Publications by authors named "Tracy K Richmond"

59 Publications

Adolescent individual, school, and neighborhood influences on young adult hypertension risk.

PLoS One 2022 28;17(4):e0266729. Epub 2022 Apr 28.

Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, California, United States of America.

Background: Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure.

Methods: Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects.

Results: The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3).

Conclusion: We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266729PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9049504PMC
May 2022

Severe Hypernatremia in an Adolescent With Anorexia Nervosa.

Clin Pediatr (Phila) 2021 12 27;60(14):586-590. Epub 2021 Oct 27.

Boston Children's Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1177/00099228211055283DOI Listing
December 2021

The Impact of the COVID-19 Pandemic on the Number of Adolescents/Young Adults Seeking Eating Disorder-Related Care.

J Adolesc Health 2021 10 12;69(4):660-663. Epub 2021 Jul 12.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

Purpose: The COVID-19 pandemic has led to the development and worsening of eating disorder (ED) symptoms in adolescents and young adults. In order to examine COVID-19-related trends in ED care-seeking at our institution.

Methods: We used interrupted time series regression to examine pre- and postpandemic monthly summary data of the following: (1) ED-related inpatient admissions for medical stabilization; (2) ED-related hospital bed-days; (3) completed outpatient ED assessments; and (4) ED outpatient care-related inquiries at a children's hospital in Boston, MA.

Results: Inpatient admissions, hospital bed-days, and outpatient care-related inquiries increased on average over time postpandemic compared to stable volume over time prepandemic (p < .01). Outpatient assessments decreased precipitously initially following COVID-19-related limitations, and rose quickly back to baseline.

Conclusion: These results indicate increased need for ED-related care during the pandemic. Bolstering resources to meet the needs of these vulnerable patients is critical as the effects of the pandemic continue to be felt.
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http://dx.doi.org/10.1016/j.jadohealth.2021.05.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415773PMC
October 2021

COVID-19 and eating disorder and mental health concerns in patients with eating disorders.

J Eat Disord 2021 Jul 2;9(1):80. Epub 2021 Jul 2.

Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115, MA, USA.

Background: The Coronavirus (COVID-19) pandemic dramatically transformed daily life for adolescents and young adults, altering social and physical environments. Previous research has shown such shifts in daily life to be especially challenging for people living with eating disorders (ED). However, the extent of this environmental change on ED symptoms and mental health (MH) has been relatively unexplored in patients with EDs. This study examines how young people with EDs feel the COVID-19 pandemic has affected their living environments as well as their ED and MH symptoms and motivation for ED recovery.

Methods: Participants were enrollees in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) who responded to an additional survey (n = 89) in July 2020 to assess their perceptions of the impact of the COVID-19 pandemic. Participants reported on concerns of their ED worsening due to increased time living in a "triggering environment" due to the pandemic as well as perceived COVID-related changes in intrusive ED thoughts, depression, anxiety, isolation, and motivation to recover. Logistic regression models, adjusted for age and ED diagnosis, examined the association of triggering environment with ED and MH symptoms.

Results: The majority of respondents reported concern for worsening of their ED due to a "triggering environment" (63%). Most reported an increase in ED thoughts (74%), feelings of anxiety (77%), depression (73%), and isolation (80%) they perceived to be related to the pandemic. Nearly one-third reported decrease in motivation to recover (29%) they perceived to be related to the pandemic. After adjusting for age and ED diagnosis, participants who reported concern for worsening of their ED due to a triggering environment had nearly 18 times the odds of decreased motivation to recover (OR 18.1; 95% CI 3.37-97.4, p = 0.003) and nearly 24 times the odds of increased ED thoughts (OR 23.8; 95% CI 4.31-131.6, p < 0.001) compared to those who did not report concern for worsening of their ED due to a triggering environment.

Conclusions: Our findings demonstrate the perceived negative impact the COVID-19 pandemic has had on the self-reported ED and MH symptoms in patients with EDs, particularly in those who report concern for a negative environmental change. These results underscore the need for heightened monitoring of patients with EDs during the pandemic.
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http://dx.doi.org/10.1186/s40337-021-00437-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253465PMC
July 2021

Access to care and worsening eating disorder symptomatology in youth during the COVID-19 pandemic.

J Eat Disord 2021 Jun 10;9(1):69. Epub 2021 Jun 10.

Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.

Background: Shelter-in-place orders and social distancing guidelines, in response to the COVID-19 pandemic, have limited traditional face-to-face interactions and led to many clinical providers transitioning to the use of videoconferencing platforms. The present study aims to assess how the COVID-19 pandemic has impacted adolescents'/young adults' (AYA) eating disorder (ED)-related care, and how access to, changes in, perceived disruptions to, and quality of care are associated with ED thoughts and behaviors.

Methods: AYA enrolled in the RECOVERY study, a pre-existing web-based longitudinal study, and completed a COVID-19-specific survey (n = 89). We examined bivariate associations of four markers of care: i) access to care, ii) changes in care, iii) perceived disruption to care, and iv) quality of care. Using multiple logistic regression, we examined the associations of pandemic-related markers of care with changes in ED thoughts and behaviors. We excluded those not engaged in treatment pre-pandemic (n = 16).

Results: In the remaining 73 participants, reported access to care was high, with 92% of respondents continuing care with at least one ED provider during the pandemic; however, 47% stopped some treatment during the pandemic. Nearly one-third (32%) perceived a disruption in treatment. Quality of care remained high with 67% reporting care to be better than or as good as pre-pandemic. Respondents acknowledged heightened symptomatology: 81% reported increased ED thoughts and 81% reported increased ED behaviors due to COVID-19-related factors. However, none of the markers of care described were significantly associated with ED thoughts or behaviors in regression analyses adjusting for demographic variables and baseline characteristics, except our quality of care measure which was approaching significance (p = 0.07).

Conclusions: Our findings show the majority of AYA who had care prior to the pandemic continued receiving some element of their multi-disciplinary ED treatment and perceived their care as high quality. None of the markers of care described were statistically associated with increased ED thoughts and behaviors.
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http://dx.doi.org/10.1186/s40337-021-00421-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190763PMC
June 2021

The Association of Malnutrition, illness duration, and pre-morbid weight status with anxiety and depression symptoms in adolescents and young adults with restrictive eating disorders: a cross-sectional study.

J Eat Disord 2021 May 17;9(1):60. Epub 2021 May 17.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.

Background: Restrictive eating disorders (EDs) are often comorbid with anxiety and depression symptoms, placing patients at risk for more severe disease, worse treatment outcomes, and higher rates of mortality. To identify risks for developing such co-morbidities, we assessed the association of malnutrition, ED illness duration, and pre-morbid weight status with symptoms of anxiety and depression in adolescents/young adults (AYAs) with EDs.

Methods: 145 participants with restrictive EDs (anorexia nervosa [AN], other specified feeding and eating disorders [OSFED], avoidant restrictive food intake disorder [ARFID]) were included from the RECOVERY study, a longitudinal web-based registry of AYAs with EDs. We measured malnutrition as percent of expected body mass index (%eBMI), based on participants' pre-morbid growth trajectory. Outcomes were anxiety and depression scores from the Generalized Anxiety Disorder 7-item (GAD-7) and Center for Epidemiologic Studies Depression (CES-D) scales. We used multiple linear regression to examine the association of malnutrition, ED duration, and pre-morbid weight status with symptoms of anxiety and depression.

Results: Mean (SD) age was 16.4(3.0) years; 87% were female; 89% white; 85% had AN, 6% OSFED, 10% ARFID. Of these, 2/3 had ED symptoms ≥1 year, 1/3 had previous higher level of ED care (HLOC), and half were taking psychiatric medications. Mean %eBMI was 90% (range 57-112%). Mean GAD-7 was 9.4(5.9) and CES-D was 24(13.8), indicating most participants had clinically significant anxiety and/or depression. Degree of malnutrition was not significantly associated with anxiety or depression adjusting for age, sex, sexual orientation, ED diagnosis, and use of psychiatric medication. Those with longer duration of ED symptoms had higher depression scores after adjusting for malnutrition, HLOC, length of ED symptoms, and time in our care (p = 0.038). Patients with pre-morbid BMIs ≥75th percentile had lower depression scores than those with pre-morbid BMIs <75th percentile (p = 0.014).

Conclusions: We find high degree of clinically relevant anxiety and depression symptoms in a population of AYAs with EDs. Our findings suggest that factors beyond malnutrition play a role in the co-morbid mood and anxiety disorders in this population. Overall, rapid ED diagnosis and comprehensive treatment for patients with EDs across the weight spectrum-and especially those with psychiatric co-morbidities-will likely aid in recovery.
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http://dx.doi.org/10.1186/s40337-021-00415-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127488PMC
May 2021

The scale matters: assessing body size with figure rating scales in a diverse sample of young adults.

Eat Weight Disord 2022 Feb 29;27(1):263-271. Epub 2021 Mar 29.

Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, USA.

Purpose: To explore intersectional differences in weight perception accuracy in a diverse sample of young adults using CDC-defined weight status labels and four separate figure rating scales (FRS).

Methods: This cross-sectional study of 322 18-25-year-olds with body mass index (BMI) ranging from 18.5 to 57.2 (M = 26.01, SD = 6.46) enrolled participants as part of a larger university subject pool cohort in the U.S. MidSouth. Height and weight measurements were obtained. Participants (55% Black, 45% white; 74% female) selected images that best represented their current body size using four FRS and described their weight perception using five labels from "very underweight" to "very overweight/obese". Receiver operating characteristic (ROC) curve analyses were used to compare variability in classification of weight status by FRS and weight perception category across gender and race.

Results: Area under the curve (AUC) statistics indicated all scales were significantly better at classifying weight status than chance. Among Black females and Black males, the culturally adapted scale had the strongest discriminatory ability [(AUC = 0.93, SE = 0.02, p < 0.001, 95% CI = 0.89-0.97) and (AUC = 0.93, SE = 0.04, p < 0.001, 95% CI = 0.86-1.00), respectively]. Among white females, the silhouette scale had the strongest discriminatory ability (AUC = 0.93, SE = .03, p < 0.001, 95% CI = 0.88-0.99). Among white males, the photo-based scale had the strongest discriminatory ability (AUC = 0.84, SE = 0.06, p = 0.001, 95% CI = 0.71-0.96). Across all groups, weight perception labels were the weakest classifier of weight status.

Conclusion: Weight perception labels are an ineffective method of assessing weight status and FRS accuracy varies by race and gender, suggesting the value of gender- and culturally tailored scales.

Level Of Evidence: Level III. Evidence obtained from well-designed cohort or case-control analytic studies.
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http://dx.doi.org/10.1007/s40519-021-01166-9DOI Listing
February 2022

Social and economic cost of eating disorders in the United States: Evidence to inform policy action.

Int J Eat Disord 2021 05 2;54(5):851-868. Epub 2021 Mar 2.

Deloitte Access Economics, Canberra, Australian Capital Territory, Australia.

Objective: To estimate one-year costs of eating disorders in the United States (U.S.) from a societal perspective, including the costs to the U.S. health system, individual and family productivity costs, lost wellbeing, and other societal economic costs, by setting and payer. Findings will inform needed policy action to mitigate the impact of eating disorders in the U.S.

Method: Costs of eating disorders were estimated using a bottom-up cost-of-illness methodology, based on the estimated one-year prevalence of eating disorders. Intangible costs of reduced wellbeing were also estimated using disability-adjusted life years.

Results: Total economic costs associated with eating disorders were estimated to be $64.7 billion (95% CI: $63.5-$66.0 billion) in fiscal year 2018-2019, equivalent to $11,808 per affected person (95% CI: $11,754-$11,863 per affected person). Otherwise Specified Feeding or Eating Disorder accounted for 35% of total economic costs, followed by Binge Eating Disorder (30%), Bulimia Nervosa (18%) and Anorexia Nervosa (17%). The substantial reduction in wellbeing associated with eating disorders was further valued at $326.5 billion (95% CI: $316.8-$336.2 billion).

Discussion: The impact of eating disorders in the U.S. is substantial when considering both economic costs and reduced wellbeing (nearly $400 billion in fiscal year 2018-2019). Study findings underscore the urgency of identifying effective policy actions to reduce the impact of eating disorders, such as through primary prevention and screening to identify people with emerging or early eating disorders in primary care, schools, and workplaces and ensuring access to early evidence-based treatment.
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http://dx.doi.org/10.1002/eat.23486DOI Listing
May 2021

Weight-Focused Public Health Interventions-No Benefit, Some Harm.

JAMA Pediatr 2021 03;175(3):238-239

Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor.

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http://dx.doi.org/10.1001/jamapediatrics.2020.4777DOI Listing
March 2021

Cross-classified multilevel models (CCMM) in health research: A systematic review of published empirical studies and recommendations for best practices.

SSM Popul Health 2020 Dec 29;12:100661. Epub 2020 Aug 29.

Department of Sociology, University of Oregon, Eugene, OR, USA.

Recognizing that health outcomes are influenced by and occur within multiple social and physical contexts, researchers have used multilevel modeling techniques for decades to analyze hierarchical or nested data. Cross-Classified Multilevel Models (CCMM) are a statistical technique proposed in the 1990s that extend standard multilevel modeling and enable the simultaneous analysis of non-nested multilevel data. Though use of CCMM in empirical health studies has become increasingly popular, there has not yet been a review summarizing how CCMM are used in the health literature. To address this gap, we performed a scoping review of empirical health studies using CCMM to: (a) evaluate the extent to which this statistical approach has been adopted; (b) assess the rationale and procedures for using CCMM; and (c) provide concrete recommendations for the future use of CCMM. We identified 118 CCMM papers published in English-language literature between 1994 and 2018. Our results reveal a steady growth in empirical health studies using CCMM to address a wide variety of health outcomes in clustered non-hierarchical data. Health researchers use CCMM primarily for five reasons: (1) to statistically account for non-independence in clustered data structures; out of substantive interest in the variance explained by (2) concurrent contexts, (3) contexts over time, and (4) age-period-cohort effects; and (5) to apply CCMM alongside other techniques within a joint model. We conclude by proposing a set of recommendations for use of CCMM with the aim of improved clarity and standardization of reporting in future research using this statistical approach.
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http://dx.doi.org/10.1016/j.ssmph.2020.100661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490849PMC
December 2020

Psychosocial, behavioral and clinical correlates of children with overweight and obesity.

BMC Pediatr 2020 06 10;20(1):291. Epub 2020 Jun 10.

Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.

Background: Psychological and behavioral correlates are considered important in the development and persistence of obesity in both adults and youth. This study aimed to identify such features in youth with severe obesity (BMI ≥ 120% of 95percentile of sex-specific BMI-for-age) compared to those with overweight or non-severe obesity.

Methods: Youth with BMI ≥ 85 percentile were invited to participate in a prospective research registry where data was collected on attributes such as family characteristics, eating behaviors, dietary intake, physical activity, perception of health and mental well-being, and cardiometabolic parameters.

Results: In a racially/ethnically diverse cohort of 105 youth (65% female, median age 16.1 years, range 4.62-25.5), 51% had severe obesity. The body fat percent increased with the higher levels of obesity. There were no differences in the self-reported frequency of intake of sugar sweetened beverages or fresh produce across the weight categories. However, the participants with severe obesity reported higher levels of emotional eating and eating when bored (p = 0.022), levels of stress (p = 0.013), engaged in fewer sports or organized activities (p = 0.044), and had suboptimal perception of health (p = 0.053). Asthma, depression and obstructive sleep apnea were more frequently reported in youth with severe obesity. The presence of abnormal HDL-C, HOMA-IR, hs-CRP and multiple cardiometabolic risk factors were more common among youth with severe obesity.

Conclusions: Youth with severe obesity have identifiable differences in psychosocial and behavioral attributes that can be used to develop targeted intervention strategies to improve their health.
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http://dx.doi.org/10.1186/s12887-020-02145-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285533PMC
June 2020

"It's Healthy Because It's Natural." Perceptions of "Clean" Eating among U.S. Adolescents and Emerging Adults.

Nutrients 2020 Jun 7;12(6). Epub 2020 Jun 7.

Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.

Definitions for the culturally trendy "clean" eating phenomenon vary: whereas some characterize it as natural and healthy, others adopt more restrictive, moralizing, and affectively-laden definitions that may reflect disordered eating. We examined levels of familiarity with "clean" eating, sources of information, and perceptions of this dietary trend among a large, diverse sample of U.S. adolescents and emerging adults recruited from the National MyVoice Text Message Cohort ( = 1266; ages 14-24 years). Participants answered five questions assessing knowledge of "clean" eating, definitions, perceived healthiness vs. harm, and willingness to adopt "clean" eating, and responses were coded by three trained researchers. Results indicate that 55% of respondents had previously heard of "clean" eating, most commonly through social media, other online sources, and peers. Definitions were heterogeneous, with 40% offering "non-processed" or "whole foods" and 13% noting "non-GMO" or "organic" components. Few respondents (0.6%) expressed outright skepticism about "clean" eating, but many (30%) identified dietary avoidance and restriction as part of the definition. Overall, 71% characterized "clean" eating as a healthy approach, whereas 6% flagged it as "unhealthy", and 18% noted elements of both healthfulness and harm. Notably, 41% reported they "probably would" try "clean" eating themselves, with greater willingness to try "clean" eating among cisgender women. Present findings highlight high levels of awareness and positive attitudes toward "clean" eating among young people in the U.S., with little recognition of the potential risks of dietary restriction. Further research should examine actual dietary behaviors to clarify potential risks of "clean" eating and related trends and thus inform strategies for eating disorder prevention.
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http://dx.doi.org/10.3390/nu12061708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352986PMC
June 2020

How do you define recovery? A qualitative study of patients with eating disorders, their parents, and clinicians.

Int J Eat Disord 2020 08 26;53(8):1209-1218. Epub 2020 May 26.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

Objective: Recovery from an eating disorder (ED) may be defined differently by different stakeholders. We set out to understand the definition of ED recovery from the perspective of patients, their parents, and clinicians.

Method: We recruited patients with EDs (n = 24, ages 12-23 years) representing different diagnoses (anorexia nervosa n = 17, bulimia nervosa n = 4, binge-ED n = 2, avoidant/restrictive food intake disorder n = 1), along with their parents (n = 20), dietitians (n = 11), therapists (n = 14), and primary care providers (n = 9) from three sites: Boston Children's Hospital, University of Michigan C. S. Mott Children's Hospital, and Penn State Hershey Children's Hospital. In-depth, semi-structured, qualitative interviews explored participants' definitions of recovery. Interviews were analyzed using inductive data-driven thematic analysis. Statistical analyses followed to examine the distribution within each theme by respondent type.

Results: Qualitative analysis resulted in the emergence of four overarching themes of ED recovery: (a) psychological well-being, (b) eating-related behaviors/attitudes, (c) physical markers, and (d) self-acceptance of body image. Endorsement of themes two and four did not significantly differ between patients, parents, and clinicians. Clinicians were significantly more likely to endorse theme one (χ = 9.90, df = 2, p = .007, φ = 0.356) and theme three (χ = 6.42, df = 2, p = .04, φ = 0.287) than patients and parents.

Discussion: Our study demonstrates overwhelming support for psychological markers as indicators of ED recovery by all three groups. Clinicians should remain open to additional markers of recovery such as body acceptance and eating-related behaviors/emotions that may be of critical importance to patients and their caregivers.
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http://dx.doi.org/10.1002/eat.23294DOI Listing
August 2020

School Social Capital and Tobacco Experimentation Among Adolescents: Evidence From a Cross-Classified Multilevel, Longitudinal Analysis.

J Adolesc Health 2020 04 27;66(4):431-438. Epub 2020 Jan 27.

Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.

Purpose: School social capital incorporates the intangible prosocial resources from social networks, including expectations and social norms, found in a school environment. School social capital may influence health behaviors such as smoking. This study examined the association of school social capital with smoking behaviors from childhood into adolescence.

Methods: We used a cohort sampled from three U.S. cities for the Healthy Passages Longitudinal Study of Adolescent Health. The primary outcome was cigarette smoking at grade 10 (Wave 3). The primary predictor of interest was school social capital at grade 5 (Wave 1). We included potential covariates at the individual, school, and neighborhood levels at Wave 1. To account for simultaneous clustering in schools and neighborhoods, cross-classified multilevel models were used.

Results: After exclusions and imputations for missing variables, our final sample contained 3,968 students as constituents of 118 schools and 479 neighborhoods. With adjustment for the covariates, school social capital for grade 5 was negatively associated with cigarette smoking in grade 10. We estimated that a 1 standard deviation increase in the school average social capital for grade 5 is associated with an odds ratio of .86 (95% credible interval: .75-.98) for school-level smoking in grade 10.

Conclusions: This study suggests that school social capital in late elementary years is associated with reduced smoking behaviors among adolescents in the U.S. Influencing school social capital through enrichment of positive social norms and parent/teacher expectations may be a useful strategy to reduce adolescent smoking, with long-term implications for adult health.
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http://dx.doi.org/10.1016/j.jadohealth.2019.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089836PMC
April 2020

A survey of physician practices on the inpatient medical stabilization of patients with avoidant/restrictive food intake disorder.

J Eat Disord 2018 26;6:22. Epub 2018 Sep 26.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA.

Background: Avoidant/restrictive food intake disorder (ARFID) was added to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition in 2013. ARFID can result in impaired growth and significant nutritional deficiency; individuals with ARFID may be so nutritionally compromised that they require medical stabilization in a hospital. Prior to the new diagnostic criteria, it is unclear how patients now diagnosed with ARFID may have been medically stabilized when hospitalized. Our study aim was to assess the inpatient medical management of adolescents with ARFID.

Methods: United States-based physician members of the Society for Adolescent Health and Medicine's Eating Disorder Special Interest Group's listserv or the National Eating Disorders Quality Improvement Collaborative were invited to participate in an anonymous survey regarding their practices of care for hospitalized patients with ARFID.

Results: Thirty-seven (44.6%) of 83 physicians completed the survey; 73.0% ( = 27) of respondents medically admitted patients with ARFID. Half of respondents who admitted did not use any protocol for refeeding; 55% of those with a protocol used an anorexia nervosa treatment protocol. Solid food and nasogastric feeds were most commonly used for nutritional rehabilitation. Few typically prescribed medications in the hospital during medical stabilization.

Conclusions: There is considerable variability of practice in the treatment of hospitalized patients with ARFID. An important next step is to test the efficacy of protocols for anorexia nervosa in treating ARFID patients.
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http://dx.doi.org/10.1186/s40337-018-0212-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157044PMC
September 2018

Does an uneven sample size distribution across settings matter in cross-classified multilevel modeling? Results of a simulation study.

Health Place 2018 07 7;52:121-126. Epub 2018 Jun 7.

Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA; Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA. Electronic address:

Background: Recent advances in multilevel modeling allow for modeling non-hierarchical levels (e.g., youth in non-nested schools and neighborhoods) using cross-classified multilevel models (CCMM). Current practice is to cluster samples from one context (e.g., schools) and utilize the observations however they are distributed from the second context (e.g., neighborhoods). However, it is unknown whether an uneven distribution of sample size across these contexts leads to incorrect estimates of random effects in CCMMs.

Methods: Using the school and neighborhood data structure in Add Health, we examined the effect of neighborhood sample size imbalance on the estimation of variance parameters in models predicting BMI. We differentially assigned students from a given school to neighborhoods within that school's catchment area using three scenarios of (im)balance. 1000 random datasets were simulated for each of five combinations of school- and neighborhood-level variance and imbalance scenarios, for a total of 15,000 simulated data sets. For each simulation, we calculated 95% CIs for the variance parameters to determine whether the true simulated variance fell within the interval.

Results: Across all simulations, the "true" school and neighborhood variance parameters were estimated 93-96% of the time. Only 5% of models failed to capture neighborhood variance; 6% failed to capture school variance.

Conclusions: These results suggest that there is no systematic bias in the ability of CCMM to capture the true variance parameters regardless of the distribution of students across neighborhoods. Ongoing efforts to use CCMM are warranted and can proceed without concern for the sample imbalance across contexts.
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http://dx.doi.org/10.1016/j.healthplace.2018.05.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171360PMC
July 2018

Relating shape/weight based self-esteem, depression, and anxiety with weight and perceived physical health among young adults.

Body Image 2018 Jun 17;25:168-176. Epub 2018 Apr 17.

Division of Adolescent and Young Adult Medicine, Boston Children's Hospital/Harvard Medical School, United States.

Simultaneous contributions of self-esteem, depression, and anxiety to weight and perceived physical health in young adults is understudied. A diverse sample of 424 young adults completed measures of shape/weight based self-esteem, depression, anxiety, and perceived physical health. Height and weight were measured to calculate body mass index (BMI). Latent profile analysis was conducted to derive patterns of depression, anxiety, and shape/weight based self-esteem. Then, we examined the association of the profiles with weight status and perceived physical health. Three profiles emerged: (1) High Shape/Weight Influence (HSWI); (2) Low Shape/Weight, Depression, & Anxiety Influence (LSWDAI); and (3) High Depression & Anxiety Influence (HDAI). The HSWI profile had significantly higher BMI than the LSWDAI and HDAI profiles, and significantly lower perceived physical health than the LSWDAI profile. Over emphasis on shape/weight, regardless of depression and anxiety, is associated with elevated weight and negative internalized health views.
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http://dx.doi.org/10.1016/j.bodyim.2018.04.003DOI Listing
June 2018

BMI Trajectories from Birth to Young Adulthood.

Obesity (Silver Spring) 2018 06 19;26(6):1043-1049. Epub 2018 Apr 19.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

Objective: This study aimed to compare BMI trajectories from childhood to early adulthood in those with overweight and/or obesity versus severe obesity.

Methods: Longitudinal BMI values (2,542 measurements) were calculated from measured heights and weights for 103 children, adolescents, or young adults with overweight, obesity, or severe obesity. Segmented regression with splines was used to model BMI trajectories.

Results: Sixty-nine participants were classified as ever having severe obesity versus 34 who never had severe obesity. Trajectories and slopes did not differ by sex or race/ethnicity. Compared with those who never had severe obesity, BMI was higher in the group with severe obesity at all ages, and BMI slope was higher for those with severe obesity at age 14 (P = 0.002), with peak slope occurring later (18 years vs. 16 years) and higher (4.5 ± 0.5 kg/m /y vs. 2.9 ± 0.5 kg/m /y; P < 0.02). In the group without severe obesity, BMI fell below zero by the mid-20s (-0.3 ± 0.6 kg/m /y); in those with severe obesity, BMI slope never reached zero (0.9 ± 0.5 kg/m /y).

Conclusions: Youth with severe obesity, compared with their peers without, started with higher BMIs, had more rapid rates of BMI increase beginning at age 14, as well as a higher peak and longer period of increase, and never achieved weight stabilization.
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http://dx.doi.org/10.1002/oby.22176DOI Listing
June 2018

Racial and Ethnic Disparities in Early Childhood Obesity.

Pediatrics 2018 01;141(1)

Boston Children's Hospital, Boston, Massachusetts.

Objectives: The prevalence of childhood obesity is significantly higher among racial and/or ethnic minority children in the United States. It is unclear to what extent well-established obesity risk factors in infancy and preschool explain these disparities. Our objective was to decompose racial and/or ethnic disparities in children's weight status according to contributing socioeconomic and behavioral risk factors.

Methods: We used nationally representative data from ∼10 700 children in the Early Childhood Longitudinal Study Birth Cohort who were followed from age 9 months through kindergarten entry. We assessed the contribution of socioeconomic factors and maternal, infancy, and early childhood obesity risk factors to racial and/or ethnic disparities in children's BMI scores by using Blinder-Oaxaca decomposition analyses.

Results: The prevalence of risk factors varied significantly by race and/or ethnicity. African American children had the highest prevalence of risk factors, whereas Asian children had the lowest prevalence. The major contributor to the BMI score gap was the rate of infant weight gain during the first 9 months of life, which was a strong predictor of BMI score at kindergarten entry. The rate of infant weight gain accounted for between 14.9% and 70.5% of explained disparities between white children and their racial and/or ethnic minority peers. Gaps in socioeconomic status were another important contributor that explained disparities, especially those between white and Hispanic children. Early childhood risk factors, such as fruit and vegetable consumption and television viewing, played less important roles in explaining racial and/or ethnic differences in children's BMI scores.

Conclusions: Differences in rapid infant weight gain contribute substantially to racial and/or ethnic disparities in obesity during early childhood. Interventions implemented early in life to target this risk factor could help curb widening racial and/or ethnic disparities in early childhood obesity.
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http://dx.doi.org/10.1542/peds.2017-0865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744272PMC
January 2018

Oral health status and longitudinal cardiometabolic risk in a national sample of young adults.

J Am Dent Assoc 2017 12;148(12):930-935

Background: Dental and cardiometabolic diseases are highly prevalent, share many common risk factors, and begin during youth. Despite poor dental health being known to influence dietary behaviors that are in turn linked to cardiometabolic health, the role of oral health on concomitant and future cardiometabolic disease is understudied. We sought to determine the association of oral health with cardiometabolic markers during adolescence and early adulthood.

Methods: Our sample included 11,556 participants with data from waves 1 (when participants were aged 12 to 19 years) and 4 (when they were aged 26 to 32 years) of the National Longitudinal Study of Adolescent to Adult Health. Multivariable linear and logistic regression separately examined associations between different markers of oral health (that is, missing teeth, periodontal disease, and deferred dental care) and markers of cardiometabolic health (that is, lipids, blood pressure, and body mass index), adjusting for sociodemographic characteristics.

Results: Mean age was 29 years at follow-up (wave 4). In adjusted analyses, deferred dental care during both adolescence (β = 1.25; 95% confidence interval [CI], 0.6 to 2.0; P = .001) and early adulthood (β = 0.9; 95% CI, 0.4 to 1.3; P < .001) was associated with an increased body mass index during early adulthood. Deferred dental care in early adulthood was also associated with increased systolic (β = 0.9; 95% CI, 0.4 to 1.5; P = .002) and diastolic (β = 1.0; 95% CI, 0.5 to 1.5; P < .001) blood pressure values and an increased likelihood of being hypertensive (odds ratio = 1.2; 95% CI, 1.0 to 1.3; P = .03).

Conclusions: In this nationally representative study deferred dental care during adolescence and concurrently in early adulthood was associated with poorer cardiometabolic disease during early adulthood. Providing better access to dental care may have benefits not only for oral health but also for long-term cardiometabolic health.

Practical Implications: Deferred dental care during adolescence and early adulthood, but not recent tooth loss or periodontal disease, is associated with increased risk of cardiometabolic disease.
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http://dx.doi.org/10.1016/j.adaj.2017.09.029DOI Listing
December 2017

Food Insecurity, Weight Status, and Perceived Nutritional and Exercise Barriers in an Urban Youth Population.

Clin Pediatr (Phila) 2018 02 20;57(2):152-160. Epub 2017 Feb 20.

1 Boston Children's Hospital, Boston, MA, USA.

Food insecurity and overweight/obesity coexist among youth; however, evidence for their association has been mixed. Our objectives were to assess the association between (1) level of food security and weight classification and (2) food insecurity and perceived nutritional and exercise barriers in an urban youth population. Patients aged 15 to 25 years completed a US Department of Agriculture Food Security Survey. Chi-square, Kruskal-Wallis tests, and logistic regression models controlling for age and gender assessed the association between food security level, weight classification, and perceived barriers. Among 376 patients, 122 (32%) were food insecure and 221 (59%) were overweight/obese. There were no significant associations between food security level and weight classification. In adjusted analyses, participants with very low food insecurity reported significantly greater odds of 3 nutritional barriers compared to participants with high food security. Food-insecure youth were more likely to report nutritional barriers, which may lead to overweight/obesity over time.
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http://dx.doi.org/10.1177/0009922817693301DOI Listing
February 2018

Longitudinal impact of weight misperception and intent to change weight on body mass index of adolescents and young adults with overweight or obesity.

Eat Behav 2017 12 18;27:7-13. Epub 2017 Aug 18.

Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA. Electronic address:

Objective: Accurate perception of one's weight status is believed to be necessary to motivate weight loss intention and subsequent weight loss among those with overweight/obesity. This proposed pathway, however, is understudied in longitudinal research. This study examined the indirect effect of weight change intention on the relationship between weight status perception and BMI change among adolescents with overweight/obesity.

Methods: Participants included 2664 adolescents with overweight/obesity (52% female) from the National Longitudinal Study of Adolescent Health. Longitudinal associations between Wave II weight status perception (accurate versus misperception) and intent to change weight (i.e., gain, lose, stay the same) on BMI change (Wave II-Wave IV) were examined using multiple linear regression. Indirect effects of weight change intention were investigated using the Monte Carlo method. Analyses were stratified by gender.

Results: Accurate perceivers (81.0% female; 60.1% male) were more likely than misperceivers (i.e., perception of "about the right weight") to report weight loss intention (p<0.001). Among females, weight status misperception and weight loss intention individually were associated with smaller (β=-1.37, 95% CI [-2.64, -0.10]) and greater (β=1.18, 95% CI [0.11, 2.25]) BMI gains, respectively. Among males, fully adjusted models suggested that weight status misperception was associated with significantly smaller gains in BMI over time (β=-1.51, 95% CI [-2.38, -0.63]). Weight change intention did not emerge as an indirect effect for either gender.

Conclusions: Although weight status misperception was protective against weight gain, weight change intention did not provide an explanation for this relationship.
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http://dx.doi.org/10.1016/j.eatbeh.2017.08.002DOI Listing
December 2017

Lesbian, Gay, Bisexual, and Transgender Adolescent Health: An Interprofessional Case Discussion.

MedEdPORTAL 2017 Aug 9;13:10615. Epub 2017 Aug 9.

Co-Director of the LEAH Nursing Fellowship, Division of Adolescent and Young Adult Medicine, Boston Children's Hospital.

Introduction: Lesbian, gay, bisexual, and transgender (LGBT) adolescents frequently endure considerable adversity as they encounter identity-related stigma. As a result, LGBT adolescents are often at disproportionate risk for experiencing negative social and health outcomes.

Methods: This four-module curriculum allows learners to explore challenges common to the clinical care of LGBT adolescents while also providing exposure to current trends and evidence in LGBT health. Through a combination of reflective exercises, didactic lectures, foundational readings, facilitated case discussion, and debate, the curriculum introduces learners to issues of assessment, treatment, and support as they relate to LGBT youth. The curriculum was written for use with learners in an interprofessional training program representing the disciplines of medicine, nursing, nutrition, social work, and psychology.

Results: Four years of evaluation data indicate that the curriculum is particularly useful for exposing learners to the complexities of serving and supporting LGBT youth and identifying personal skills that may require additional development. Learners emerge with greater confidence in identifying local and national LGBT resources.

Discussion: Incorporating cultural humility is key to fostering a commitment to lifelong learning and maintaining learners' confidence when working with marginalized populations. Optimal discussion occurs when learners in all disciplines contribute, yet instructors can teach modules separately or modify them when learners from all disciplines are not present. In addition, learners emerge with greater confidence in connecting with outside resources, which assists both referrals for patients and self-directed learning.
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http://dx.doi.org/10.15766/mep_2374-8265.10615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374743PMC
August 2017

Contextual Effects of Neighborhoods and Schools on Adolescent and Young Adult Marijuana Use in the United States.

Subst Abuse 2017 6;11:1178221817711417. Epub 2017 Jun 6.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Little is known about the unique contribution of schools vs neighborhoods in driving adolescent marijuana use. This study examined the relative contribution of each setting and the influence of school and neighborhood socioeconomic status on use. We performed a series of cross-classified multilevel logistic models predicting past 30-day adolescent (N = 18 329) and young adult (N = 13 908) marijuana use using data from Add Health. Marijuana use differed by age, sex, race/ethnicity, and public assistance in adjusted models. Variance parameters indicated a high degree of clustering by school (σ2 = 0.30) and less pronounced clustering by neighborhood (σ2 = 0.06) in adolescence when accounting for both levels simultaneously in a cross-classified multilevel model. Clustering by school persisted into young adulthood (σ2 = 0.08). Parental receipt of public assistance increased the likelihood of use during adolescence (odds ratio = 1.39; 95% confidence interval: 1.19-1.59), and higher parental education was associated with increased likelihood of use in young adulthood. These findings indicate that both contexts may be promising locations for intervention.
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http://dx.doi.org/10.1177/1178221817711417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462815PMC
June 2017

History of Overweight/Obesity as Predictor of Care Received at 1-year Follow-Up in Adolescents With Anorexia Nervosa or Atypical Anorexia Nervosa.

J Adolesc Health 2017 Jun 8;60(6):674-679. Epub 2017 Mar 8.

Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.

Purpose: Previous research has indicated that patients with anorexia nervosa (AN) or atypical AN with premorbid history of overweight/obesity have greater weight loss and longer illness duration than patients with no such history. However, little is known about the association of premorbid overweight/obesity and receiving inpatient medical care during treatment for an eating disorder.

Methods: Using logistic regression, we sought to determine if history of overweight/obesity was associated with receiving inpatient medical care in a sample of 522 patients (mean age 15.5 years, 88% female) with AN/atypical AN.

Results: Binary results demonstrated greater percent weight loss (27.4% vs. 16.2%) and higher percent median body mass index (%mBMI, 99.8% vs. 85.2%) at presentation in those with a history of overweight/obesity (p < .001) but no difference in duration of illness (p = .09). In models adjusted for demographics and percent weight loss, history of overweight/obesity was associated with lower odds of receiving inpatient medical care (odds ratio .60 [95% confidence interval: .45-.80]) at 1-year follow-up. However, these associations were no longer significant after adjusting for %mBMI. Mediation results suggest that %mBMI fully mediates the relationship between history of overweight/obesity and inpatient medical care, in that those with a history of overweight/obesity are less likely to receive care due to presenting at a higher weight.

Conclusions: Our findings suggest that, despite greater degree of weight loss and no difference in duration of illness, participants with a history of overweight/obesity are less likely to receive inpatient medical care.
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http://dx.doi.org/10.1016/j.jadohealth.2017.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375315PMC
June 2017

Racial/ethnic and weight status disparities in dieting and disordered weight control behaviors among early adolescents.

Eat Behav 2017 08 14;26:104-107. Epub 2017 Feb 14.

Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA.

Background: This study examined whether racial/ethnic minority early adolescents with overweight/obesity are at increased risk of disordered weight control behaviors, defined as unhealthy behaviors aiming to control or modify shape and weight, ranging from self-induced vomiting to the use of dietary supplements.

Methods: U.S. Middle school children (n=12.511) provided self-report of gender, race/ethnicity, height, and weight as well as dieting and disordered weight control behaviors.

Results: In the entire sample, 25.6% (n=1514) of girls and 16.6% (n=1098) of boys reported dieting within the last month, while 3.5% (n=200) of girls and 2.7% (n=176) of boys reported DWCB. Within all racial/ethnic groups, participants classified as being overweight/obese (34% to 50%) were more likely to report dieting compared to their counterparts without overweight/obesity (9.6% to 29.6%). Racial/ethnic minority children with overweight/obesity had an increased risk of dieting and disordered weight control behaviors compared to their counterparts without overweight/obesity, and, for some outcomes, compared to their White peers with overweight/obesity.

Conclusions: Racial/ethnic minority early adolescents with overweight/obesity are a particularly vulnerable group for disordered eating.
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http://dx.doi.org/10.1016/j.eatbeh.2017.02.005DOI Listing
August 2017

Protective Misperception? Prospective Study of Weight Self-Perception and Blood Pressure in Adolescents With Overweight and Obesity.

J Adolesc Health 2017 Jun 14;60(6):680-687. Epub 2017 Feb 14.

Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Purpose: Underestimating one's weight is often seen as a barrier to weight loss. However, recent research has shown that weight underperception may be beneficial, with lower future weight gain and fewer depressive symptoms. Here, we examine the relationship between adolescent weight underperception and future blood pressure.

Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, we obtained a nationally representative sample of 2,463 adolescents with overweight and obesity (students in grades 8-12 in 1996). We used multivariable linear regression to prospectively examine the relationship between weight self-perception in adolescence and blood pressure in adulthood (year 2008; follow-up rate 80.3%), controlling for age, gender, race/ethnicity, smoking, alcohol consumption, education level, household income, and body mass index. Additional analyses were stratified by gender and race/ethnicity.

Results: Youth with overweight/obesity who underperceived their weight had lower blood pressure in adulthood than those who perceived themselves to be overweight. The decrease in systolic blood pressure was -2.5 mm Hg (95% confidence interval: -4.3, -0.7; p = .006). Although the interaction by gender was statistically insignificant (p = .289), important differences appeared upon stratification by gender. Young men showed no significant difference in adult blood pressure related to weight self-perception. Conversely, in young women, weight underperception was associated with an average decrease in systolic blood pressure of -4.3 mm Hg (95% confidence interval: -7.0, -1.7; p = .002).

Conclusions: Contrary to conventional wisdom, weight underperception is associated with improved health markers in young women. The observed differences in blood pressure are clinically relevant in magnitude, and interventions to correct weight underperception should be re-examined for unintended consequences.
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http://dx.doi.org/10.1016/j.jadohealth.2016.12.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441931PMC
June 2017

Disentangling overlapping influences of neighborhoods and schools on adolescent body mass index.

Obesity (Silver Spring) 2016 12 10;24(12):2570-2577. Epub 2016 Nov 10.

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.

Objective: To compare the simultaneous influence of schools and neighborhoods on adolescent body mass index (BMI).

Methods: Analyzing data from a nationally representative sample of adolescents in grades 7 to 12 (n = 18,200), cross-classified multilevel modeling was used to examine the fixed and random effects of individuals, schools, and neighborhoods on adolescent BMI. Additionally, the ability of school and neighborhood demographics to explain racial/ethnic disparities in BMI was assessed.

Results: There were 18,200 students nested in 128 schools and 2,259 neighborhoods, with 2,757 unique combinations of schools and neighborhoods. In girls, schools (v  = 0.18, CI: 0.06-0.33) contributed twice that of neighborhoods (u  = 0.08, CI: 0.01-0.20) to the variance in BMI, while in males, schools (u  = 0.15, CI: 0.05-0.30) and neighborhoods (v  = 0.16, CI: 0.05-0.31) had similar contributions. The interaction of the neighborhood and school random effects contributed significantly to the variance of male and female BMI. Characteristics of neighborhoods and schools explained a large portion of the racial/ethnic disparity in female BMI.

Conclusions: In an analysis of a nationally representative sample including multiple racial and ethnic groups, the BMI variance of adolescent females was associated with schools more than neighborhoods. In males, there was no difference in school or neighborhood association with BMI.
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http://dx.doi.org/10.1002/oby.21672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479485PMC
December 2016

Cross-sectional and Prospective Examination of Weight Misperception and Depressive Symptoms Among Youth with Overweight and Obesity.

Prev Sci 2017 02;18(2):152-163

Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.

This study aims to determine the association between weight misperception (considering oneself average or underweight) and depressive symptoms among youth with overweight/obesity. Linear regression models (adjusted for age, BMI, parental education, percent poverty) were used to examine cross-sectional (wave II, 1996, n = 3898, M  = 15.9, SD = 0.13) and longitudinal (from wave II to IV, 1996-2008/2009, n = 2738, M  = 28.5, SD = 0.06) associations between weight misperception and depressive symptoms (Center for Epidemiologic Studies-Depression Scale) in a subsample of White, Black, Asian, Hispanic, and Multi-racial male and female youth with overweight/obesity participating in the National Longitudinal Study of Adolescent Health. Average BMI was 29.0 (0.16) at wave II and 35.7 (0.23) at wave IV. Thirty-two percent misperceived their weight status as average weight (n = 1151, 30 %) or underweight (n = 99, 3 %). In fully adjusted cross-sectional models, White (β = -1.92, 95 % CI = -2.79, -1.06) and Multi-racial (β = -4.43, 95 % CI = -6.90, -1.95) youth who perceived themselves as average weight had significantly lower depressive symptoms compared to accurate weight-perceivers. In fully adjusted longitudinal models, White youth (β = -0.41, 95 % CI = -0.81, -0.004) who perceived themselves as average weight had significantly lower depressive symptoms 12 years later. Findings suggest that weight misperception may be protective against depression among White adolescents and young adults with overweight/obesity. Clinical and population interventions should consider potential harmful effects of correcting weight misperceptions on the mental health of youth with overweight/obesity.
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http://dx.doi.org/10.1007/s11121-016-0714-8DOI Listing
February 2017

Weight misperception among young adults with overweight/obesity associated with disordered eating behaviors.

Int J Eat Disord 2016 Oct 24;49(10):937-946. Epub 2016 May 24.

Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Objective: The purpose of this study was to examine the cross-sectional association between weight misperception among young adults with overweight/obesity and disordered eating behaviors.

Method: In a subsample of young adults with overweight or obesity participating in Wave III (2001-2002) of The National Longitudinal Study of Adolescent to Adult Health (n = 5,184), we examined the cross-sectional association between weight under-perception (i.e., perceiving oneself to be at a healthy body weight or underweight) and disordered eating (fasting/meal skipping for weight control, purging/pills for weight control, overeating/loss of control eating, and use of performance-enhancing products/substances).

Results: About 20% of young adult females under-perceived their weight compared to 48% of males. Individuals who misperceived their weight as healthy were significantly less likely to report fasting/meal skipping (Females: OR: 0.25, 95% CI: 0.14-0.43; Males: OR: 0.31, 95% CI: 0.20-0.48) and vomiting or taking diet pills/laxatives/diuretics (Females: OR: 0.10, 95% CI: 0.04-0.25; Males: OR: 0.10, 95% CI: 0.04-0.25) for weight control. Among females, those who misperceived their weight status as healthy were also less likely to report overeating or loss of control eating (OR: 0.41, 95% CI: 0.24-0.71). Greater use of performance-enhancing products/substances was seen among males who under-perceived their weight as healthy (OR: 2.06, 95% CI: 1.57-2.72) and among both females (OR: 2.29, 95% CI: 1.40-20.0) and males (OR: 2.27, 95% CI: 1.13-4.55) who perceived themselves to be underweight.

Discussion: Weight under-perception among young adults with overweight/obesity may convey some benefit related to disordered eating behaviors, but could be a risk factor for the use of performance-enhancing products/substances. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord ; 49:937-946).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064910PMC
http://dx.doi.org/10.1002/eat.22565DOI Listing
October 2016
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