Generation Health Study Research Articles

Marijuana-, alcohol-, and drug-impaired driving among emerging adults: Changes from high school to one-year post-high school

IntroductionDriving while impaired (DWI) increases the risk of a motor vehicle crash by impairing performance. Few studies have examined the prevalence and predictors of marijuana, alcohol, and drug-specific DWI among emerging adults. MethodsThe data from wave 3 (W3, high school seniors, 2012, N=2407) and wave 4 (W4, one year after high school, N=2178) of the NEXT Generation Health Study with a nationally representative cohort. W4 DWI (≥1day of past 30days) was specified for alcohol-specific, marijuana-specific, alcohol/marijuana-combined, illicit drug-related DWI. Multinomial logistic regression models estimated the association of W4 DWI with W3 covariates (perceived peer/parent influence, drinking/binge drinking, marijuana/illicit drug use), and W4 environmental status variables (work/school/residence) adjusting for W3 overall DWI, demographic, and complex survey variables. ResultsOverall DWI prevalence from W3 to W4 changed slightly (14% to 15%). W4 DWI consisted of 4.34% drinking-specific, 5.02% marijuana-specific, 2.41% drinking/marijuana combined, and 3.37% illicit drug-related DWI. W3 DWI was significantly associated with W4 alcohol-related and alcohol/marijuana-combined DWI, but not other DWI. W3 marijuana use, binge drinking, and illicit drug use were positively associated with W4 marijuana-specific, alcohol/marijuana-combined, and illicit drug-related DWI, respectively. W3 friend drunkenness and marijuana use were positively associated with W4 alcohol-specific and marijuana-related DWI, respectively. W3 peer marijuana use was negatively associated with W4 alcohol-specific DWI. ConclusionsDriving under the influence of alcohol, marijuana, and illicit drugs is a persistent, threatening public health concern among emerging U.S. adults. High school seniors' binge drinking as well as regular alcohol drinking and marijuana/illicit drug use were independently associated with respective DWI one year after high school. Peer drunkenness and marijuana use in high school may be related to subsequent DWI of emerging adults. Practical applicationsThe results support the use of injunctive peer norms about getting drunk and smoking marijuana in guiding the development of prevention programs to reduce youth DWI.

Assessment of adolescent weight status: Similarities and differences between CDC, IOTF, and WHO references

ObjectiveThe research sought to determine the reliability of assessing adolescents' weight status based on three standard criteria, Centers for Disease Control and Prevention (CDC) growth charts, International Obesity Task Force (IOTF) standards, and the World Health Organization (WHO) growth references. MethodsData from the NEXT Generation Health Study US 10th grade cohort (n=2323, mean age=16.19years) starting in 2009 were used. Kappa statistics assessed agreement of assignment to weight categories. Associations of weight status with perceived body image, weight control intention, and general health were examined using linear regressions accounting for complex survey design. ResultsKappas across weight status criteria were≥.89 and agreement exceeded 90% in all analyses. For all three criteria, overweight and obese participants, compared to normal weight, were significantly more likely to indicate fatter body image, higher weight control intention, and poorer general health; small differences in the regression coefficients by classification method were observed. ConclusionThe three criteria of weight status classifications substantially agreed. Associations of weight status with selected health correlates were similar regardless of the methods. Thus, the three classifications can be considered comparable for most research and practice purposes.

Transitions in Riding With an Alcohol/Drug-Impaired Driver From Adolescence to Emerging Adulthood in the United States.

The purpose of this study was to examine changes and predictors of changes in riding with an alcohol/drug-impaired driver (RWI) from 10th grade through the first post-high school year. Transition models were used to estimate the association of four waves (W1-W4) of RWI with W4 environmental-status variables and time-varying covariates in the NEXT Generation Health Study, a nationally representative cohort of U.S. 10th graders (N = 2,785). Overall, 33% (weighted) of adolescents reported RWI in the past 12 months in W1, and slightly declined in W2 (24%), W3 (27%), and W4 (26%). Across time, transition models with generalized estimating equations showed that RWI was more likely among those who previously reported RWI (ORs from 3.62 to 3.66, p < .001), substance use (ORs from 1.81 to 1.82, p < .001), and heavy episodic drinking (ORs from 1.85 to 1.86, p < .001). Those living on college campuses were somewhat more likely to engage in RWI (OR = 1.38, .05 < p <.10) than those living at home. The effects of parental monitoring knowledge and peer alcohol/substance use on RWI were suppressed when individual substance use and heavy episodic drinking were taken into consideration. Substance use and heavy episodic drinking in previous waves and the history of RWI were persistent factors of RWI in a dynamic pattern. The setting in which emerging adults live during their first post-high school year could affect their engagement in RWI. The findings suggest that harm-reduction strategies should focus on the identification of early RWI coupled with reduction of substance use and heavy episodic drinking.

The Effect of Residence, School Status, Work Status, and Social Influence on the Prevalence of Alcohol Use Among Emerging Adults.

The first year after high school is a transitional year, with increased independence from parental supervision, contact with other independent youth, and exposure to new environments, all of which may influence substance use. This article reports longitudinal predictors of change in the prevalence of alcohol use and heavy episodic drinking among adolescents and environmental correlates (i.e., residence, college attendance, and work status) with drinking the year after high school. A national sample of study participants (N = 2,659; 55% female) in the NEXT Generation Health Study were followed annually from 10th grade (Wave 1) to the year after high school (Wave 4). Longitudinal binary outcomes, including recent (30-day) drinking and two measures of heavy episodic drinking, were examined. Transition models with generalized estimating equations estimated the effect of previous drinking behaviors, social influences, and current residential status and activity (school and/or work) on drinking prevalence. Drinking increased from 40.5% among high school seniors (Wave 3) to 53.5% in Wave 4 for 30-day use, and from 29.0% to 41.2% for heavy episodic drinking. Significant predictors of 30-day drinking included previous drinking status (odds ratio [OR] = 5.48), peer drinking often (OR = 3.25), parental expectations (OR = 0.91), and current year living on campus (OR = 2.10). The same significant predictors with similar magnitudes were found for both measures of heavy episodic drinking. Peer use did not interact with college attendance or residence. Predictors of drinking and heavy episodic drinking during the first year after high school included being White, living on campus, previous drinking, lower parental expectations, and having peers who drink.

Abstract 10464: Are Adolescents Meeting the 2020 Goals of the American Heart Association for Ideal Cardiovascular Health?

Introduction: There are limited data on whether adolescents meet the 7 metrics of the American Heart Association’s ideal cardiovascular health (ICVH), and relations between ICVH and demographic characteristics. The behavioral metrics (ICVH-B) are: never tried/never smoked; normal BMI (≤85th percentile); physical activity (PA) ≥ 60 min daily; and consuming a healthy diet (4-5 components).The ICVH physiological metrics are: blood pressure (BP) &lt;90th percentile; total blood cholesterol (TBC) &lt;170 mg/dl; and fasting blood glucose (FBG) &lt;100 mg/dl. Methods: We assessed the four ICVH-B in the NEXT Generation Health Study (NEXT), a nationally represented cohort of U.S. 10 th graders (N= 2,734, 16.24±0.53 years). NEXT participants were categorized as ideal (met 4 metrics), intermediate (met 2-3), or poor (met 0-1). All 7 metrics were assessed in NEXT Plus, an intensively measured sub-sample of NEXT (n=278 overweight, n=282 normal weight). NEXT Plus participants’ ICVH was categorized into ideal (≥5 metrics), intermediate (2-4 metrics) or poor (0-1 metrics). Results: Of the NEXT adolescents, 0.4% met ICVH-B criteria for ideal, 26% for intermediate, and 72% for poor health. Nonsmoking was the most (85%) and healthy diet the least (23%) prevalent metric. ICVH-B prevalence estimates did not differ significantly by race/ethnicity or family affluence. Of the NEXT Plus students, 0.2% met all 7 ICVH metrics; 28% were categorized as ideal, 71% as intermediate and 1% as poor. Regarding the behavioral metrics, 51% were of normal weight by design, 85% were nonsmokers, 26% met PA criteria, and 39% reported a healthy diet; most met the physiological metrics, 96% for BP, 76% for TBC, and 53% for FBG. Conclusion: Few U.S. adolescents met the ideal cardiovascular health metric. Notably, the two metrics least likely to be met were behavioral, and herefore potentially modifiable through intervention at the individual, family,environment and policy levels.

Trajectories of eating behaviors in a nationally representative cohort of U.S. adolescents during the transition to young adulthood.

BackgroundDiets of U.S. adolescents and adults do not meet recommendations, increasing risk of chronic disease. This study examined trajectories and predictors of eating behaviors in U.S. youth from age 16–20 years, and evaluated longitudinal associations of eating behaviors with weight outcomes.MethodsData come from the first four waves (years) of the NEXT Generation Health Study, a nationally representative cohort of U.S. students in 10th grade during the 2009–2010 school year (n = 2785). Annual surveys queried frequency of food group intake (times/day of fruit and vegetables, whole grains, sugar-sweetened soda, sweet and salty snacks), and meal practices (days/week of breakfast, family meals, fast food, and television during meals). Body mass index (BMI, kg/m2) was calculated from self-reported height and weight. Adjusted generalized estimating equations and linear mixed models with multiple imputation for missing data estimated eating behavior trajectories overall and by baseline weight status (normal weight = 5 ≤ BMI%ile < 85, overweight = 85 ≤ BMI%ile < 95, obese = BMI%ile ≥ 95), accounting for the complex sampling design. Separate GEE models estimated longitudinal associations of food group frequencies with meal practices and of BMI with eating behaviors.ResultsEating behaviors tracked strongly from wave 1–4 (residual intraclass correlation = 41 % - 51 %). Across all baseline weight categories, frequency of food group intake and meal practices decreased over time, except for fast food, which remained stable. Fruit/vegetable intake frequency was associated positively with family meals (β ± SE = 0.33 ± 0.05) and breakfast (0.18 ± 0.03), and inversely with fast food (−0.31 ± 0.04), while whole grain intake frequency was associated positively with family meals (0.07 ± 0.02), television meals (0.02 ± 0.009) and breakfast (0.04 ± 0.01). Soda and snacks were positively associated with television meals (0.08 ± 0.008 and 0.07 ± 0.009, respectively) and fast food (0.24 ± 0.02 and 0.20 ± 0.03, respectively), while soda was inversely associated with breakfast frequency (−0.05 ± 0.01). Time-varying BMI was unrelated to eating behaviors other than an inverse association with time-varying snacks (−0.33 ± 0.12).ConclusionsStrong tracking over time supports the importance of early establishment of health-promoting eating behaviors in U.S. adolescents. Findings suggest meal practices may be important intervention targets. Lack of evidence for hypothesized associations of BMI and eating behaviors indicates the need for research confirming these findings using more precise measures of dietary intake.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-015-0298-x) contains supplementary material, which is available to authorized users.

Reciprocal Associations Between Parental Monitoring Knowledge and Impaired Driving in Adolescent Novice Drivers

Objective: Adolescent driving while alcohol/drug impaired (DWI) and parental monitoring knowledge may have notable interplay. However, the magnitude and direction of causality are unclear. This study examined possible reciprocal associations among adolescents between DWI and parental monitoring knowledge.Methods: The data were from waves 1, 2, and 3 (W1, W2, and W3) of the NEXT Generation Health Study, with longitudinal assessment of a nationally representative sample of 10th graders starting in 2009–2010 (n = 2,525 at W1) and analyzed in 2014. Those who had obtained an independent/unsupervised driving license were included for the analysis. Autoregressive cross-lagged path analysis was used to examine potential reciprocal associations between DWI and parental monitoring knowledge of both mothers and fathers, controlling for potential confounders.Results: Stability of fathers’ and mothers’ monitoring knowledge across 3 consecutive interview waves was identified. W1 monitoring knowledge of both fathers and mothers was prospectively associated with DWI at W2 but not for W2 with W3. A significant negative association between adolescent DWI at W2 and mothers’ monitoring knowledge at W3 was found but not between W1 and W2. None of the associations between DWI and fathers’ monitoring knowledge from W1 to W2 or from W2 to W3 were significant.Conclusions: Early (10th grade) parental monitoring knowledge may predict lower adolescent self-reported DWI in 11th grade. More notably, adolescent DWI did not seem to increase parental monitoring knowledge. Future interventions are needed to improve parental monitoring knowledge and enhance awareness of the DWI risk in their adolescent novice drivers.

A Functional Data Analysis Approach for Circadian Patterns of Activity of Teenage Girls.

Background: Longitudinal or time-dependent activity data are useful to characterize the circadian activity patterns and to identify physical activity differences among multiple samples. Statistical methods designed to analyze multiple activity sample data are desired, and related software is needed to perform data analysis.Methods: This paper introduces a functional data analysis (fda) approach to perform a functional analysis of variance (fANOVA) for longitudinal circadian activity count data and to investigate the association of covariates such as weight or body mass index (BMI) on physical activity. For multiple age group adolescent school girls, the fANOVA approach is developed to study and to characterize activity patterns. The fANOVA is applied to analyze the physical activity data of three grade adolescent girls (i.e., grades 10, 11, and 12) from the NEXT Generation Health Study 2009–2013. To test if there are activity differences among girls of the three grades, a functional version of the univariate F-statistic is used to analyze the data. To investigate if there is a longitudinal (or time-dependent activity count) difference between two samples, functional t-tests are utilized to test: (1) activity differences between grade pairs; (2) activity differences between low-BMI girls and high-BMI girls of the NEXT study.Results: Statistically significant differences existed among the physical activity patterns for adolescent school girls in different grades. Girls in grade 10 tended to be less active than girls in grades 11 & 12 between 5:30 and 9:30. Significant differences in physical activity were detected between low-BMI and high-BMI groups from 8:00 to 11:30 for grade 10 girls, and low-BMI group girls in grade 10 tended to be more active.Conclusions: The fda approach is useful in characterizing time-dependent patterns of actigraphy data. For two-sample data defined by weight or BMI values, fda can identify differences between the two time-dependent samples of activity data. Similarly, fda can identify differences among multiple physical activity time-dependent datasets. These analyses can be performed readily using the fda R program.

Are Adolescents Meeting the 2020 Goals of the American Heart Association (AHA) for Ideal Cardiovascular Health? (906.1)

BackgroundThe American Heart Association's (AHA) ideal cardiovascular health (ICVH) consists of 7 metrics (4 health behaviors 3 health factors): nonsmoking (NS), BMI (蠄85th percentile), physical activity (PA, 蠅 60 min daily), healthy diet (4‐5 components), blood pressure (BP, &lt;90th percentile), blood cholesterol (TBC, &lt;170 mg/dl) and fasting blood glucose (FBG,&lt;100 mg/dl). We studied the prevalence of the health behaviors among 2,700 adolescents in the NEXT Generation Health Study (NEXT GEN) and the 7 metrics in NEXT PLUS, a random sample of the NEXT GEN.MethodsCardiovascular health behaviors (CVHB) were assessed in NEXT GEN adolescents (16.24±0.53 years) yearly from 2010‐2014 and were categorized into ideal (蠅5 metrics), intermediate (2‐5 metrics) or poor (&lt;2 metrics) based on AHA guidelines. Descriptive statistics were obtained using SPSS 19.0.ResultsOf the NEXT PLUS students (N= 577), only 0.2% met all 7 ICVH metrics. 84.6% were non‐smokers, 26.4% met PA criteria, and 39.2% met fruits and vegetables criteria. Only 28.1 % were categorized as ideal, 70.9% as intermediate and 1% as poor. 95.8% had ideal criteria for BP, 75.8% for TBC, and 52.8% for FBG. BMI was &lt;85th percentile in 51.2%. Of the NEXT GEN adolescents, the prevalence of nonsmoking was stable (81%‐86%), and ideal indicators of BMI, physical activity and healthy diet were low across all four years, 2010‐2014. The proportion of NEXT GEN adolescents meeting all four CVHB was low: 0.4%, 0.4%, 0.4% and 0.5% yearly from 2010‐2014, respectively.ConclusionThe exceedingly low prevalence of ICVH among US adolescents suggests the need for a concerted effort at the individual, family, environment and policy levels to improve CVH among adolescents.

Mixed model and estimating equation approaches for zero inflation in clustered binary response data with application to a dating violence study

The NEXT Generation Health study investigates the dating violence of adolescents using a survey questionnaire. Each student is asked to affirm or deny multiple instances of violence in his/her dating relationship. There is, however, evidence suggesting that students not in a relationship responded to the survey, resulting in excessive zeros in the responses. This paper proposes likelihood-based and estimating equation approaches to analyze the zero-inflated clustered binary response data. We adopt a mixed model method to account for the cluster effect, and the model parameters are estimated using a maximum-likelihood (ML) approach that requires a Gaussian-Hermite quadrature (GHQ) approximation for implementation. Since an incorrect assumption on the random effects distribution may bias the results, we construct generalized estimating equations (GEE) that do not require the correct specification of within-cluster correlation. In a series of simulation studies, we examine the performance of ML and GEE methods in terms of their bias, efficiency and robustness. We illustrate the importance of properly accounting for this zero inflation by reanalyzing the NEXT data where this issue has previously been ignored.

Weight perceptions, misperceptions, and dating violence victimization among U.S. adolescents.

Dating violence is a major public health issue among youth. Overweight/obese adolescents experience peer victimization and discrimination and may be at increased risk of dating violence victimization. Furthermore, given the stigma associated with overweight/obesity, perceptions and misperceptions of overweight may be more important than actual weight status for dating violence victimization. This study examines the association of three weight indices (weight status, perceived weight, and weight perception accuracy) with psychological and physical dating violence victimization. The 2010 baseline survey of the 7-year NEXT Generation Health Study used a three-stage stratified clustered sampling design to select a nationally representative sample of U.S. 10th-grade students (n = 1,983). Participants who have had a boyfriend/girlfriend reported dating violence victimization and perceived weight. Weight status was computed from measured height/weight. Weight perception accuracy (accurate/underestimate/overestimate) was calculated by comparing weight status and perceived weight. Gender-stratified regressions examined the association of weight indices and dating violence victimization. Racial/ethnic differences were also examined. The association of weight indices with dating violence victimization significantly differed by gender. Overall, among boys, no associations were observed. Among girls, weight status was not associated with dating violence victimization, nor with number of dating violence victimization acts; however, perceived weight and weight perception accuracy were significantly associated with dating violence victimization, type of victimization, and number of victimization acts. Post hoc analyses revealed significant racial/ethnic differences. White girls who perceive themselves (accurately or not) to be overweight, and Hispanic girls who are overweight, may be at increased risk of dating violence victimization. These findings suggest a targeted approach to dating violence victimization prevention.

Motivation and planning as mediators of the relation between social support and physical activity among U.S. adolescents: a nationally representative study

BackgroundMore than half of U.S. high-school students do not meet the moderate and vigorous physical activity (MVPA) 5 hours per week recommendation. The purpose of this study was to determine how individual dimensions (motivation and planning) mediate the relationship of social context with physical activity by integrating available measures of personal characteristic including internal/external motivations (derived from Self-Determination Theory -SDT]) for MVPA, MVPA planning, peer MVPA, and parental support to better understand adolescent MVPA.MethodsSurvey responses of a nationally representative cohort of 11th graders (N = 2439) in the NEXT Generation Health Study were analyzed with structural equation modeling.ResultsAdolescent MVPA was directly, significantly associated with MVPA planning (β = 0.17), peer MVPA (β = 0.21), and internal motivation (β = 0.50). Internal motivation was associated with peer MVPA (β = 0.31), parental support for MVPA (β = 0.16), and external motivation (β = 0.40). A significant relation between parental support and external motivation (β = 0.31) was also found.ConclusionsAdolescents with higher internal motivation and more active friends were more likely to engage in MVPA. The results are consistent with SDT and suggest that planning is an important construct for adolescent MVPA.

Associations among body mass index, waist circumference, dietary factors and cardiometabolic risks in 10th grade students: The NEXT Generation Health Study

ObjectiveTo identify associations among body mass index (BMI), waist circumference (WC), dietary factors and cardiometabolic indicators in US adolescents.ApproachA random sample of overweight (N=282) and normal‐weight (N=278) 10th‐grade students at baseline of the NEXT Generation Health Study.ResultsLow density lipoprotein cholesterol (LDL‐C), high density lipoprotein cholesterol (HDL‐C), triglycerides (TG), total cholesterol (TC), diastolic blood pressure (DBP), mean arterial pressure (MAP), WC, hemoglobin A1C, C‐reactive protein (CRP), uric acid and serum fructose were significantly higher in overweight 10th graders than in normal weight. Overweight youth had 2.4 unit higher DBP than normal weight. Controlling for covariates, BMI percentile was significantly associated with WC (B=0.03, p&lt;.001), DBP (= 0.06, p&lt;.01), MAP (B=0.06, p&lt;.001), TC(B = 0.01, p&lt;.01), LDL‐C (B = 0.01, p&lt;.01), HDL‐C (B=− 0.002, p&lt;.001), CRP (B=0.02, p&lt;.01), and uric acid (B=0.01, p&lt;.01). Tenth graders with WC ≥90th percentile had significantly higher metabolic indicators. SBP was associated with intake of added sugar (B=0.09, p&lt;.03) but not with sodium or solid fats.ConclusionThese findings underscore the role of obesity in increasing cardiovascular disease (CVD) risk factors and a need for interventions that target high school students to prevent further CVD risks.Grant Funding Source: This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Developmentand the National Heart, Lung, and Blood Institute (Contract #HHSN2672008000009c).

Prevalence and patterns of polysubstance use in a nationally representative sample of 10th graders in the United States.

The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students. A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524). Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms. The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.

13. Genetic taste perception and food preferences

Food reward sensitivity may influence susceptibility to overeating in a permissive food environment, contributing to unintended weight gain and intentional weight loss behavior. This study examined associations of food reward sensitivity, assessed by the Power of Food Scale (PFS), with weight outcomes and dieting in a nationally representative cohort of U.S. emerging adults. Wave 5 (W5, 5th year of follow-up) respondents from the NEXT Generation Health Study were included (N = 2202, W5 age = 20.3 ± 0.02 years). Baseline and W5 BMI, W5 weight status (normal weight = 18.5 ≤ BMI < 25, overweight = 25 ≤ BMI < 30, obese = BMI ≥ 30), BMI change (W5-baseline BMI) and onset of overweight or obesity (OWOB) were calculated from self-reported height and weight. PFS (aggregate and 3 domain scores: food available, present, and tasted) and dieting for weight-loss were assessed at W5. Adjusted linear regressions estimated associations of PFS with W5 BMI and BMI change. Log-binomial regressions estimated associations of high W5 BMI (≥25), OWOB onset and dieting with PFS. Post hoc analyses estimated associations of PFS with W5 perceived weight status (overweight vs. about right or underweight). W5 BMI = 25.73 ± 0.32 kg/m2, and OWOB onset occurred in 27.7% of participants. The PFS-food available score was associated with BMI change, β ± SE = 0.41 ± 0.19. Other PFS scores were not associated with weight outcomes. Dieting prevalence was higher in participants with high versus low W5 BMI (61% versus 32%), and was positively associated with all PFS scores except the PFS-food tasted score, e.g., relative risk (RR) of dieting for PFS-aggregate = 1.13, 95%CI [1.01–1.26]. Post-hoc analyses indicated perceived overweight was positively associated with PFS-food available, 1.12, [1.01–1.24], and PFS-food present, 1.13, [1.03–1.24]. PFS was positively related to dieting and perceived overweight, but not concurrent or change in weight status in a representative cohort of U.S. emerging adults.