables and reported access to water fountains. Results About half (54.7%) of participants used parks/playgrounds. Among those, 55.0% reported access to water fountains. Factors significantly associated with reported access to water fountains were being male [odds ratio (OR) = 1.42; 95% confidence interval (CI) = 1.09, 1.85] and living in the Pacific region (versus East North Central region, OR = 2.56; 95% CI = 1.61, 4.06). Age, race/ethnicity, household income, marital status, education, smoking and physical activity were not significantly associated with reported access to water fountains. Conclusions Among 54.7% of adults using parks/playgrounds, reported access to water fountains was significantly differed by sex and region. This study provides information that can be considered when developing interventions to increase access to drinking water in public facilities. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups. METHODS: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length >95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age >95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (Als)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and Als/ANs than that among other racial/ethnic groups. CONCLUSIONS: The high incidence underscores the importance of early- life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and Als/ANs. [ABSTRACT FROM AUTHOR]

Background: The Institute of Medicine noted that current food and beverage marketing practices promote unhealthful diets. However, little public health research has been conducted on food marketing directed toward adolescents, especially using caregiver- and adolescent-reported data., Methods: We assessed perceived frequency of food/beverage advertising exposure and common locations of food/beverage marketing exposure for adolescents using 2012 Summer ConsumerStyles and YouthStyles survey data on US adults ≥18 years of age and their children ages 12-17 (n=847), respectively. Exposure to advertisements for fast food, soda, fruit drinks, sports drinks, energy drinks, and bottled water were categorized as <1 time/week, 1-6 times/week, and ≥1 time/day, and don't know. Weighted chi-square tests were used to examine the difference between caregivers' and adolescents' responses., Results: The majority of caregivers and adolescents reported that adolescents viewed advertisements ≥1 time/day across all food/beverage categories with the highest, at least daily, exposure reported for fast food. Caregivers more frequently reported that adolescents viewed all food/beverage advertisements ≥1 time/day than the adolescents reported (chi-square tests, p<0.0001). Both caregivers and adolescents reported that the adolescents view food/beverage marketing most frequently on television followed by at the supermarket., Conclusions: Our study showed that adolescents reported lower frequency of food and beverage advertising exposure than their caregivers. Further research may be needed to verify self-reported exposure data on food and beverage advertising as a way to obtain data for use in research on its relationship with diet quality and obesity.

Objective: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups., Methods: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile., Results: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups., Conclusions: The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs.

Background: Among school-aged youth, we sought to identify characteristics associated with (1) exceeding screen time recommendations (ie, television/videos/video games more than 2 hours/weekday), and (2) exceeding screen time recommendations, the presence of a television in the bedroom, and obesity., Methods: Using 2007 National Survey of Children's Health data, we used multivariable logistic regression to identify sociodemographic and behavioral characteristics associated with excessive screen time among 6 to 11- and 12 to 17-year-olds on a typical weekday. For 12 to 17-year-olds only, we used logistic regression to examine the odds of obesity using the same variables as above, with the addition of screen time., Results: Overall, 20.8% of 6 to 11-year-olds and 26.1% of 12 to 17-year-olds had excessive screen time. For both age groups, having a bedroom TV was significantly associated with excessive screen time. For the older age group, the dual scenario of excessive screen time with a bedroom TV had the strongest association with obesity (OR = 2.5, 95% CI 1.9, 3.2)., Conclusions: Given the similar risk factors for excess screen time and having a TV in the bedroom, a public health challenge exists to design interventions to reduce screen time among school-aged youth., (Published 2013. This article is a U.S. Government work and is in the public domain in the USA.)

Objective: Obesity is associated with adverse health outcomes in people with and without disabilities. However, little is known about disability prevalence among people who are obese. The purpose of this study is to determine the prevalence and type of disability among adults who are obese., Design and Methods: Pooled data from the 2003-2009 National Health Interview Survey (NHIS) were analyzed to obtain national prevalence estimates of disability, disability type and obesity. The disability prevalence was stratified by body mass index (BMI): healthy weight (BMI 18.5-<25.0), overweight (BMI 25.0-<30.0), and obese (BMI ≥ 30.0)., Results: In this pooled sample, among the 25.4% of US adults who were obese, 41.7% reported a disability. In contrast, 26.7% of those with a healthy weight and 28.5% of those who were overweight reported a disability. The most common disabilities among respondents with obesity were movement difficulty (32.5%) and work limitation (16.6%)., Conclusions: This research contributes to the literature on obesity by including disability as a demographic in assessing the burden of obesity. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs., (Copyright © 2013 The Obesity Society.)

Context: Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group., Evidence Acquisition: Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews., Evidence Synthesis: Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates., Conclusions: Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education., (Published by Elsevier Inc.)

Introduction: Obesity is associated with adverse health outcomes in people with and without disabilities; however, little is known about disability prevalence among people who are obese. The purpose of this study was to determine the prevalence and type of disability among obese adults in the United States., Methods: We analyzed pooled data from sample adult modules of the 2003-2009 National Health Interview Survey (NHIS) to obtain national prevalence estimates of disability, disability type, and obesity by using 30 questions that screened for activity limitations, vision and hearing impairment, and cognitive, movement, and emotional difficulties. We stratified disability prevalence by category of body mass index (BMI, measured as kg/m(2)): underweight, less than 18.5; normal weight, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or higher., Results: Among the 25.3% of adult men and 24.6% of women in our pooled sample who were obese, 35.2% and 46.9%, respectively, reported a disability. In contrast, 26.7% of men and 26.8% women of normal weight reported a disability. Disability was much higher among obese women than among obese men (46.9% vs 35.2%, P < .001). Movement difficulties were the most common disabilities among obese men and women, affecting 25.3% of men and 37.9% of women., Conclusion: This research contributes to the literature on obesity by including disability as a demographic in characterizing people by body mass index. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs.

Universal, school-based programs, intended to prevent violent behavior, have been used at all grade levels from pre-kindergarten through high school. These programs may be targeted to schools in a high-risk area-defined by low socioeconomic status or high crime rate-and to selected grades as well. All children in those grades receive the programs in their own classrooms, not in special pull-out sessions. According to the criteria of the systematic review methods developed for the Guide to Community Preventive Services (Community Guide), there is strong evidence that universal, school-based programs decrease rates of violence among school-aged children and youth. Program effects were consistent at all grade levels. An independent, recently updated meta-analysis of school-based programs confirms and supplements the Community Guide findings.