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.

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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.