Solomon Mezgebu - Academia.edu (original) (raw)
Papers by Solomon Mezgebu
Journal of Adolescent Health, 2011
Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordere... more Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordered weight control behaviors (DWCB) have been linked to overweight and weight gain in multiple ways, but little is known about DWCB in youth of color, especially boys. We examined the distribution and determinants of ethnic and gender disparities in DWCB in early adolescents. Methods-In fall 2005, 47 Massachusetts middle schools participating in the Healthy Choices overweight prevention study administered a self-report baseline survey assessing student sociodemographics, height, weight, and DWCB (vomiting or use of laxatives or diet pills in the past month to control weight). Data from 16,978 girls and boys were used in multivariate logistic regression models to estimate the odds of DWCB in youth of color compared to their white peers, controlling for individual-and school-level factors. Results-Among white youth, 2.7% of girls and 2.3% of boys reported DWCB. The odds of DWCB were elevated 2-10 times in most ethnic group relative to whites. Disparities were attenuated but persisted after controlling for multiple individual-and school-level factors. Conclusions-Ethnic disparities in DWCB must be considered in efforts to address the epidemic of childhood overweight.
Medico research chronicles, 2017
Eating Disorders, Feb 19, 2013
We investigated the contribution of school environmental factors to individual and school variati... more We investigated the contribution of school environmental factors to individual and school variation in disordered weight control behaviors (DWCB). Analyses were based on self-report data gathered from 18,567 middle-school students in 2005 and publicly available data on school characteristics. We observed large differences across schools in percent of students engaging in DWCB in the past month, ranging from less than 1% of the student body to 12%. School-neighborhood poverty was associated with higher odds of DWCB in boys. Preventive strategies need to account for wide variability across schools and environmental factors that may contribute to DWCB in early adolescence.
Academic Pediatrics, Jul 1, 2013
OBJECTIVE: Family practices around weight-related behaviors can shape children's development of d... more OBJECTIVE: Family practices around weight-related behaviors can shape children's development of disordered weight control behaviors (DWCB), such as vomiting, taking laxatives, or taking diet pills without a prescription. This study examined family meal and physical activity (PA) practices associated with DWCB among a multiethnic sample of youth. METHODS: We assessed self-report data on frequency of family sit-down dinners, types of parental involvement in their children's PA, and DWCB are from 15,461 6th to 8th grade girls and boys in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005).
Preventing Chronic Disease, Nov 29, 2012
MEDSCAPE CME Medscape, LLC is pleased to provide online continuing medical education (CME) for th... more MEDSCAPE CME Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Preventing Chronic Disease. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journalbased CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd ; (4) view/print certificate.
American Journal of Public Health, Mar 1, 2009
Obesity, a major health concern in the United States, 1 results in an estimated 240 000 premature... more Obesity, a major health concern in the United States, 1 results in an estimated 240 000 premature deaths 2-4 and medical costs of over $90 billion 5,6 annually. An objective of Healthy People 2010 is to reduce the prevalence of adult obesity (body mass index [BMI] ‡ 30 kg/m 2) to less than 15% nationwide. 7 Numerous studies 8-10 confirm that rates of obesity are rapidly rising in almost all sociodemographic groups. Recent national data 11, 12 suggest that obesity has reached an historical high, affecting 32% of the adult population. 11 Obesity control is a complex process that requires approaches at all levels-federal, state, and community, as well as organizational, interpersonal, and individual. 13, 14 Control programs that address the specific needs of communities are likely to be more effective than are nonspecific programs planned at higher geopolitical levels such as county or state. 15, 16 Similar to the rest of the nation, Massachusetts encounters shortages of resources for obesity control. For effective use of limited resources, estimates of community-specific prevalence are needed to identify communities with the greatest needs. In addition, city and town public officials and community-based organizations increasingly ask the Massachusetts Department of Public Health for obesity prevalence data that are timely and community specific. In Massachusetts, the Behavioral Risk Factor Surveillance System (BRFSS) 17 is the only source of population-based data on the prevalence of obesity among residents 18 years or older. However, the current BRFSS does not provide prevalence data at the community level because most communities do not have adequate sample sizes for directly calculating prevalence with reasonable precision. Small-area estimation models can be adapted to overcome this limitation and provide community-level prevalence estimates. Using the BRFSS data and small-area estimation models, we estimated and analyzed geographic variations and temporal trends in obesity prevalence in 398 communities (including 339 towns and small cities and 59 subdivisions of the 12 largest cities) in Massachusetts. To assist in the planning of statewide obesity control efforts, we developed a method for classifying communities into priority groups based on adult obesity prevalence estimates and the precision of these estimates. METHODS Small-area estimation models generate community-specific prevalence estimates by making use of (1) the associations of obesity with individual-and community-level characteristics, (2) data from multiple years and across geographic regions, and (3) community demographic characteristics. Our models used the following data for the years 1999 to 2005: (1) individual-level data on body weight, body height, and sociodemographic characteristics for adults residing in the communities under study, (2) community characteristics associated with obesity at least in part independently of individual-level characteristics (such as community-level per capita income), and (3) community composition by age, gender, race/ethnicity, marital status, education, and income. Community-level variables were categorized in the same way as their individual-level counterparts. Individual-Level Data Individual-level data were obtained from the Massachusetts BRFSS collected from 1999 through 2005. The BRFSS collects uniform data on preventive health practices and risk behaviors associated with chronic diseases, injuries, and infectious diseases in the adult population. Data are collected annually from a sample of community-dwelling adults 18 years or older through a random-digit-dialing telephone survey. For the period of this study (1999-2005), response rates calculated by the CASRO method 18 ranged from 33% (in 2000) Objectives. We developed a method to evaluate geographic and temporal variations in community-level obesity prevalence and used that method to identify communities in Massachusetts that should be considered high priority communities for obesity control. Methods. We developed small-area estimation models to estimate community-level obesity prevalence among community-living adults 18 years or older. Individual-level data from the Behavioral Risk Factors Surveillance System from 1999 to 2005 were integrated with community-level data from the 2000 US Census. Small-area estimation models assessed the associations of obesity (body mass index ‡ 30 kg/m 2) with individual-and community-level characteristics. A classification system based on level and precision of obesity prevalence estimates was then used to identify high-priority communities. Results. Estimates of the prevalence of community-level obesity ranged from 9% to 38% in 2005 and increased in all communities from 1999 to 2005. Fewer than 7% of communities met the Healthy People 2010 objective of prevalence rates below 15%. The highest prevalence rates occurred in communities characterized by lower income, less education, and more blue-collar workers. Conclusions. Similar to the rest of the nation, Massachusetts faces a great challenge in reaching the national obesity control objective. Targeting highpriority communities identified by small-area estimation may maximize use of limited resources.
Journal of Adolescent Health, Feb 1, 2012
To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of... more To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of middle schools participating in the Healthy Choices (HC) study and the crime rate in the neighborhood surrounding these schools were associated with individual studentreported physical activity (PA) levels. Also of interest was whether or not crime rate modified the effect of recreational areas on PA. Methods: This analysis used baseline data from the HC study; a study of more than 20,000 6th-8th grade students within 47 Massachusetts (MA) middle schools. Data on parks and recreation areas in MA were obtained through the MassGIS website. Recreation areas of interest included open recreational space, trails, and bike trails. The participating schools were geocoded and mapped along with the MA parks and recreation areas in ArcMap. The primary predictors were the counts of the number of parks and recreation areas in 400m, 800m, and 1500m radii around each of the schools, obtained using ArcGIS, and crime rates in the corresponding census tract areas. The two outcomes were overall and vigorous individual-level PA. To assess overall PA, students reported how many days in the previous 7 they were active for 60ϩ minutes. For vigorous PA, students reported how many days within the last 7 they engaged in exercise that made them sweat or breathe hard for 20ϩ minutes, which provided information on the intensity level of the exercise. Overall PA was dichotomized based on meeting the HC goal (5ϩ days vs. less). Vigorous PA was also dichotomized (3ϩ days vs. less). Using generalized estimating equations, we examined the association of counts of recreational areas in a 400m, 800m, and 1500m radius around the school and crime rates around the school with students' overall and vigorous PA. We also examined whether or not the relationship between recreational space and PA was modified by crime. Models were adjusted for individual race/ethnicity and gender, while simultaneously accounting for the clustering of observations within schools. Results: The number of parks and recreation areas in a 400m, 800m, and 1500m radius was not associated with overall PA (all pϾ0.05) or vigorous PA (all pϾ0.05). Violent crimes/100k was negatively associated with vigorous PA (bϭ-0.0006 pϭ0.0139, bϭ-0.0006 pϭ0.0141, bϭ-0.0006 pϭ0.0156, respectively) but not overall PA (all pϾ0.05). Individual race/ethnicity and gender were the only significant predictors of overall PA in all models (all pϽ0.03) and were also significant predictors of vigorous PA (all pϽ0.01). In areas with higher crime rates, middle school students reported less vigorous PA compared to their peers in areas with lower crime rates. Violent crimes did not modify the effect of parks and recreation resources on individual PA (overall and vigorous). Conclusions: Violent crimes/100k had a strong inverse association with vigorous PA, but not overall PA. The presence of parks and
PLOS ONE, Aug 21, 2015
Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based ... more Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting. Objective Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity. Methods We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components.
Journal of Nutrition Education and Behavior, Nov 1, 2014
Objective: To explore barriers and facilitators to implementing and sustaining Healthy Choices, a... more Objective: To explore barriers and facilitators to implementing and sustaining Healthy Choices, a three-year multi-component obesity prevention intervention implemented in middle schools in Massachusetts. Methods: Using purposive sampling, 56 in-depth interviews were conducted with middleschool employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses. Results: State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers while staff buy-in and technical assistance were seen as facilitating implementation. Respondents felt that intervention sustainability was dependent on external funding and expert assistance. Conclusions and Implications: Results confirm the importance of gaining faculty and staff support. Schools implementing large scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.
<p>Baseline Socio-demographic Characteristics of Schools Participating in Massachusetts Hea... more <p>Baseline Socio-demographic Characteristics of Schools Participating in Massachusetts Healthy Choices (n = 45).</p
<p><sup>a</sup> Percent of students in school achieving behavior, averaged acro... more <p><sup>a</sup> Percent of students in school achieving behavior, averaged across schools</p><p><sup>b</sup> Student’s paired t-test of significant difference from baseline to follow-up, adjusted for school % free and reduced price school lunch, % white, % female and mean age</p><p><sup>c</sup> Including 100% fruit juice; fruits and vegetables</p><p><sup>d</sup> n = 35 schools, 7th grade students only; overweight = BMI ≥ 85th percentile and < 95th percentile; obese = BMI ≥ 95th percentile of NCHS/CDC 2000 growth reference</p><p>Percent across Schools Achieving Behavioral Goals<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134470#t002fn001" target="_blank"><sup>a</sup></a> and Percent Overweight and Obese at Baseline and 3-Year Follow-up<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134470#t002fn002" target="_blank"><sup>b</sup></a>.</p
<p>Distribution of Intervention Components implemented in Year 2 in Massachusetts Middle Sc... more <p>Distribution of Intervention Components implemented in Year 2 in Massachusetts Middle Schools Participating in the Healthy Choices Program (N = 35).</p
<p>Change in school-level percent overweight and obese and percent obese from baseline to f... more <p>Change in school-level percent overweight and obese and percent obese from baseline to follow-up, Massachusetts Healthy Choices (n = 35).</p
BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control be... more BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth. METHODS: Self-reported data on dietary weight management behaviors, strengthening/toning exercises, moderate-to-vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools. RESULTS: Disordered weight control behaviors were reported by 3.6 % of girls and 3.1 % of boys. Youth who engaged...
PLOS ONE, 2015
Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based ... more Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting. Objective Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity. Methods We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components.
Journal of School Health, 2012
BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control be... more BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth.METHODS: Self‐reported data on dietary weight management behaviors, strengthening/toning exercises, moderate‐to‐vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools.RESULTS: Disordered weight control behaviors were reported by 3.6% of girls and 3.1% of boys. Youth who engaged in ...
Journal of Adolescent Health, 2011
Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordere... more Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordered weight control behaviors (DWCB) have been linked to overweight and weight gain in multiple ways, but little is known about DWCB in youth of color, especially boys. We examined the distribution and determinants of ethnic and gender disparities in DWCB in early adolescents. Methods-In fall 2005, 47 Massachusetts middle schools participating in the Healthy Choices overweight prevention study administered a self-report baseline survey assessing student sociodemographics, height, weight, and DWCB (vomiting or use of laxatives or diet pills in the past month to control weight). Data from 16,978 girls and boys were used in multivariate logistic regression models to estimate the odds of DWCB in youth of color compared to their white peers, controlling for individual-and school-level factors. Results-Among white youth, 2.7% of girls and 2.3% of boys reported DWCB. The odds of DWCB were elevated 2-10 times in most ethnic group relative to whites. Disparities were attenuated but persisted after controlling for multiple individual-and school-level factors. Conclusions-Ethnic disparities in DWCB must be considered in efforts to address the epidemic of childhood overweight.
Journal of Adolescent Health, 2012
To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of... more To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of middle schools participating in the Healthy Choices (HC) study and the crime rate in the neighborhood surrounding these schools were associated with individual studentreported physical activity (PA) levels. Also of interest was whether or not crime rate modified the effect of recreational areas on PA. Methods: This analysis used baseline data from the HC study; a study of more than 20,000 6th-8th grade students within 47 Massachusetts (MA) middle schools. Data on parks and recreation areas in MA were obtained through the MassGIS website. Recreation areas of interest included open recreational space, trails, and bike trails. The participating schools were geocoded and mapped along with the MA parks and recreation areas in ArcMap. The primary predictors were the counts of the number of parks and recreation areas in 400m, 800m, and 1500m radii around each of the schools, obtained using ArcGIS, and crime rates in the corresponding census tract areas. The two outcomes were overall and vigorous individual-level PA. To assess overall PA, students reported how many days in the previous 7 they were active for 60ϩ minutes. For vigorous PA, students reported how many days within the last 7 they engaged in exercise that made them sweat or breathe hard for 20ϩ minutes, which provided information on the intensity level of the exercise. Overall PA was dichotomized based on meeting the HC goal (5ϩ days vs. less). Vigorous PA was also dichotomized (3ϩ days vs. less). Using generalized estimating equations, we examined the association of counts of recreational areas in a 400m, 800m, and 1500m radius around the school and crime rates around the school with students' overall and vigorous PA. We also examined whether or not the relationship between recreational space and PA was modified by crime. Models were adjusted for individual race/ethnicity and gender, while simultaneously accounting for the clustering of observations within schools. Results: The number of parks and recreation areas in a 400m, 800m, and 1500m radius was not associated with overall PA (all pϾ0.05) or vigorous PA (all pϾ0.05). Violent crimes/100k was negatively associated with vigorous PA (bϭ-0.0006 pϭ0.0139, bϭ-0.0006 pϭ0.0141, bϭ-0.0006 pϭ0.0156, respectively) but not overall PA (all pϾ0.05). Individual race/ethnicity and gender were the only significant predictors of overall PA in all models (all pϽ0.03) and were also significant predictors of vigorous PA (all pϽ0.01). In areas with higher crime rates, middle school students reported less vigorous PA compared to their peers in areas with lower crime rates. Violent crimes did not modify the effect of parks and recreation resources on individual PA (overall and vigorous). Conclusions: Violent crimes/100k had a strong inverse association with vigorous PA, but not overall PA. The presence of parks and
Eating Disorders, 2013
We investigated the contribution of school environmental factors to individual and school variati... more We investigated the contribution of school environmental factors to individual and school variation in disordered weight control behaviors (DWCB). Analyses were based on self-report data gathered from 18,567 middle-school students in 2005 and publicly available data on school characteristics. We observed large differences across schools in percent of students engaging in DWCB in the past month, ranging from less than 1% of the student body to 12%. School-neighborhood poverty was associated with higher odds of DWCB in boys. Preventive strategies need to account for wide variability across schools and environmental factors that may contribute to DWCB in early adolescence.
Journal of Adolescent Health, 2011
Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordere... more Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordered weight control behaviors (DWCB) have been linked to overweight and weight gain in multiple ways, but little is known about DWCB in youth of color, especially boys. We examined the distribution and determinants of ethnic and gender disparities in DWCB in early adolescents. Methods-In fall 2005, 47 Massachusetts middle schools participating in the Healthy Choices overweight prevention study administered a self-report baseline survey assessing student sociodemographics, height, weight, and DWCB (vomiting or use of laxatives or diet pills in the past month to control weight). Data from 16,978 girls and boys were used in multivariate logistic regression models to estimate the odds of DWCB in youth of color compared to their white peers, controlling for individual-and school-level factors. Results-Among white youth, 2.7% of girls and 2.3% of boys reported DWCB. The odds of DWCB were elevated 2-10 times in most ethnic group relative to whites. Disparities were attenuated but persisted after controlling for multiple individual-and school-level factors. Conclusions-Ethnic disparities in DWCB must be considered in efforts to address the epidemic of childhood overweight.
Medico research chronicles, 2017
Eating Disorders, Feb 19, 2013
We investigated the contribution of school environmental factors to individual and school variati... more We investigated the contribution of school environmental factors to individual and school variation in disordered weight control behaviors (DWCB). Analyses were based on self-report data gathered from 18,567 middle-school students in 2005 and publicly available data on school characteristics. We observed large differences across schools in percent of students engaging in DWCB in the past month, ranging from less than 1% of the student body to 12%. School-neighborhood poverty was associated with higher odds of DWCB in boys. Preventive strategies need to account for wide variability across schools and environmental factors that may contribute to DWCB in early adolescence.
Academic Pediatrics, Jul 1, 2013
OBJECTIVE: Family practices around weight-related behaviors can shape children's development of d... more OBJECTIVE: Family practices around weight-related behaviors can shape children's development of disordered weight control behaviors (DWCB), such as vomiting, taking laxatives, or taking diet pills without a prescription. This study examined family meal and physical activity (PA) practices associated with DWCB among a multiethnic sample of youth. METHODS: We assessed self-report data on frequency of family sit-down dinners, types of parental involvement in their children's PA, and DWCB are from 15,461 6th to 8th grade girls and boys in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005).
Preventing Chronic Disease, Nov 29, 2012
MEDSCAPE CME Medscape, LLC is pleased to provide online continuing medical education (CME) for th... more MEDSCAPE CME Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Preventing Chronic Disease. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journalbased CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd ; (4) view/print certificate.
American Journal of Public Health, Mar 1, 2009
Obesity, a major health concern in the United States, 1 results in an estimated 240 000 premature... more Obesity, a major health concern in the United States, 1 results in an estimated 240 000 premature deaths 2-4 and medical costs of over $90 billion 5,6 annually. An objective of Healthy People 2010 is to reduce the prevalence of adult obesity (body mass index [BMI] ‡ 30 kg/m 2) to less than 15% nationwide. 7 Numerous studies 8-10 confirm that rates of obesity are rapidly rising in almost all sociodemographic groups. Recent national data 11, 12 suggest that obesity has reached an historical high, affecting 32% of the adult population. 11 Obesity control is a complex process that requires approaches at all levels-federal, state, and community, as well as organizational, interpersonal, and individual. 13, 14 Control programs that address the specific needs of communities are likely to be more effective than are nonspecific programs planned at higher geopolitical levels such as county or state. 15, 16 Similar to the rest of the nation, Massachusetts encounters shortages of resources for obesity control. For effective use of limited resources, estimates of community-specific prevalence are needed to identify communities with the greatest needs. In addition, city and town public officials and community-based organizations increasingly ask the Massachusetts Department of Public Health for obesity prevalence data that are timely and community specific. In Massachusetts, the Behavioral Risk Factor Surveillance System (BRFSS) 17 is the only source of population-based data on the prevalence of obesity among residents 18 years or older. However, the current BRFSS does not provide prevalence data at the community level because most communities do not have adequate sample sizes for directly calculating prevalence with reasonable precision. Small-area estimation models can be adapted to overcome this limitation and provide community-level prevalence estimates. Using the BRFSS data and small-area estimation models, we estimated and analyzed geographic variations and temporal trends in obesity prevalence in 398 communities (including 339 towns and small cities and 59 subdivisions of the 12 largest cities) in Massachusetts. To assist in the planning of statewide obesity control efforts, we developed a method for classifying communities into priority groups based on adult obesity prevalence estimates and the precision of these estimates. METHODS Small-area estimation models generate community-specific prevalence estimates by making use of (1) the associations of obesity with individual-and community-level characteristics, (2) data from multiple years and across geographic regions, and (3) community demographic characteristics. Our models used the following data for the years 1999 to 2005: (1) individual-level data on body weight, body height, and sociodemographic characteristics for adults residing in the communities under study, (2) community characteristics associated with obesity at least in part independently of individual-level characteristics (such as community-level per capita income), and (3) community composition by age, gender, race/ethnicity, marital status, education, and income. Community-level variables were categorized in the same way as their individual-level counterparts. Individual-Level Data Individual-level data were obtained from the Massachusetts BRFSS collected from 1999 through 2005. The BRFSS collects uniform data on preventive health practices and risk behaviors associated with chronic diseases, injuries, and infectious diseases in the adult population. Data are collected annually from a sample of community-dwelling adults 18 years or older through a random-digit-dialing telephone survey. For the period of this study (1999-2005), response rates calculated by the CASRO method 18 ranged from 33% (in 2000) Objectives. We developed a method to evaluate geographic and temporal variations in community-level obesity prevalence and used that method to identify communities in Massachusetts that should be considered high priority communities for obesity control. Methods. We developed small-area estimation models to estimate community-level obesity prevalence among community-living adults 18 years or older. Individual-level data from the Behavioral Risk Factors Surveillance System from 1999 to 2005 were integrated with community-level data from the 2000 US Census. Small-area estimation models assessed the associations of obesity (body mass index ‡ 30 kg/m 2) with individual-and community-level characteristics. A classification system based on level and precision of obesity prevalence estimates was then used to identify high-priority communities. Results. Estimates of the prevalence of community-level obesity ranged from 9% to 38% in 2005 and increased in all communities from 1999 to 2005. Fewer than 7% of communities met the Healthy People 2010 objective of prevalence rates below 15%. The highest prevalence rates occurred in communities characterized by lower income, less education, and more blue-collar workers. Conclusions. Similar to the rest of the nation, Massachusetts faces a great challenge in reaching the national obesity control objective. Targeting highpriority communities identified by small-area estimation may maximize use of limited resources.
Journal of Adolescent Health, Feb 1, 2012
To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of... more To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of middle schools participating in the Healthy Choices (HC) study and the crime rate in the neighborhood surrounding these schools were associated with individual studentreported physical activity (PA) levels. Also of interest was whether or not crime rate modified the effect of recreational areas on PA. Methods: This analysis used baseline data from the HC study; a study of more than 20,000 6th-8th grade students within 47 Massachusetts (MA) middle schools. Data on parks and recreation areas in MA were obtained through the MassGIS website. Recreation areas of interest included open recreational space, trails, and bike trails. The participating schools were geocoded and mapped along with the MA parks and recreation areas in ArcMap. The primary predictors were the counts of the number of parks and recreation areas in 400m, 800m, and 1500m radii around each of the schools, obtained using ArcGIS, and crime rates in the corresponding census tract areas. The two outcomes were overall and vigorous individual-level PA. To assess overall PA, students reported how many days in the previous 7 they were active for 60ϩ minutes. For vigorous PA, students reported how many days within the last 7 they engaged in exercise that made them sweat or breathe hard for 20ϩ minutes, which provided information on the intensity level of the exercise. Overall PA was dichotomized based on meeting the HC goal (5ϩ days vs. less). Vigorous PA was also dichotomized (3ϩ days vs. less). Using generalized estimating equations, we examined the association of counts of recreational areas in a 400m, 800m, and 1500m radius around the school and crime rates around the school with students' overall and vigorous PA. We also examined whether or not the relationship between recreational space and PA was modified by crime. Models were adjusted for individual race/ethnicity and gender, while simultaneously accounting for the clustering of observations within schools. Results: The number of parks and recreation areas in a 400m, 800m, and 1500m radius was not associated with overall PA (all pϾ0.05) or vigorous PA (all pϾ0.05). Violent crimes/100k was negatively associated with vigorous PA (bϭ-0.0006 pϭ0.0139, bϭ-0.0006 pϭ0.0141, bϭ-0.0006 pϭ0.0156, respectively) but not overall PA (all pϾ0.05). Individual race/ethnicity and gender were the only significant predictors of overall PA in all models (all pϽ0.03) and were also significant predictors of vigorous PA (all pϽ0.01). In areas with higher crime rates, middle school students reported less vigorous PA compared to their peers in areas with lower crime rates. Violent crimes did not modify the effect of parks and recreation resources on individual PA (overall and vigorous). Conclusions: Violent crimes/100k had a strong inverse association with vigorous PA, but not overall PA. The presence of parks and
PLOS ONE, Aug 21, 2015
Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based ... more Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting. Objective Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity. Methods We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components.
Journal of Nutrition Education and Behavior, Nov 1, 2014
Objective: To explore barriers and facilitators to implementing and sustaining Healthy Choices, a... more Objective: To explore barriers and facilitators to implementing and sustaining Healthy Choices, a three-year multi-component obesity prevention intervention implemented in middle schools in Massachusetts. Methods: Using purposive sampling, 56 in-depth interviews were conducted with middleschool employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses. Results: State-mandated testing, budget limitations, and time constraints were viewed as implementation barriers while staff buy-in and technical assistance were seen as facilitating implementation. Respondents felt that intervention sustainability was dependent on external funding and expert assistance. Conclusions and Implications: Results confirm the importance of gaining faculty and staff support. Schools implementing large scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.
<p>Baseline Socio-demographic Characteristics of Schools Participating in Massachusetts Hea... more <p>Baseline Socio-demographic Characteristics of Schools Participating in Massachusetts Healthy Choices (n = 45).</p
<p><sup>a</sup> Percent of students in school achieving behavior, averaged acro... more <p><sup>a</sup> Percent of students in school achieving behavior, averaged across schools</p><p><sup>b</sup> Student’s paired t-test of significant difference from baseline to follow-up, adjusted for school % free and reduced price school lunch, % white, % female and mean age</p><p><sup>c</sup> Including 100% fruit juice; fruits and vegetables</p><p><sup>d</sup> n = 35 schools, 7th grade students only; overweight = BMI ≥ 85th percentile and < 95th percentile; obese = BMI ≥ 95th percentile of NCHS/CDC 2000 growth reference</p><p>Percent across Schools Achieving Behavioral Goals<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134470#t002fn001" target="_blank"><sup>a</sup></a> and Percent Overweight and Obese at Baseline and 3-Year Follow-up<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134470#t002fn002" target="_blank"><sup>b</sup></a>.</p
<p>Distribution of Intervention Components implemented in Year 2 in Massachusetts Middle Sc... more <p>Distribution of Intervention Components implemented in Year 2 in Massachusetts Middle Schools Participating in the Healthy Choices Program (N = 35).</p
<p>Change in school-level percent overweight and obese and percent obese from baseline to f... more <p>Change in school-level percent overweight and obese and percent obese from baseline to follow-up, Massachusetts Healthy Choices (n = 35).</p
BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control be... more BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth. METHODS: Self-reported data on dietary weight management behaviors, strengthening/toning exercises, moderate-to-vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools. RESULTS: Disordered weight control behaviors were reported by 3.6 % of girls and 3.1 % of boys. Youth who engaged...
PLOS ONE, 2015
Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based ... more Introduction Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting. Objective Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity. Methods We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components.
Journal of School Health, 2012
BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control be... more BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth.METHODS: Self‐reported data on dietary weight management behaviors, strengthening/toning exercises, moderate‐to‐vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools.RESULTS: Disordered weight control behaviors were reported by 3.6% of girls and 3.1% of boys. Youth who engaged in ...
Journal of Adolescent Health, 2011
Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordere... more Objectives-Ethnic disparities in childhood overweight are well-documented. In addition, disordered weight control behaviors (DWCB) have been linked to overweight and weight gain in multiple ways, but little is known about DWCB in youth of color, especially boys. We examined the distribution and determinants of ethnic and gender disparities in DWCB in early adolescents. Methods-In fall 2005, 47 Massachusetts middle schools participating in the Healthy Choices overweight prevention study administered a self-report baseline survey assessing student sociodemographics, height, weight, and DWCB (vomiting or use of laxatives or diet pills in the past month to control weight). Data from 16,978 girls and boys were used in multivariate logistic regression models to estimate the odds of DWCB in youth of color compared to their white peers, controlling for individual-and school-level factors. Results-Among white youth, 2.7% of girls and 2.3% of boys reported DWCB. The odds of DWCB were elevated 2-10 times in most ethnic group relative to whites. Disparities were attenuated but persisted after controlling for multiple individual-and school-level factors. Conclusions-Ethnic disparities in DWCB must be considered in efforts to address the epidemic of childhood overweight.
Journal of Adolescent Health, 2012
To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of... more To determine if the number of parks and recreation areas within 400, 800, and 1500 meter radii of middle schools participating in the Healthy Choices (HC) study and the crime rate in the neighborhood surrounding these schools were associated with individual studentreported physical activity (PA) levels. Also of interest was whether or not crime rate modified the effect of recreational areas on PA. Methods: This analysis used baseline data from the HC study; a study of more than 20,000 6th-8th grade students within 47 Massachusetts (MA) middle schools. Data on parks and recreation areas in MA were obtained through the MassGIS website. Recreation areas of interest included open recreational space, trails, and bike trails. The participating schools were geocoded and mapped along with the MA parks and recreation areas in ArcMap. The primary predictors were the counts of the number of parks and recreation areas in 400m, 800m, and 1500m radii around each of the schools, obtained using ArcGIS, and crime rates in the corresponding census tract areas. The two outcomes were overall and vigorous individual-level PA. To assess overall PA, students reported how many days in the previous 7 they were active for 60ϩ minutes. For vigorous PA, students reported how many days within the last 7 they engaged in exercise that made them sweat or breathe hard for 20ϩ minutes, which provided information on the intensity level of the exercise. Overall PA was dichotomized based on meeting the HC goal (5ϩ days vs. less). Vigorous PA was also dichotomized (3ϩ days vs. less). Using generalized estimating equations, we examined the association of counts of recreational areas in a 400m, 800m, and 1500m radius around the school and crime rates around the school with students' overall and vigorous PA. We also examined whether or not the relationship between recreational space and PA was modified by crime. Models were adjusted for individual race/ethnicity and gender, while simultaneously accounting for the clustering of observations within schools. Results: The number of parks and recreation areas in a 400m, 800m, and 1500m radius was not associated with overall PA (all pϾ0.05) or vigorous PA (all pϾ0.05). Violent crimes/100k was negatively associated with vigorous PA (bϭ-0.0006 pϭ0.0139, bϭ-0.0006 pϭ0.0141, bϭ-0.0006 pϭ0.0156, respectively) but not overall PA (all pϾ0.05). Individual race/ethnicity and gender were the only significant predictors of overall PA in all models (all pϽ0.03) and were also significant predictors of vigorous PA (all pϽ0.01). In areas with higher crime rates, middle school students reported less vigorous PA compared to their peers in areas with lower crime rates. Violent crimes did not modify the effect of parks and recreation resources on individual PA (overall and vigorous). Conclusions: Violent crimes/100k had a strong inverse association with vigorous PA, but not overall PA. The presence of parks and
Eating Disorders, 2013
We investigated the contribution of school environmental factors to individual and school variati... more We investigated the contribution of school environmental factors to individual and school variation in disordered weight control behaviors (DWCB). Analyses were based on self-report data gathered from 18,567 middle-school students in 2005 and publicly available data on school characteristics. We observed large differences across schools in percent of students engaging in DWCB in the past month, ranging from less than 1% of the student body to 12%. School-neighborhood poverty was associated with higher odds of DWCB in boys. Preventive strategies need to account for wide variability across schools and environmental factors that may contribute to DWCB in early adolescence.