Background: The rate of adolescent overweight and obesity has more than quadrupled over the past few decades, and has become a major public health problem [1]. In 2011, 55% of 12-19 year olds in the United States (U.S.) were overweight or obese [2]. Adolescence is a pivotal time in which many health risk behaviors such as tobacco, alcohol, and drug use are initiated. Such health risk behaviors have been significantly associated with overweight and obesity among adolescents. Objective: The purpose of this study is to evaluate the relationship between obesity and the health risk behaviors most commonly associated with premature morbidity and mortality among adolescents with a novel micro area estimate approach that uses weighted hierarchical logistic regression to nest individuals in classes, classes in schools, and schools in districts. Methods: This study is a secondary analysis of a state-wide representative sample of middle school students that participated in the 2010 Tennessee Middle School Youth Risk Behavior Survey (YRBS). Data was collected from 119 (85.6%) of Tennessee’s local education agencies (LEAs), 456 (95.2%) schools, and 64,790 of 78,441 (82.6%) students. The outcome variable was adolescent obesity (≥ 95th BMI percentile). Explanatory variables were divided into four levels [1] district level: use seatbelt/helmet, asked to show ID for tobacco purchase; [2] school level: ever tried smoking, received HIV education in school; [3] class level: average number of days smoked, having ever exercised to lose weight; [4] individual level: having ever been in fight, early onset of substance use, physical activity, and thought about, planed, or attempted suicide. Weighted hierarchical logistic regression analysis was performed to assess the association between risk factors or protective factors and obesity using effect size (ES) and odds ratio (OR) estimates. Results: The study sample included 64,790 middle school students in the state of Tennessee with a mean age of 12.8 years, of which (49.42%) were females and (50.58%) were males. Nearly one-fourth of the students had a BMI at or above the 95th percentile (22.30%). Weighted hierarchical logistic regression analysis shows that seatbelt and helmet use [ES: -2.161 OR: 0.020, 95% CI: (0.006, 0.070)], and weight misperception [ES: 1.256 OR: 9.720, 95% CI: (9.216, 10.251)], having ever exercised to lose weight [ES: -0.340 OR: 0.540, 95% CI: (0.446, 0.654)], having ever tried smoking [ES: 0.705 OR: 3.581, 95% CI: (2.637, 4.863)] and gender (male vs female) [ES: 0.327 OR: 1.810, 95% CI: (1.740, 1.880)] were strongly associated with adolescent obesity. Results from this study also showed that Black, Hispanic or Latino adolescents were more likely to be obese than Whites, Indian, and Asian adolescent [ES: 0.129 OR: 1.260, 95% CI: (1.200, 1.330)], students with grades of mostly C, D and F were more likely to be obese than those with grades of mostly A and B [ES: 0.189 OR: 1.409, 95% CI: (1.303, 1.523)], and that students having an eating disorder [ES: 0.251 OR: 1.576, 95% CI: (1.508, 1.648)] and/or engagement in sports teams [ES: -0.197 OR: 0.700, 95% CI: (0.674, 0.728)] had small or medium ES association with adolescent obesity. Conclusion:This study uses small area estimates in weighted hierarchical logistic regression models to describe the prevalence and distribution of health risk behaviors associated with adolescent obesity among middle school student subpopulations in Tennessee. The value of small area estimates has been demonstrated previously in a variety of other contexts, and again here offers important insights for intervention design and resource allocation at different micro-levels within small and large areas (i.e., district, school, and class). This work adds to the growing body of research that supports community-driven school-based lifestyle interventions targeting early-onset chronic disease and, more specifically, enhances the geographic resolution with which adolescent obesity can be addressed in middle school populations across Tennessee.

No description available.

Physical fights among middle school students is a problem in our school systems, with 24.7% of students having been in a physical fight one or more times in 2013. The purpose of this study was to estimate the extent to which physical fights among middle school students in Tennessee was associated with demographic factors (age, sex and race) and to identify individual level factors that influence the likelihood of middle school students engaging in a physical fight.The 2013 Tennessee Youth Risk Behavior Survey (YBRS) data was used for this study, which is an annual cross-sectional school data collected by the National Center for Health Statistics of the Center for Disease Control and Prevention. A total of 5589 Tennessee Middle school students were included in the analysis. The outcome variable was physical fighting. Explanatory variables included demographic variables, life styles and health behavior risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported.The analyses indicate that male students were more likely to be involved in a physical fight than the female students (OR 2.89, 95% CI 2.49-3.36) and white students were less likely to be involved in a physical fight than the non-White students (OR 0.50, 95% CI 0.43-0.58). For every one year increase in age, the relative odds of being involved in a physical fight increased by 9.4% (OR 1.09, 95% CI 1.02-1.18). Similarly, students who ever tried to commit suicide (OR 1.89, 95% CI 1.39-2.53), drink alcohol (OR 2.48, 95% CI 2.02-3.05) and smoke cigarettes (OR 1.95, 95% CI 1.56-2.44) were more likely to be involved in a physical fight than those who did not. Students who carried a weapon were more likely to be involved in a physical fight than those students who did not (OR 2.72, 95% CI 2.31-3.20). While Students who watched television for 3 or more hours per day were more likely to engage in physical fights (OR 1.20, 95%CI 1.04-1.39) than students who did not, students with school grades A and B (OR 0.58, 95% CI 0.49-0.68), feeling safe and secure at school (OR 0.73, 95% CI 0.62-0.87), sleeping eight or more hours per day (OR 0.80, 95% CI 0.69-0.92) were less likely to be involved in a fight in school than other students.Age, gender, race, smoking, alcohol, use of marijuana, sleeping time, school performance, school safety environment, suicide attempt and TV time were potential risk factors associated with physical fights among middle school students. Strategies to reduce physical fights among students in Tennessean middle schools are needed.

Introduction. Suicide-related fatalities are the third leading cause of death among adolescents, resulting in approximately 4,600 deaths annually. According to findings from the 2005 National College Health Assessment, engagement in weekly physical activity (PA) reduced the risk of suicidal behaviors. Data from the 2010 middle school Youth Risk Behavior Survey (YRBS) administered by Tennessee Coordinated School Health this study investigates the cross-sectional relationships of PA with suicidal behaviors, while simultaneously considering explanatory variables such as personal characteristics, sedentary behaviors, drug use, extreme weight control behaviors (EWCB), body mass index (BMI) and weight misperception. Methods. This is a secondary analysis of data from the 2010 Tennessee Middle School YRBS conducted among 65,182 middle school students of which 60,715 students were included in the final analysis. Items assessed were PA, sports team engagement, PE class, sedentary behaviors, suicidal behaviors, drug use, EWCB, BMI, weight misperception and selected personal characteristics. A bivariate analysis was used to create simple descriptive statistics, including means, standard deviations and proportions. Overall, approximately 21.15% (N= 13,704) reported suicidal behaviors, specifically, 18.30% reported ever having thoughts of suicide, 11.13% had ever made a suicide plan and 7.02% had one or more suicide attempts in their lifetime. A logistic regression analysis was conducted to compare the odds of experiencing suicidal behaviors in adolescents who engaged in PA, sports teams, and PE class, with students who did not perform these activities. We used odds ratios (OR) to assess effect size (ES), rather than p-values to assess statistical significance due to the study’s large sample size. As general rules of thumb, there is a small effect size when ES=0.20 or OR = 1.44, 0.694, medium effect size when ES=0.50 or OR = 2.47, 0.405 and large effect size when ES=0.80 or OR = 4.25, 0.235. Results. Based on ES, age, race/ethnicity, gender, grade in school, sports team engagement, PE class attendance, sedentary behaviors, drug use and EWCB were associated with suicidal behaviors. Associations were strongest for drug/substance use and EWCB and suicidal behaviors, both with large ESs. Although weakened when controlling for other independent variables, the ES of race/ethnicity (other vs white non-Hispanic), gender, sports team engagement, drug/substance use and EWCB on suicidal behaviors were >0.20. The ES of age, PE class attendance, and sedentary behaviors were <0.20. Conclusion. Findings suggest that sports team engagement is associated with reduced risk for suicidal behaviors; whereas, no effects were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help screen for risk of suicidal behaviors.

Introduction: Childhood obesity has more than quadrupled in the last 30 years, with the prevalence in adolescents aged 12-17 years increasing from 5% in 1980 to 21% in 2012. The purpose of this study was to estimate the extent to which childhood obesity in Tennessee is associated with between-context differences (districts, schools and classes) and to identify factors at the district, school, class, and individual level that influence the individual weight status among 64,790 Tennessee children and adolescents. Methods: Crosssectional data from the Youth Risk Behavior Survey (YRBS) conducted in Tennessee (2010) were used to conduct multilevel analyses that account for the nesting of students in classes, classes in schools and schools in districts. The outcome variable was childhood obesity (>95th percentile). Explanatory variables included district-level factors (the proportion of children wearing seat belts or helmets in district and the proportion of being asked to show proof of age), school-level factors (current tobacco use in school, and HIV/AIDS education in school), class-level factors (the average of smoking days in past 30 days and the proportion of ever having exercised to lose weight in class) and individual-level factors (state geographical regions, age, gender, grade, ever ridden in a car driven by someone who had been drinking alcohol, ever carried a weapon, made a plan to kill yourself, ever used or early onset use of tobacco, alcohol, marijuana, exercised to control weight, school day television time, days of physical education (PE) classes. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported. Results: Multilevel analyses indicate that 0.90%, 0.08%, and 0.45% of the variation in obesity is associated with class, school and district differences, respectively. Male middle schoolers were at greater risk for obesity [OR: 1.82, C.I. (1.75, 1.89)] compared to females. For every one year increase in age, the relative odds of obesity increased by 11% (OR 0.89, 95% CI 0.88-0.91). Students with worse grades were more likely to have obesity [OR: 1.33, C.I. (1.13, 1.56)]. Students who watched TV 3 hours or more per day were more likely to be obese [OR: 1.31, C.I. (1.23, 1.40)] compared to those who did less than 3 hours per day. Similarly students who ever tried cigarettes were more likely to be obese [OR: 2.15, C.I. (1.62, 2.85)] compared to those students who did not. Students who reported wearing seat belts [OR: 0.05, C.I. (0.02, 0.16)] were less likely to be obese. Conclusions: This study highlights a number of modifiable factors on multiple levels associated with child and adolescent obesity in the state of Tennessee. The results emphasize the importance of targeting programs beyond individual adolescent factors to the child’s classes, schools, and school districts, to reduce the prevalence of obesity among Tennessee adolescents.

No description available.

The purpose of the present study was to utilize a statewide, representative sample of students in grades 6-8 in Tennessee to determine the co-occurrence of health risk behaviors such as smoking, substance use and eating disorders, among adolescents by determining the impact gender, age, race, and geographic region have on the association of these behaviors with the prevalence of adolescent obesity. We also explored the role that district, school, and class level health risk behavior variables play in adolescent obesity. Among adolescent females in the sample, 17.25% were obese, whereas 27.27% of males were obese. Stratified Hierarchical Logistic Regression Analysis demonstrated that several variables such as having ever tried smoking, having a weight misperception, and eating disorder, watching TV for more than 3 hours a day, and not engaging on a sports team remained consistent in their significant association with adolescent obesity across all groups. The findings from this study suggest that certain risk behaviors play an important role in adolescent obesity. Perhaps the most significant finding of our study that requires more investigation is the effect of education on adolescent obesity.

Objectives: Asthma is a genetic disease that requires an environmental trigger to manifest in predisposed individuals. This study aims to assess the prevalence of asthma among U.S. adolescents and possible environmental triggers to asthma. Methods: This is a secondary analysis of the Youth Risk Behavioral Survey 2015 (YRBS 2015). A total of 15,624 high school students in the U.S. were included in this analysis. The YRBS was established by Center for disease control and prevention (CDC) in 1991 to monitor six priority health risk behaviors among youths and young adults. Data were collected via self-administered questionnaire which was validated by CDC through a two test reliability studies. The Data was analyzed using SAS v 9.4. Results: The overall prevalence of asthma was 23.08% with no significant difference between male (22.84%) and female (23.31%). Simple logistic regression analysis showed that the estimated odds of having asthma among individuals that initiated cigarette smoking before the age of 13 years was about 40% higher than those who did not (Odds Ratio (OR): 1.40, 95% CI: 1.22-1.62, p<0.0001). The odds of having asthma was also significantly higher among individuals who used marijuana before the age of 13 years (OR: 1.25, 95% CI: 1.11-1.46, p<0.001) than those who did not. Furthermore, the estimated odds of having asthma was 25% higher in individuals currently using marijuana (OR: 1.25, 95%CI: 1.14-1.37, p<0.0001) than those who do not and 44% higher among obese individuals (OR: 1.44, 95%CI: 1.29-1.60, p<0.0001) compared to non-obese individuals. Sleeping eight or more hours per day was protective against asthma (OR: 0.81, 95% CI: 0.74-0.88, P<0.0001). After adjusting for age and other factors, multiple logistic regression showed that the odds of having asthma was approximately 26% higher among individuals who initiated cigarette smoking before the age of 13 years (adjusted OR (aOR): 1.26, 95% CI: 1.01- 1.57, P=0.037) than those who did not. Moreover, the odds of having asthma was 18% higher among those who initiated alcohol drinking before the age of 13 years (aOR: 1.18, 95%CI: 1.04-1.35, P=0.014), compared to those who did not. There was no association found between asthma and physical activity, the use of marijuana after adjusting for age and other potential risk factors. Conclusion: While sleeping more than eight hours per day was protective against asthma, early initiation of cigarette smoking, marijuana, and alcohol drinking was positively associated with asthma. Encouraging children to sleep minimum of eight hours per day will potentially decrease asthma prevalence.