United States Adolescents Research Articles

Attitudes toward Nutrition and Dietary Habits and Effectiveness of Nutrition Education in Active Adolescents in a Private School Setting: A Pilot Study.

This study was designed to pilot a survey to investigate nutrition knowledge, attitudes, and beliefs toward nutrition, exercise, and dietary habits of active adolescents. Participants included 117 middle school and 40 high school students. General and sport nutrition knowledge, dietary habits, and attitudes toward nutrition education were collected via three electronic surveys. Among middle schoolers, 79.5% of students stated feeling they could benefit from advice about nutrition compared to 92.5% of high school students. The topic scoring the highest in both populations was hydration; the lowest scoring topic category was protein and exercise. Knowledge about healthy eating reportedly comes from parents and coaches most frequently for both high school and middle school students. Less than 40% of students stated their diet meets their nutritional needs. Both middle school and high school students stated a desire to learn more about nutrition, but most nutrition information currently received comes from non-nutrition-related professionals. There is a need for validation of a nutrition knowledge and behavior instrument for United States adolescents, and room for improvement in general and sport nutrition knowledge in active adolescents in all topic areas.

US adolescents at risk for not meeting physical activity recommendations by season

BACKGROUNDWe sought to identify regional and seasonal variation in not meeting physical activity (PA) recommendations of ≥ 60 minutes a day of moderate-to-vigorous physical activity (MVPA) and 3 hours of vigorous physical activity per week (VPA) in a longitudinal cohort of U.S. adolescents.METHODSParticipants in the Growing Up Today Study 2, a prospective study of 10,918 adolescents, self-reported season-specific weekly hours of MVPA and VPA from 2004 through 2011. To assess variation in PA by climate, we grouped the contiguous U.S. into nine climatically consistent geographic regions. We also examined MVPA and VPA by season, sex, ethnicity, weight status, and age group.RESULTSThe majority (85%) of adolescents did not meet the MVPA recommendation, and 91% did not meet the VPA recommendation, for one or more seasons over the four study years. Across all climate regions, adolescents were two times more likely to not meet the MVPA recommendation during the winter compared to summer (OR 2.02, 95% CI 1.96-2.08).CONCLUSIONRegardless of climate region, gender, ethnicity, or age group, adolescents were more likely not to meet MVPA or VPA recommendations in the winter than the summer. Adolescents may benefit from interventions aimed at increasing PA in the winter.

The influence of taekwondo training on school-life adaptation and exercise value in the United States.

Previous experience has shown that school-based taekwondo training in the United States (US) results in many beneficial effect sregarding school education and the physical health of the adolescent participants; of especial significance, the training plays an important role in terms of exercise value and school-life adaptation. To explore this overall effect, a self-administered questionnaire was distributed to 401 adolescents over the age of 10 years. The survey comprisesa total of 29 questions that consist of 17 exercise-value-related questions (general, moral, and status) and 12 questions that are related to school-life adaptation (adaptation to teachers, adaptation to academic activities, adaptation to rule compliance, and adaptation to school activities). The survey results show that taekwondo training affects school-life adaptation by helping to improve student morality and by bolstering the students compliance with school rules during their schooling. The exercise value of taekwondo training is considered a necessity for US adolescents due to the corresponding educational aspects; in particular, the training plays a very important role in the maintenance of amenable student-teacher and student-peer relationships. From the previously mentioned findings, and if taekwondo teachers train their students carefully with educational missions in mind, it is expected that taekwondo training will play a very important role in the cultivation of anappropriate education value among US adolescents.

Trends and correlates of unhealthy dieting behaviours among adolescents in the United States, 1999\u20132013

BackgroundThe increase in adiposity problems among United States adolescents has been accompanied by persistently high prevalence of unhealthy dieting behaviours (UDBs) such as fasting, taking diet pills/powders/liquids, and vomiting/taking laxatives. This study aimed to examine the associations of self-perceptions of weight status, weight change intentions (WCIs) and UDBs with sex, age and race, as well as trends of UDBs in American adolescents across the weight spectrum.MethodsData come from the biennial cross-sectional, school-based surveys, the Youth Risk Behaviour Surveillance System (1999–2013, n = 113,542). The outcome measures were the self-reported UDBs: fasting for 24 h or more; taking diet pills/powders/liquids; and vomiting/taking laxatives. Sex-stratified logistic regressions assessed relationships between weight status misperceptions across all weight statuses, race and WCIs with UDBs. Differential trends between races were assessed using race*year interaction terms.ResultsIn males, all non-White races had higher odds of fasting and vomiting/taking laxatives than Whites (except fasting in Hispanic/Latinos), with Adjusted Odds Ratios (AORs) between 1.44 and 2.07. In females, Black/African Americans and Hispanic/Latinos had lower odds of taking diet pills/powders/liquids compared to Whites (AORs 0.50 and 0.78 respectively). Racial disparities persisted throughout the study period. Prevalence of fasting and vomiting/taking laxatives did not change between 1999 and 2013 for all races, while taking diet pills/powders/liquids decreased. Compared to individuals of normal weight who were accurate weight status perceivers, individuals of almost all other combinations of weight status and weight status perception had significantly higher odds of displaying any UDB outcome. Overestimation of weight status was found to be the strongest determinant of UDBs. Compared to individuals endorsing "not wanting to do anything" about their weight, individuals endorsing all other WCIs (including wanting to gain weight) also showed significantly higher odds for every UDB outcome, with wanting to lose weight having AORs of the greatest magnitudes.ConclusionsPrevalence of UDBs is persistently high, and highest among females across all racial groups. UDBs may elevate undesired weight gain and weight loss in individuals who are obese/overweight and underweight respectively. Further research into weight status perceptions among adolescents may inform efforts to reduce UDBs.

Daily Digital Technology Use Linked to Mental Health Symptoms for High-risk Adolescents

Abstract United States adolescents spend an unprecedented amount of time using digital technology to access the Internet and engage with social media. There is concerned that this continuous connectivity could increase their mental health symptoms, especially for at-risk adolescents. A new study has reported that on days that at-risk adolescents used technology more, they experienced more conduct problems and higher attention-deficit hyperactivity disorder (ADHD) symptoms compared to days when they used digital technologies less. However, the study also found that on days when adolescents spent more time using digital technologies they were less likely to report symptoms of depression and anxiety. Further research is needed to assess whether changing technology use can alter mental health symptoms and long-term mental health outcomes.

English Validation of the Parental Socialization Scale-ESPA29.

Parenting styles have traditionally been studied following the classical two-dimensional orthogonal model of parental socialization. The Parental Socialization Scale ESPA29 is used to measure the four styles of parental socialization through the acceptance/involvement and strictness/imposition dimensions. The ESPA29 scale is a developmentally appropriate measure of parenting styles, which has been validated in several languages including Spanish, Italian, and Brazilian Portuguese. In this study, the English translation of the ESPA29 was evaluated. The objective of the work is to test the ESPA29’s structure of parenting practices with a United States sample measuring parenting practices using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scores of fathers’ and mothers’ behavioral practices toward their children were obtained for a sample of 911 United States adolescents between 14 and 18 years of age. First, the total sample was split and a principal components analysis with varimax rotation was carried out with one of the two halves. EFA showed a two-factor structure fully congruent with the theoretical model for mothers’ and fathers’ scores. Next, a CFA was calculated on the second half by using the factor structure obtained in the previous EFA. The CFA replicated the two-factor structure with appropriate fit index. The seven parenting practices that were measured loaded appropriately on the acceptance/involvement and strictness/imposition dimensions. Then, the multigroup analysis between girls and boys showed equal loading in the factors and equal covariation between the acceptance/involvement and the strictness/imposition dimensions. Additionally, the two dimensions of the ESPA29 scale were related to self-esteem in order to obtain an external validity index. The findings confirm the invariant structure of the ESPA29 was in the United States and their equivalence in both fathers’ and mothers’ scores. These findings validate the instrument and confirm its applicability in cross-cultural research on parenting practices and child adjustment.

Serum Alanine Aminotransferase Trends and Their Relationship with Obesity and Metabolic Syndrome in United States Adolescents, 1999-2014.

Nonalcoholic fatty liver disease (NAFLD), characterized by hepatocyte dysfunction, fat accumulation, and fibrosis, is the most common cause of chronic liver disease in children. Elevated levels of serum alanine aminotransferase (ALT) are used clinically to identify potential liver dysfunction. Our goal was to assess for changes in the national prevalence of elevated ALT over time and potential relationship to trends in the metabolic syndrome (MetS) severity and elevated body mass index (BMI). We studied 5411 non-Hispanic white, non-Hispanic black, and Hispanic adolescents aged 12-19 with complete MetS Z-score and ALT data from the National Health and Nutrition Examination Survey 1999-2014. Elevated ALT levels were defined by two different cutoffs: one for both sexes (30 U/L) and another that was sex specific (22 U/L girls; 25 U/L boys). MetS severity was assessed using a sex- and race-/ethnicity-specific MetS Z-score. We did not find a statistically significant linear increase in either mean ALT or the prevalence of elevated ALT differed over time. As expected, ALT levels were significantly correlated with BMI Z-score and MetS Z-score (P < 0.0001). Over time, BMI Z-scores increased and MetS severity Z-score decreased. Prevalence of elevated ALT did not exhibit a linear change between 1999 and 2014 in U.S. adolescents, potentially due to divergent trends regarding BMI and MetS severity. Continued vigilance in monitoring BMI and ALT levels is advised for the U.S. adolescent population. MetS Z-score could act as an additional tool to monitor risk of elevated ALT and subsequent development of NAFLD.

Association Between Hay Fever and High Myopia in United States Adolescents and Adults.

To investigate the relationship between hay fever and refractive error in a representative sample of adolescents and adults in the United States. This cross-sectional study included 5,744 participants aged ≥12 years from the 2005 to 2006 National Health and Nutrition Examination Survey who participated in the allergy questionnaire, completed objective refraction and keratometry in both eyes, and had immunoglobulin E (IgE) serology. The primary predictor variable, refractive error, was classified as emmetropia (-0.99 to +0.99 diopters [D]), low myopia (-1.00 to -2.99 D), moderate myopia (-3.00 to -5.99 D), high myopia (≥-6.00 D), or hyperopia (≥1.00 D). Covariates included age, gender, race, asthma, eczema, total serum IgE ≥120 kU/L, corneal steepness, and corneal astigmatism. The primary outcome was hay fever. The study population's mean age was 41.7 years; 48.8% of subjects were men and 51.2% were women. The prevalence of hay fever was 12.1% overall. High myopes had 2.7 times higher odds of hay fever compared to emmetropes (OR 2.67, CI, 1.57-4.51, P=0.001), which was independent of demographics, atopic conditions, IgE serology, and keratometry measurements. The association between hay fever and high myopia identified in this large cross-sectional study remains speculative and was not mediated through corneal steepness or corneal astigmatism. Further prospective studies may help elucidate the directionality of the association between hay fever and high myopia.

Lower face asymmetry as a marker for developmental instability.

Fluctuating asymmetries in the craniofacial skeleton have been shown to be predictive for mortality from degenerative diseases. We investigate whether lower face asymmetries are a potential marker for the developmental origins of health and disease. The lower face of a representative sample of 6654 12- to 17-year old United States (US) adolescents (1966-1970, National Health Examination Survey III) was classified as asymmetric when the mandibular teeth occluded prognathically (forward) or retrognathically (backward) on one side of the face only. It was investigated whether these lower face asymmetries were directional (preferentially to the left or the right) or fluctuating (random left-right distribution) in the US population. Lower face asymmetries affected 1 in 4 of the US adolescents. Unilateral retrognathic dental occlusions were fluctuating asymmetries, had a US prevalence of 17.0% (95% confidence interval: 15.5-18.4) and were associated with race/ethnicity (P < .0001), not with handedness (P < .7607). Unilateral prognathic dental occlusions were directional asymmetries (P < .0001), had a US prevalence of 7.6% (95% confidence interval: 6.4-8.7) and were associated with large household size (P < .001) and handedness (P < .0223). Lower face asymmetries were not associated with distinct heritable traits such as color blindness. The findings suggest that lower face asymmetries are a marker for environmental stress and cerebral lateralization during early development.

Associations of Physical Activity, Sedentary Time, and Screen Time With Cardiovascular Fitness in United States Adolescents: Results From the NHANES National Youth Fitness Survey.

Most US adolescents do not meet guidelines of at least 60 daily minutes of moderate- to vigorous-intensity physical activity. In addition, sedentary behaviors among this age group are of increasing concern. This study examined the association of movement behaviors with cardiovascular fitness among US adolescents. Data from the 2012 NHANES National Youth Fitness Survey were used to assess the association of movement behaviors (physical activity, sedentary time, screen time) with cardiovascular fitness among adolescent males and females. Multiple logistic regressions were used to test the independent and interactive effects of movement behaviors on cardiovascular fitness. Among females, physical activity was directly associated with cardiovascular fitness; no significant association was observed between sedentary behaviors and CVF. Among males, sedentary time moderated the relationship between physical activity and cardiovascular fitness, such that a significant, direct association was only observed among those with high sedentary time (OR: 5.01; 95% CI: 1.60, 15.70). Results from this cross-sectional analysis suggest that among female US adolescents, physical activity, but not sedentary behavior, is associated with cardiovascular fitness. Among males, the interaction between physical activity and sedentary time seems to be important for cardiovascular fitness. Longitudinal studies are warranted to confirm these findings.

Persistence of extra-medical prescription pain reliever use among United States adolescents: A latent class analysis

Persistence of extra-medical prescription pain reliever use among United States adolescents: A latent class analysis

United States Adolescents' Television, Computer, Videogame, Smartphone, and Tablet Use: Associations with Sugary Drinks, Sleep, Physical Activity, and Obesity

To quantify the relationships between youth use of television (TV) and other screen devices, including smartphones and tablets, and obesity risk factors. TV and other screen device use, including smartphones, tablets, computers, and/or videogames, was self-reported by a nationally representative, cross-sectional sample of 24 800 US high school students (2013-2015 Youth Risk Behavior Surveys). Students also reported on health behaviors including sugar-sweetened beverage (SSB) intake, physical activity, sleep, and weight and height. Sex-stratified logistic regression models, adjusting for the sampling design, estimated associations between TV and other screen device use and SSB intake, physical activity, sleep, and obesity. Approximately 20% of participants used other screen devices for ≥5 hours daily. Watching TV ≥5 hours daily was associated with daily SSB consumption (aOR = 2.72, 95% CI: 2.23, 3.32) and obesity (aOR = 1.78, 95% CI: 1.40, 2.27). Using other screen devices ≥5 hours daily was associated with daily SSB consumption (aOR = 1.98, 95% CI: 1.69, 2.32), inadequate physical activity (aOR = 1.94, 95% CI: 1.69, 2.25), and inadequate sleep (aOR = 1.79, 95% CI: 1.54, 2.08). Using smartphones, tablets, computers, and videogames is associated with several obesity risk factors. Although further study is needed, families should be encouraged to limit both TV viewing and newer screen devices.

Risk factors for self-report of not receiving an HIV test among adolescents in NYC with a history of sexual intercourse, 2013 YRBS

ABSTRACTThe Centers for Disease Control and Prevention has previously recommended that all adolescents undergo HIV testing in the United States (US). Despite these recommendations, national HIV testing among US adolescents has remained low. This study estimated the prevalence of and identified risk factors for not receiving an HIV test among adolescents with a history of sexual intercourse in New York City (NYC), an urban area that has been greatly impacted by the HIV epidemic. Cross-sectional data on 1199 NYC high school students who completed the 2013 NYC Youth Risk Behavior Survey were used. Modified Poisson regression models were used to assess whether demographic factors, alcohol/drug use and sexual behaviors were associated with self-report of lack of HIV testing. In the weighted study population, about 72% were ≥16 years old, approximately 35% were African-American and nearly half were male. Sixty percent reported no history of HIV testing. In adjusted analyses, younger age, male gender, White race/ethnicity, heroin use, as well as reporting one prior sexual partner, were significantly and positively associated with no prior history of HIV testing. Our findings suggest that among NYC adolescents with a history of sexual intercourse, the prevalence of HIV testing is low. HIV testing may have been low in part because of limited experience with current screening guidelines among clinicians. Furthermore, many of the adolescents identified as being more likely to not be tested may have not been screened because of inadequate knowledge about HIV, a low perceived HIV risk or an unstable lifestyle. Therefore, to increase HIV testing among NYC adolescents, interventions that enhance HIV knowledge among adolescents as well as interventions that promote review and application of current screening guidelines among clinicians should be implemented in NYC. Educational interventions should especially be targeted at the adolescents identified in this study.

Phenotypic characteristics of adolescents with concave and convex facial profiles – The National Health Examination Survey

It has been suggested that facial traits are informative on the inherited susceptibility to tuberculosis and obesity, two current global health issues. Our aim was to compare the phenotypic characteristics of adolescents with dental markers for a concave (n=420), a convex (n=978), and a straight (n=3542) facial profile in a nationally representative sample of United States adolescents. The results show that adolescents with a concave facial profile, when compared to a straight facial profile, had an increased waist-to-height ratio (Δ, 1.1 [95% CI 0.5–1.7], p<0.003) and an increased acne prevalence (OR, 1.5 [95% CI 1.2–1.9], p<0.001). Adolescents with a convex facial profile, when compared to a straight facial profile, had an increased prevalence of tuberculosis (OR, 4.3 [95% CI 1.4–13.1], p<0.02), increased ectomorphy (Δ, 0.3 [95% CI 0.2–0.4], p<0.0001), increased left-handedness (OR, 1.4 [95% CI 1.1–1.7], p<0.007), increased color-blindness (OR, 1.7 [95% CI 1.3–2.3], p<0.004), and rhesus ee phenotype (OR, 1.3 [95% CI 1.1–1.5], p<0.008). Adolescents with a concave facial profile, when compared to a convex profile, had increased mesomorphy (Δ, 1.3 [95% CI 1.1–1.5], p<0.0001), increased endomorphy (Δ, 0.5 [95% CI 0.4–0.6], p<0.0001), lower ectomorphy (Δ, 0.5 [95% CI 0.4–0.6], p<0.0001), and lower vocabulary test scores (Δ, 2.3 [95% CI 0.8–3.8], p<0.008). It is concluded that population-based survey data confirm that distinct facial features are associated with distinct somatotypes and distinct disease susceptibilities.

Health-Related Quality of Life and Asthma Among United States Adolescents

W Cui, M Zack, H Zahran. J Pediatr. 2015;166(2):358–364 To examine the associations of asthma symptoms and adolescents’ behaviors/characteristics and their effects on health-related quality of life (HRQoL). The sample analysis included 7063 adolescents, aged 12 to 17 years, who participated in the NHANES Survey in the United States. Data were collected from 2001 to 2010 NHANES. HRQoL measures included self-rated health, physically and mentally unhealthy days, and activity limitation days. Asthma was classified as never having asthma, …

Trends in High Blood Pressure among United States Adolescents across Body Weight Category between 1988 and 2012

To examine trends in pre-high blood pressure (BP [HBP]) and HBP among US adolescents by body weight category during 1988-2012. We estimated pre-HBP and HBP prevalence among 14,844 participants aged 12-19 years using National Health and Nutrition Examination Surveys from 1988-1994, 1999-2002, 2003-2006, and 2007-2012. Pre-HBP and HBP were defined based on age-sex-height-specific BP percentiles. We examined the temporal trends in pre-HBP and HBP across category of body weight (normal weight vs overweight/obese), adjusted for potential explanatory factors, and estimated the number of adolescents with pre-HBP and HBP. Between 1988 and 2012, the prevalence of HBP decreased and pre-HBP did not change. Among normal weight adolescents, multivariable adjusted pre-HBP prevalence was 11.0% during 1988-2012, and 10.9% during 2007-2012 (P = .923 for trend); adjusted HBP prevalence increased from 1988-1994 (0.9%) to 1999-2002 (2.3%), then declined significantly to 1.4% during 2007-2012 (P = .049). Among overweight/obese adolescents, adjusted pre-HBP prevalence was 17.5% during 1988-2012, and 20.9% during 2007-2012 (P = .323); adjusted HBP prevalence declined significantly from 7.2% during 1988-1994 to 3.2% during 2007-2012 (P = .018). Because of population growth, estimated number of adolescents with pre-HBP or HBP increased, from 4.18 million during 1988-1994 to 5.59 million during 2007-2012. Between 1988 and 2012, pre-HBP prevalence was consistently higher among overweight/obese adolescent than those of normal weight, and the pattern remain unchanged. HBP prevalence declined significantly, especially among overweight/obese adolescent that are not completely explained by sociodemographic or lifestyle characteristics.

Epidemiological evidence on extra-medical use of prescription pain relievers: transitions from newly incident use to dependence among 12-21 year olds in the United States using meta-analysis, 2002-13.

Background. When 12-to-21-year-olds start using prescription pain relievers extra-medically, some of them transition into opioid dependence within 12 months after such use. Our main aim for this epidemiological research on 12-to-21-year-olds in the United States (US) is to estimate the risk of becoming a newly incident case of opioid dependence within 12 months after onset of using prescription pain relievers extra-medically (EMPPR).Methods. Meta-analyses from multiple independent replication samples now are possible, based upon nationally representative survey samples of US adolescents age 12–21 years. All 12-to-21-year-olds were sampled and recruited for the US National Surveys on Drug Use and Health, with standardized assessments of EMPPR use and opioid dependence (NSDUH, 2002–2013).Results. Peak risk for a transition from start of EMPPR use to opioid dependence within 12 months is seen at mid-adolescence among 14-to-15-year-olds (6.3%, 8.7% per year), somewhat earlier than peak risk for starting EMPPR use (seen for 16-to-19-year-olds at 4.1%, 5.9% per year). Applied to 12-to-21-year-olds in the US between 2002–2013, an estimated 8 million started using PPR extra-medically. Each year, roughly 42,000 to 58,000 transitioned into opioid dependence within 12 months after onset of such use.Discussion. These epidemiological estimates for the US in recent years teach us to expect one transition into adolescent-onset opioid dependence within 12 months for every 11–16 newly incident EMPPR users, yielding perhaps 120 newly incident opioid dependent cases in need of practitioner attention or treatment services, each day of each year. This evidence can be used to motivate more effective public health prevention, outreach, and early intervention programs as might prevent or delay occurrence of EMPPR use and opioid dependence.

Health-Related Quality of Life and Asthma among United States Adolescents

To examine the direction and the magnitude of associations between asthma and health-related quality of life (HRQoL) in a population-based sample of US adolescents. We obtained data from the 2001-2010 cross-sectional National Health and Nutrition Examination Survey. We used multinomial logistic regression and negative binomial regression to estimate corresponding percentages, prevalence ratios (PRs), and predicted days of 4 domains of HRQoL by 3 asthma status categories: never having asthma, having asthma without symptoms, and having asthma with symptoms. Compared with those who never had asthma, adolescents with asthma with symptoms of dry cough or wheezing reported significantly worse self-rated health (13.58% [95% CI, 10.32%-17.67%] vs 7.54% [95% CI, 6.50%-8.72%] for fair or poor health), significantly impaired physical health (PR = 1.34, P = .004; adjusted physically unhealthy days, 2.7 days vs 2 days), and impaired mental health (PR = 1.26, P = .025). Among adolescents having asthma with symptoms, those who currently smoked reported 1 more physically unhealthy day and 2.4 more mentally unhealthy days than those who did not smoke and did not have asthma. Those reporting limited physical functioning reported 2 more physically unhealthy days and 1.5 more mentally unhealthy days than those who did not report limited functioning. Adolescents with asthma and symptoms reported worse HRQoL compared with those with asthma not reporting symptoms and those without asthma. Those who smoked or reported limited physical functioning reported worse physical and mental HRQoL. Reducing symptoms, quitting smoking, and improving physical functioning may improve HRQoL among adolescents with asthma.

Family ties: Maternal-offspring attachment and young adult nonmedical prescription opioid use

BackgroundNonmedical prescription drug use is prevalent among young adults, yet little is known about modifiable determinants of use. We examined whether maternal-offspring attachment reported at mean age 21 was associated with nonmedical prescription opioid use at mean age 26, and investigated whether a history of depressive symptoms and substance use played a role in associations between maternal-offspring attachment and nonmedical prescription opioid use. MethodsWe used data from the Growing Up Today Study, a longitudinal cohort of United States adolescents followed into young adulthood. Maternal-offspring attachment was reported by young adults and their mothers, and defined as mutual low, mutual medium or high, and dissonant. Analyses were carried out in the full sample using generalized estimating equation models, and in a sibling subsample, using conditional fixed effects models to control for stable aspects of the family environment. ResultsAnalyses with the full sample and the sibling subsample both showed that mutual medium/high maternal-offspring attachment at age 21 was associated with lower odds of nonmedical prescription opioid use at age 26 (RR=0.74; 95% CI=0.57–0.97 in full sample). The association was partly mediated by mean age 23 offspring smoking, heavy episodic drinking, and illicit drug use. ConclusionsPromoting reciprocal attachment in the maternal-offspring dyad should be investigated as a strategy to prevent nonmedical prescription opioid use by young adulthood. Even in young adulthood, programs that target both parents and offspring may have greater impact on offspring substance use than programs that target offspring alone.

Health-related quality of life and body mass index among US adolescents.

To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents. From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes-self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days-in four BMI categories-obese, overweight, normal weight, and underweight-of approximately 6,000 US adolescents aged 12-17 years. We also estimated the percentages for boys and girls separately. Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95% CI 15-22) of obese adolescents reported fair or poor health compared to only 5% (95% CI 4-7) of normal-weight adolescents. Thirty-seven percent (95% CI 33-42) of obese adolescents reported excellent or very good health, compared to 65% (94% CI 63-67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls. Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls.