Project EAT: Publications

Objectives: This study determined the prevalence of Minnesota urban youths reaching the Healthy People 2010 objectives for obesity and intake of fat, calcium, fruits, vegetables, and grains and compared prevalence rates across sociodemographic characteristics.
Methods: The study sample included 4746 adolescents (aged 11–18 years) from the Minneapolis/St. Paul area who completed dietary surveys and participated in anthropometric measurements as part of a school-based population study.
Results: Considerable gaps were seen between the existing prevalence rates for obesity and nutrient and food patterns and the targeted Healthy People 2010 prevalence rates. For example, 12.5% of the girls and 16.6% of the boys had body mass index values at or greater than the 95th percentile (target = 5%). Only 29.5% of the girls and 42.5% of the boys were meeting the daily recommended intakes for calcium (target = 75%). Similarly, percentages of youths consuming the recommended amounts of fat, fruits, vegetables, and grains were lower than the targeted percentages. There were large sociodemographic disparities in obesity and eating patterns, particularly across race/ethnicity and socioeconomic status.
Conclusions: Concerted public health efforts are needed to achieve the Healthy People 2010 objectives for obesity and nutrition and to reduce racial/ethnic and socioeconomic disparities.

Objective: To assess adolescents’ perceptions about factors influencing their food choices and eating behaviors.
Design: Data were collected in focus-group discussions.
Subjects/setting: The study population included 141 adolescents in 7th and 10th grade from 2 urban schools in St Paul, Minn, who participated in 21 focus groups.
Analysis: Data were analyzed using qualitative research methodology, specifically, the constant comparative method.
Results: Factors perceived as influencing food choices included hunger and food cravings, appeal of food, time considerations of adolescents and parents, convenience of food, food availability, parental influence on eating behaviors (including the culture or religion of the family), benefits of foods (including health), situation-specific factors, mood, body image, habit, cost, media, and vegetarian beliefs. Major barriers to eating more fruits, vegetables, and dairy products and eating fewer high-fat foods included a lack of sense of urgency about personal health in relation to other concerns, and taste preferences for other foods. Suggestions for helping adolescents eat a more healthful diet include making healthful food taste and look better, limiting the availability of unhealthful options, making healthful food more available and convenient, teaching children good eating habits at an early age, and changing social norms to make it “cool” to eat healthfully.
Applications/conclusions: The findings suggest that if programs to improve adolescent nutrition are to be effective, they need to address a broad range of factors, in particular environmental factors (eg, the increased availability and promotion of appealing, convenient foods within homes, schools, and restaurants).

Background: This study aims to identify correlates of fruits and vegetables from within the domains of personal factors (taste preferences, health/nutrition attitudes, weight/body concerns, and self-efficacy), behavioral factors (meal frequency, fast food intake, and weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). This study further aims to identify correlates of home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between availability and taste preferences.
Methods: The population included 3957 adolescents from 31 public middle and high schools in Minnesota. Structural equation modeling was used for model testing.
Results: The strongest correlates of fruit/vegetable intake were home availability of fruits/vegetables and taste preferences of fruits/vegetables. The final model explained 13% of the variance in fruit/vegetable intake, 45% of the variance in home availability, and 28% of the variance in taste preferences. Correlates of home availability included social support for healthy eating, family meal patterns, family food security, and socio-economic status. Correlates of taste preferences included health/nutrition attitudes and home availability of fruits/vegetables. A test of interaction effects indicated that when home availability of fruits/vegetables was low, intake patterns did not differ, regardless of taste preferences. In contrast, even when taste preferences for fruits/vegetables were low, if fruits/vegetables were available, intake increased.
Conclusions: Interventions to increase fruit/vegetable intake in adolescents need to target socio-environmental factors such as greater availability of fruits/vegetables.

Objective To describe adolescent involvement in preparing and shopping for food and examine if extent of involvement is related to diet quality.
Design Cross-sectional study design. Past week frequency of involvement in preparing and shopping for food was self-reported on the Project EAT (Eating Among Teens) survey. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire.
Subjects/setting Middle school and high school students from Minneapolis/St Paul, MN, public schools.
Statistical analyses performed Associations between involvement and sociodemographic characteristics were examined using cross tabulations. General linear modeling was used to compare dietary intakes of adolescents across different levels of involvement in preparing and shopping for food.
Results The majority of adolescents reported helping prepare dinner (68.6%) and nearly half reported shopping for groceries (49.8%) at least once during the past week. Greater involvement in these food tasks was related to sex (female), grade level (middle school), race (Asian American), socioeconomic status (low), family meal frequency (high), and weight status (overweight). Frequency of preparing food was related to lower intakes of fat (P<0.01) and higher intakes of fruits and vegetables, fiber, folate, and vitamin A. Preparing was related to lower intakes of carbonated beverages among female adolescents (P<0.01) and lower intakes of fried foods among male adolescents (P<0.01). In contrast, food shopping frequency was related to greater consumption of fried foods among female adolescents (P<0.01).
Conclusions Adolescents should be encouraged to help with meal preparation and may benefit from interventions and programs that teach skills for cooking and making healthful purchasing decisions.

Objective To describe adolescent involvement in preparing and shopping for food and examine if extent of involvement is related to diet quality.
Design Cross-sectional study design. Past week frequency of involvement in preparing and shopping for food was self-reported on the Project EAT (Eating Among Teens) survey. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire.
Subjects/setting Middle school and high school students from Minneapolis/St Paul, MN, public schools.
Statistical analyses performed Associations between involvement and sociodemographic characteristics were examined using cross tabulations. General linear modeling was used to compare dietary intakes of adolescents across different levels of involvement in preparing and shopping for food.
Results The majority of adolescents reported helping prepare dinner (68.6%) and nearly half reported shopping for groceries (49.8%) at least once during the past week. Greater involvement in these food tasks was related to sex (female), grade level (middle school), race (Asian American), socioeconomic status (low), family meal frequency (high), and weight status (overweight). Frequency of preparing food was related to lower intakes of fat (P<0.01) and higher intakes of fruits and vegetables, fiber, folate, and vitamin A. Preparing was related to lower intakes of carbonated beverages among female adolescents (P<0.01) and lower intakes of fried foods among male adolescents (P<0.01). In contrast, food shopping frequency was related to greater consumption of fried foods among female adolescents (P<0.01).
Conclusions Adolescents should be encouraged to help with meal preparation and may benefit from interventions and programs that teach skills for cooking and making healthful purchasing decisions.

Background: Diets abundant in fruits and vegetables are associated with reduced risk for chronic disease, but intakes of adolescents are often inadequate. To design effective interventions it is important to understand how dietary intake changes longitudinally during adolescence and to monitor progress in the population toward fruit and vegetable consumption recommendations. The objective of this study was to examine longitudinal and secular trends in fruit and vegetable intake among two cohorts of Minnesota adolescents over the period 1999–2004.
Methods: Measures of fruit and vegetable intake and demographics were completed by 944 boys and 1161 girls who were Project EAT participants in 1999 and 2004. In 2005, mixed linear regression models were used to estimate (1) longitudinal trends among two cohorts of young people during developmental transitions and (2) age-matched secular trends between the two cohorts of young people at middle adolescence.
Results: Longitudinal trends indicated that adolescents decreased their daily intake of fruit and vegetables by an average of 0.7 servings during the transition from early to middle adolescence and by 0.6 servings from middle to late adolescence. Analyses of age-matched secular trends at middle adolescence showed a mean daily decrease of 0.7 servings among girls and 0.4 servings among boys between 1999 and 2004.
Conclusions: The large longitudinal and secular declines in fruit and vegetable intakes of adolescents indicate a strong need for further research to understand why consumption is decreasing among adolescents and to develop more effective interventions for increasing fruit and vegetable consumption during this critical developmental period.

Background: During the transition from adolescence to young adulthood, the intake of fruit and vegetables tends to decline, and national survey data indicate that few young adults consume the recommended amounts. This study aimed to identify longitudinal correlates of follow-up fruit and vegetable intake in early young adulthood.

Methods: Surveys and food frequency questionnaires were completed by 1495 adolescent participants in high school classrooms at baseline (in 1998-1999; mean age=15.9 years, SD=0.8) and by mail at follow-up (in 2003-2004; mean age=20.4 years, SD=0.8). In 2007, linear regression methods were used to identify baseline factors associated with follow-up fruit and vegetable intake.

Results: Baseline taste preferences, perceived benefits of healthy eating, fast-food intake, time spent watching television, family-meal frequency, and home food availability were correlates of both fruit and vegetable intake during young adulthood across gender. After adjusting for baseline intake, the only correlate of both fruit and vegetable intake during young adulthood across gender was taste preferences.

Conclusions: The findings suggest that nutrition interventions for adolescents should provide opportunities for them to taste more fruit and vegetables, and should address supports for healthy eating both within and outside the home environment.

Background: Prior studies have found that family meals and other aspects of meal structure are associated with dietary intake during adolescence, but little research has characterized meals in young adulthood.
Objective: This study was designed to describe attitudes regarding the social nature of meals, time constraints on meals, and meal regularity in young adults. In addition, this study aimed to describe the sociodemographic characteristics of young adults who report eating dinner with others and “eating on the run,” and examine associations of these behaviors with meal attitudes and dietary intake.
Design: Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a Minnesota population-based study.
Subjects/Setting: Mailed surveys and food frequency questionnaires were completed in 2003-2004 by 1,687 young adult (mean age=20.5 years; 44% male) participants.
MAIN OUTCOMES MEASURED AND STATISTICAL ANALYSES PERFORMED: χ2 tests were calculated to examine differences in meal attitudes and behaviors according to sociodemographic characteristics. Relationships between meal attitudes and behaviors were explored using Spearman’s correlation coefficients. Linear regression models adjusted for demographic characteristics were used to examine associations between meal behaviors and dietary intake variables.
Results: The majority of young adults reported they enjoy and value eating with others, but 35% of males and 42% of females reported lacking time to sit down and eat a meal. Eating dinner with others was significantly associated (P≤0.01) with several markers of better dietary intake, including higher intakes of fruit, vegetables, and dark-green and orange vegetables. Eating on the run was significantly associated (P<0.01) with higher intakes of soft drinks, fast food, total fat and saturated fat, and lower intake of several healthful foods.
Conclusions: Findings suggest that health services and programs for young adults should encourage taking the time to sit down for meals and to share meals with others.

Background: Prior research has found that television viewing is associated with poor diet quality, though little is known about its long-term impact on diet, particularly during adolescence. This study examined the associations between television viewing behavior with dietary intake five years later.
Methods: Survey data, which included television viewing time and food frequency questionnaires, were analyzed for 564 middle school students (younger cohort) and 1366 high school students (older cohort) who had complete data available at Time 1 (1998–1999) and five years later at Time 2 (mean age at Time 2, 17.2 ± 0.6 and 20.5 ± 0.8 years, respectively). Regression models examined longitudinal associations between Time 1 television viewing behavior and Time 2 dietary intake adjusting for sociodemographic characteristics, Time 1 dietary intake, and Time 2 total daily energy intake.
Results: Respondents were categorized as limited television users (<2 hours/daily), moderately high television viewers (2–5 hours/daily), and heavy television viewers (≥5 hours/daily). Among the younger cohort, Time 1 heavy television viewers reported lower fruit intake and higher sugarsweetened beverage consumption than the other two groups. Among the older cohort, watching five or more hours of television per day at Time 1, predicted lower intakes of fruits, vegetables, whole grain and calcium-rich foods, and higher intakes of trans fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages (products commonly advertised on television) five years later.
Conclusion: Television viewing in middle and high school predicted poorer dietary intake five years later. Adolescents are primary targets of advertising for fast food restaurants, snack foods, and sugar-sweetened beverages, which may influence their food choices. Television viewing, especially during high school, may have long-term effects on eating choices and contribute to poor eating habits in young adulthood.

Detailed research examining concurrent longitudinal and secular changes in adolescent beverage intake is not currently available, particularly since the year 2000. This study’s objective was to evaluate these trends in beverage intake in a large, diverse adolescent cohort. Project EAT (Eating Among Teens)-II is a 5-year longitudinal study (n=2,516) including two cohorts, which allows for the observation of longitudinal changes from early to mid-adolescence (junior high to high school) and from mid- to late adolescence (high school to post high school). Project EAT-II also examined secular trends in adolescent health behavior from 1999-2004 in mid-adolescence. Daily beverage servings were assessed using the Youth and Adolescent Food Frequency Questionnaire. Longitudinal findings indicate that intake of soda and sugar-sweetened beverages (including soda, sweetened iced teas, and fruit drinks) increased significantly among younger males, and alcohol increased across all groups (P<0.01). Consumption of certain beverages decreased with age: fruit juice (among all males and older females, P≤0.02), milk (older adolescents, P<0.01), other milk beverages (all females and older males, P<0.01), diet soda (younger adolescents, P<0.01), and coffee/tea (all males and younger females, P<0.01). Significant secular decreases were observed in fruit juice and coffee/tea for males and females (P≤0.05). Overall, these findings reflect recent secular and longitudinal shifts in adolescent beverage consumption during the critical transition period from early to mid-adolescence and mid- to late adolescence. Although additional research is needed to better understand nuances in adolescent consumption patterns, registered dietitians and other health care practitioners working with adolescents should address the importance of limiting sugar-sweetened beverages with low nutrient density.

A diet-patterns approach has often been used to describe eating patterns in adults but has rarely been used in adolescents. We used principal components factor analysis to: 1) describe the dietary patterns of a cohort of ethnically diverse youth during early and middle adolescence; 2) examine if the patterns persisted 5 y later; and 3) study secular trends. Project EAT-I (Time 1) collected data on 4746 middle school (younger cohort) and high school (older cohort) students in 31 Minnesota schools in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n = 2516) of the original cohort in 2003-2004. Dietary intake was assessed at Time 1 and 2 using the Youth/Adolescent FFQ. We identified dietary patterns separately by cohort (older/younger) and gender (boys/girls). At Time 1, we identified 4 patterns in early and middle adolescents that were relatively consistent between boys and girls that we labeled vegetable, fruit, sweet/salty snack food, and starchy food. Longitudinal analyses indicated that patterns were relatively stable over 5 y, with the exception of a new fast food pattern. Examination of age-matched secular trends in middle adolescents (older cohort at Time 1, younger cohort at Time 2) showed similar patterns, with the exception of the fast food pattern that emerged at Time 2 among middle adolescent boys. We identified dietary patterns in this adolescent population that differed from those usually found in adults. Patterns were similar across gender and age cohorts and were relatively similar over time, with the exception a new fast food pattern.

Objective: To examine characteristics of adolescents who value eating locally grown, organic, nongenetically engineered, and/or nonprocessed food and whether they are more likely than their peers to meet Healthy People 2010 dietary objectives.
Design: Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT: Eating Among Teens).
Setting: Participants completed a mailed survey and food frequency questionnaire in 2004.
Participants: Males and females (N = 2516), ages 15-23 years.
Main outcome measures: Dietary intake of fruit, vegetables, fat, grains, calcium, and fast food.
Analysis: Chi-square tests, logistic regression models adjusting for race/ethnicity, socioeconomic status, and vegetarian status.
Results: Percentages of adolescents who reported that it was somewhat or very important that their food be locally grown, organic, nongenetically engineered, and nonprocessed were 20.9%, 23.2%, 34.1%, and 29.8%, respectively. Those who valued each practice were more likely than their peers to be nonwhite (P < .001) and have a low socioeconomic status (P < .001). Adolescents who valued ≥ 2 practices were more likely than their peers to have a dietary pattern consistent with the Healthy People 2010 objectives (P < .001) for fruit, vegetable, and fat intake.
Conclusions and Implications: It may beneficial to discuss alternative food production practices as part of nutrition education programs for adolescents.

Objective: To describe changes in calcium and dairy intake during the transition from middle adolescence to young adulthood and to identify baseline correlates of calcium intake in young adulthood.
Design: Population-based, 5-year follow-up study (Project EAT: Eating Among Teens).
Setting: Baseline surveys were completed in Minneapolis/St. Paul, MN schools and by mail at follow-up.
Participants: Males and females (N = 1521) attending high school at baseline (mean age = 15.9 years) and with a mean age of 20.5 years at follow-up.
Main outcome measures: Calcium intake.
Analysis: Mixed and linear regression methods were used to respectively examine trends and correlates of intake.
Results: During the transition to young adulthood, mean daily calcium intakes of females and males decreased by an average of 153 mg and 194 mg respectively. Mealtime milk availability, health/nutrition attitudes, taste preference for milk, healthful weight control behaviors, and peer support for healthful eating at baseline were associated with better follow-up calcium intake. Time spent watching television and lactose intolerance were associated with lower intake at follow-up.
Conclusions and Implications: Nutrition interventions are needed to counter longitudinal decreases in calcium intake. Interventions targeted to adolescents should address the availability of milk at meals and other identified supports for healthful eating.

We examined whether young adult meal patterning, dietary intake, and home food availability differed among nonstudents, 2-year college students, and 4-year college students (N = 1687; mean age = 20.5 years). Unadjusted analyses showed that few young adults consumed optimal diets and, compared with 4-year college students, nonstudents and 2-year students consumed fewer meals and poorer diets. After controlling for sociodemographics and living arrangements, we found that over half of the observed associations remained significant (P < .05). Nutrition interventions are needed for young adults, particularly specific at-risk groups.

Background: National survey data indicate few adolescents or young adults consume whole grains in the amount recommended to prevent chronic disease and maintain a healthful weight. Interventions are needed to address this gap; however, little is known about what modifiable factors influence whole-grain intake among youth. Objective: This study aimed to identify socioenvironmental, personal, and behavioral correlates of whole-grain intake among adolescents and young adults.
Design: Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a population-based study in Minnesota. Mailed surveys and food frequency questionnaires were completed by male (44.8%) and female (55.2%) participants in 2003-2004, including 792 adolescents (mean age=17.2 years) and 1,686 young adults (mean age=20.5 years). Linear regression models adjusted for demographic characteristics were used to identify factors associated with energy-adjusted daily intake of whole grains.
Results: Mean daily intake of whole grains was lower than recommended among adolescents (males: 0.59±0.04 servings, females: 0.61±0.04 servings) and young adults (males: 0.68±0.03 servings, females: 0.58±0.03 servings). Home availability of whole-grain bread, self-efficacy to consume ≥3 daily servings of whole grains, and preference for the taste of whole-grain bread were positively associated with whole-grain intake during adolescence and young adulthood across sex. Conversely, fast-food intake was associated with lower intake of whole grains among adolescents and young adults of both sexes. The factors examined in this study explained 28% to 34% of variance in whole-grain intake across sex and the two age groups.
Conclusions: The findings suggest nutrition interventions should address the availability of whole-grain foods in homes and restaurants. In addition, young people should be provided with opportunities to taste a variety of whole-grain foods to enhance taste preferences and self-efficacy to consume whole-grain products.

Background: The replacement of refined grains in the diet with whole grains may help prevent chronic disease and excess weight gain, but intakes in adolescents are often lower than recommended.
Objectives This study aimed to examine demographic disparities and 5-y longitudinal and secular trends (1999-2004) in whole-grain intake among 2 cohorts of Minnesota adolescents.
Design: Whole-grain intake was examined among 996 adolescent males and 1222 adolescent females who were Project EAT (Eating Among Teens) participants in 1999 and 2004. Multinomial logistic regression models were used to examine demographic differences in whole-grain intake. Mixed linear regression models were used to estimate 1) longitudinal trends among 2 cohorts of adolescents during developmental transitions and 2) age-matched secular trends between the cohorts at middle adolescence.
Results: In 1999, 11% of adolescent males and 13% of adolescent females reported that they consumed more than one daily serving of whole grains. Whole-grain intake was lowest among youth of the Native American and white races and among youth of high socioeconomic status. During the transition from middle to late adolescence, whole-grain intake increased by a mean of 0.14 daily servings among adolescent males and 0.09 daily servings among adolescent females. No significant changes in whole-grain intake were shown among either sex during the transition from early to middle adolescence. Yeast breads, popcorn, and ready-to-eat breakfast cereals were major sources of whole grains in 1999 and 2004.
Conclusion: Findings suggest the need to advance efforts that target improvements in the amount of whole-grain foods selected by adolescents.

Objective:
To identify predictors of breakfast consumption among adolescents.
Methods:
Five-year longitudinal study Project EAT (Eating Among Teens). Baseline surveys were completed in Minneapolis-St. Paul schools and by mail at follow-up by youth (n = 800) transitioning from middle to high school. Linear regression models examined associations between baseline predictors and follow-up breakfast consumption.
Results:
Frequency of breakfast consumption at follow-up was positively associated with baseline breakfast consumption and inversely associated with baseline weight concerns (P < .01). Perceptions of being too rushed in the morning to eat a healthful breakfast were associated with lower breakfast frequency 5 years later among girls (P < .01). After adjusting for baseline breakfast consumption, none of the associations with predictor variables remained statistically significant.
Conclusions and Implications:
Early adolescence is an important time to establish regular breakfast consumption. Interventions aimed at increasing breakfast consumption should include messages about healthful weight management and ideas for quick, healthful breakfasts.

Objectives To examine whether involvement in food preparation tracks over time, between adolescence (15-18 years), emerging adulthood (19-23 years) and the mid-to-late twenties (24-28 years), as well as 10-year longitudinal associations between home food preparation, dietary quality and meal patterning.

Design: Population-based, longitudinal cohort study.

Setting: Participants were originally sampled from Minnesota public secondary schools (USA).

Subjects: Participants enrolled in Project EAT (Eating Among Teens and Young Adults)-I, EAT-II and EAT-III (n 1321).

Results: Most participants in their mid-to-late twenties reported an enjoyment of cooking (73 % of males, 80 % of females); however, few prepared meals including vegetables most days of the week (24 % of males, 41 % of females). Participants in their mid-to-late twenties who enjoyed cooking were more likely to have engaged in food preparation as adolescents and emerging adults (P < 0·01); those who frequently prepared meals including vegetables were more likely to have engaged in food preparation as emerging adults (P < 0·001), but not as adolescents. Emerging adult food preparation predicted better dietary quality five years later in the mid-to-late twenties, including higher intakes of fruit, vegetables and dark green/orange vegetables, and less sugar-sweetened beverage and fast-food consumption. Associations between adolescent food preparation and later dietary quality yielded few significant results.

Conclusions: Food preparation behaviours appeared to track over time and engagement in food preparation during emerging adulthood, but not adolescence, was associated with healthier dietary intake during the mid-to-late twenties. Intervention studies are needed to understand whether promoting healthy food preparation results in improvements in eating patterns during the transition to adulthood.

The relationship between dietary intake and obesity is complex, and dietary pattern analysis may offer new insight. We examined associations between dietary patterns identified in a diverse cohort of adolescents and weight status cross-sectionally and over a 5-year period. Project EAT (Eating Among Teens) (Time 1) collected data on 4746 middle (younger cohort) and high school (older cohort) students in 1998-9. EAT-II (Time 2) resurveyed 2516 of the original cohort in 2003-4. All analyses were run separately by age cohort and sex. The relationship between dietary patterns identified previously (vegetable, fruit, vegetable & fruit, starchy food, sweet & salty snack food, and fast food) and weight status was examined using logistic regression. All analyses were adjusted for socioeconomic status, race/ethnicity and activity level (longitudinal analyses were also adjusted for baseline weight status). In cross-sectional analyses, higher adherence to dietary patterns loading heavily on vegetables was associated with lower risk of overweight/obese weight status in older and younger girls, whereas higher adherence to a ‘sweet & salty snack food’ pattern was associated with lower risk in older and younger boys. These associations were found prospectively in older boys and girls, but were no longer significant in analyses adjusting for baseline weight status. We did not find consistent or intuitive associations between dietary patterns and weight status. Identified patterns may not capture the elements of diet that are truly important in determining adolescent weight, or diet may not be the primary driver in determining weight status at this age. Methodological difficulties in assessing diet must also be taken into consideration.

Few young adults meet national recommendations to consume at least 2 c fruit and 2 to 3 c vegetables daily. Effective strategies and messaging are needed to address this disparity, but research examining influences on fruit and vegetable (F/V) intake during young adulthood has been limited and primarily cross-sectional. This study was conducted to identify 5-year and 10-year longitudinal predictors of F/V intake in young adulthood. The sample included 476 male and 654 female participants enrolled in a population-based cohort study (Projects EAT-I, II, and III [Eating and Activity in Teens and Young Adults]). Participants completed surveys and food frequency questionnaires in Minneapolis/St Paul, MN, high school classrooms in 1998-1999 (mean age=15.8 years, adolescence) and follow-up measures in 2003-2004 (mean age=20.4 years, emerging adulthood) and 2008-2009 (mean age=26.2 years, young adulthood). In young adulthood, average daily intake was 0.9 servings of fruit (excluding juice) and 1.8 servings of vegetables (excluding potatoes). Factors examined in adolescence and in emerging adulthood that were predictive of F/V intake in young adulthood included favorable taste preferences, fewer perceived time barriers to healthy eating, higher home availability of F/V, and limited home availability of unhealthy foods. Analyses also identified additional factors that were specifically relevant to fruit (eg, breakfast patterns) or vegetable intake (eg, home food preparation) and of particular relevance during emerging adulthood (eg, significant other’s healthy eating attitudes). Findings suggest individual and socioenvironmental factors, particularly food preferences and home food availability, during adolescence and emerging adulthood may influence F/V intake in young adulthood.

Objective: This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.
Design: Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.
Subjects/setting: The study sample included 902 adolescents and their parent or guardian.
Results: Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P<0.01) and soft drink availability was inversely associated with dairy intake (ttrend=2.08, P=0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend=3.65, P<0.01). Parental intakes were positively associated with dairy intake for boys (ttrend=2.04, P=0.04), and with dairy (ttrend=2.43, P=0.01), vegetable (ttrend=3.72, P<0.01) and fruit (ttrend=3.17, P<0.01) intakes for girls.
Conclusions/applications: Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents’ intake of healthful food choices.

Objective: To identify correlates of calcium, dairy, and milk intakes among male and female adolescents.
Design: Cross-sectional study design. Adolescents self-reported measures pertaining to correlates on the Project EAT (Eating Among Teens) survey and completed a food frequency questionnaire at school.
Subjects/Setting: Subjects were a total of 4,079 middle and high school students from Minneapolis/St Paul, MN, public schools.
Statistical Analyses Performed: Multiple linear regression models based on social cognitive theory were examined by sex.
Results: Male adolescents reported higher daily intakes of calcium (male: 1,217±663 mg; female: 1,035±588 mg; P<0.001), dairy servings (male: 2.9±1.9; female: 2.4±1.7; P<0.001), and milk servings (male: 2.0±1.5; female: 1.5±1.4; P<0.001) than female adolescents. Calcium intakes of male adolescents were significantly and positively related to availability of milk at meals, taste preference for milk, eating breakfast, higher socioeconomic status, and social support for healthful eating; intakes were significantly and inversely related to consumption of soft drinks and fast food. Among female adolescents, availability of milk at meals, taste preference for milk, eating breakfast, higher socioeconomic status, personal health/nutrition attitudes, and self-efficacy to make healthful food choices were significantly and positively related to intakes; intakes were significantly and inversely related to fast-food consumption. Models of calcium intake explained 71% of the variance in male adolescents and 72% of the variance in female adolescents.
Conclusions: Multicomponent interventions with a focus on the family environment are likely to be most effective in increasing calcium intakes among adolescents.

Objective: Evaluate the relationship between maternal concern for healthful eating and maternal and adolescent dietary intake, eating behavior, and home food environment.
Design: Mothers of a subsample of adolescents who participated in a school-based survey (Project Eating Among Teens [EAT]) completed telephone interviews.
Participants: Seven hundred fourteen mother–adolescent pairs.
Variables Measured: Mothers responded to a question regarding how much they are personally concerned with eating healthfully, and adolescents responded to a question regarding perceptions of their mothers’ concern about eating healthfully. Dependent variables included adolescent and parent food intake and home food environment.
Analysis: Multinomial cumulative logistic regression models, adjusted for maternal race/ethnicity, socioeconomic status (SES), and adolescent grade level.
Results: A positive association was found between maternal concern for healthful eating and maternal fruit and vegetable intake, maternal breakfast and lunch consumption, and serving fruits and vegetables in the home. Maternal concern for healthful eating (as reported by mothers) was not associated with adolescent behavior. Adolescent perception of maternal concern for healthful eating was positively associated with adolescent fruit and vegetable intake.
Conclusions and Implications: Mother’s concern for healthful eating is associated with maternal eating behavior and the home food environment. Adolescent perceptions of maternal attitudes are a stronger predictor than actual maternal attitudes of adolescent behavior. Parents should be encouraged to share their beliefs regarding the importance of healthful eating with their adolescents.

Objective: The objective of the present work was to cross-sectionally examine and compare dietary behaviours and home food environments by young adults’ living situation.
Design: Using data from Project EAT (Eating Among Teens)-II, a large diverse youth cohort originally sampled in Minnesota, linear regression was used to examine self-reported meal frequency, dietary intake and home food availability outcomes by living situation (i.e. living with parents, renting an apartment/house or living on a college campus).
Subjects: Young adults (n 1687), mean age 20.5 years.
Results: Results suggested that young adults living with their parents or in rented apartments/houses had less frequent meals, poorer dietary intake and less healthy home food availability compared with those living on campus. These findings were evident even after controlling for sociodemographic factors (e.g. race/ethnicity, socio-economic status), particularly among females.
Conclusions: Although few emerging adults consume diets that are consistent with national recommendations, those living with parents and in rented apartments/houses may represent particularly at-risk groups. These differences in dietary factors across living situations appear to exist beyond the sociodemographic differences in these populations. Effective nutrition and healthy eating promotion strategies are needed for young adults.

Purpose: Parental encouragement for healthy eating and physical activity has been found to be associated with the long-term healthy habits of adolescents, whereas parental encouragement to diet has been associated with disordered eating behaviors among adolescents. However, little is known about how parental encouragement changes as adolescents grow older (longitudinal trends), or how parental encouragement has changed over time (secular trends). This study examined 5-year longitudinal and secular trends in adolescents’ report of their parents’ encouragement to eat healthily, be physically active, and diet.
Methods: Project Eating Among Teens surveyed a cohort of Minnesota adolescents (n = 2,516) in the years 1999 and 2004. Mixed-model regressions were used to assess changes in adolescents’ reports of parental encouragement from early to middle adolescence (middle school to high school) and from middle to late adolescence (high school to post-high school), and secular changes in parental encouragement among middle adolescents between the years 1999 and 2004.
Results: Longitudinally, there were significant decreases in parental encouragement to eat healthy food, be active, and diet between early and middle adolescence. Between middle and late adolescence, among males parental encouragement for all behaviors decreased, whereas among females parental encouragement to diet increased. Few secular changes in parental encouragement were observed between 1999 and 2004.
Conclusion: Given the importance of parental support for healthy eating and physical activity, efforts should be made to help parents maintain a high level of encouragement for their children’s healthy behavior throughout adolescence. Parents of late adolescent females should aim to decrease the pressure on their daughters to diet during these critical developmental years.

The study objectives were to (1) increase our knowledge about family meal patterns of adolescents, (2) identify factors that adolescents perceive as reasons for not eating meals with their family, and (3) assess adolescents’ perceptions on whether they eat more healthful foods at family meals than in other eating situations. Focus group discussions were conducted with 141 adolescents from 7th and 10th grade health education classes from urban junior and senior high schools in Minnesota. Twenty-one focus groups were audiotaped, tapes were transcribed verbatim, transcripts were reviewed for emerging themes, and themes were coded using content analysis procedures. For some adolescents, family meals were part of their daily routine, whereas for others, family meals were not the norm. Diversity also existed with regard to the context of family meals, such as activities during meals and settings for meals. Major reasons for not having meals as a family included parent and teen schedules, teen desire for autonomy, dissatisfaction with family relations, and dislike of food served at family meals. Most of the adolescents thought that they would eat more healthful foods if they ate more often with their families. Key factors that appeared to influence whether participation in family meals would lead to a more healthful diet included food availability at meals, rules around mealtimes, and health-related attitudes of family members. There is great diversity in both the quantity and quality of meals in the families of adolescents. Health care providers working with youth and their families should inquire about family meals and encourage the practice of eating with family members, taking into account what is feasible for a particular family.

This study aimed to increase our understanding of family meal patterns among adolescents. A school-based survey was completed by 252 junior and senior high students. Nearly a third (30.7%) reported that their families had eaten a meal together at least seven times over the past week, but a similar percentage (31.9%) reported two or fewer family meals over the past week. Frequent television viewing during meals was reported by about half (52.8%) of the respondents. Adolescents reported feeling more certain about making healthful food choices at family meals than in other eating situations. Findings from this pilot study indicate that further investigations of family meal patterns among youth and the associations between family meals and eating behaviors are warranted.

Objective: To examine family meal patterns and associations with sociodemographic characteristics and dietary intake in adolescents.
Design: A population-based cross-sectional study design was employed. Adolescents completed the Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire within their schools.
Subjects/setting: The study population included 4,746 middle and high school students from Minneapolis/St. Paul public schools with diverse racial and socioeconomic backgrounds.
Statistical analyses: Associations were examined using cross tabulations, log-linear modeling, and linear regressions.
Results: There was a wide distribution in the frequency of family meals during the previous week: never (14.0%), 1 or 2 times (19.1%), 3 to 6 times (40.1%), and 7 or more times (24.8%). Sociodemographic characteristics associated with more frequent family meals included gender (boys), school level (middle school), race (Asian American), mother’s employment status (not employed), and socioeconomic status (high). Frequency of family meals was positively associated with intake of fruits, vegetables, grains, and calcium-rich foods and negatively associated with soft drink consumption. Positive associations were also seen between frequency of family meals and energy; protein (percentage of total calories); calcium; iron; folate; fiber; and vitamins A, C, E, and B-6.
Conclusions: Family meals appear to play an important role in promoting positive dietary intake among adolescents. Feasible ways to increase the frequency of family meals should be explored with adolescents and their families.

Objective: To determine the association between frequency of family meals and multiple indicators of adolescent health and well-being (tobacco, alcohol, and marijuana use; academic performance; self-esteem; depressive symptoms; and suicide involvement) after controlling for family connectedness.
Methods: Data come from a 1998-1999 school-based survey of 4746 adolescents from ethnically and socioeconomically diverse communities in the Minneapolis/St Paul, Minn, metropolitan area. Logistic regression, controlling for family connectedness and sociodemographic variables, was used to identify relationships between family meals and adolescent health behaviors.
Results: Approximately one quarter (26.8%) of respondents ate 7 or more family meals in the past week, and approximately one quarter (23.1%) ate family meals 2 times or less. Frequency of family meals was inversely associated with tobacco, alcohol, and marijuana use; low grade point average; depressive symptoms; and suicide involvement after controlling for family connectedness (odds ratios, 0.76-0.93).
Conclusions: Findings suggest that eating family meals may enhance the health and well-being of adolescents. Public education on the benefits of family mealtime is recommended.

Purpose: To examine associations between family meal patterns (frequency, priority, atmosphere, and structure of family meals) and disordered eating (unhealthy weight control behaviors, binge eating, and chronic dieting) in adolescent girls and boys.
Methods: Survey and anthropometric data were collected from 4746 ethnically diverse adolescents from public middle and senior high schools who participated in the Project EAT study (Eating Among Teens). Variables of interest included family meal patterns and disordered eating behaviors. Logistic regressions were performed to examine associations between family meal patterns and disordered eating behaviors adjusting for body mass index, sociodemographic characteristics, family connectedness, and weight pressures within the home.
Results: In general, adolescents who reported more frequent family meals, high priority for family meals, a positive atmosphere at family meals, and a more structured family meal environment were less likely to engage in disordered eating. For example, 18.1% of girls who reported 1-2 family meals/week engaged in extreme weight control behaviors compared with 8.8% of girls who reported 3-4 family meals/week. Making family meals a priority, in spite of scheduling difficulties, emerged as the most consistent protective factor for disordered eating. Associations between family meal patterns and disordered eating behaviors tended to be stronger among girls than among boys. Family meal patterns were more consistently associated with unhealthy weight control behaviors than with chronic dieting and binge eating. Although associations between family meals and disordered eating were weakened after adjusting for more global familial factors, including family connectedness and weight-specific pressures within the home, a number of the associations remained statistically significant, suggesting an independent relationship between family meals and disordered eating.
Conclusion: Family meals have the potential to play an important role in the prevention of unhealthy weight control behaviors among youth. Findings suggest that attention needs to be directed toward increasing family meal frequency and creating a positive environment for family meals.

Objective: To examine and compare the family mealtime environment from the perspectives of both adolescents and parents.
Design: Adolescents completed a school-based survey and parents participated in a telephone interview as part of Project EAT (Eating Among Teens).
Subjects/setting: Participants were 902 adolescent females (n=424) and males (n=478) and one of their guardians/ parents.
Statistical analyses performed: Frequencies, Χ2 analyses, and Spearman correlations were used to assess relationships.
Results: Parents were more likely than adolescents to report eating five or more family meals per week, the importance of eating together, and scheduling difficulties (P<0.001). Younger adolescents were more likely than older adolescents to report eating five or more family meals per week, higher importance of eating together, and more rule expectations at mealtime (P<0.001), whereas older adolescents were more likely to report scheduling difficulties (P<0.001). Girls reported more family meals per week and more scheduling conflicts than boys did; boys reported more rules at mealtime than girls did (P<0.001).
Conclusions: Family meals are perceived positively by both adolescents and parents. Family meals may be a useful mechanism for enhancing family togetherness, and for role modeling behaviors that parents would like their children to emulate. Dietetics professionals can capitalize on positive attitudes toward family meals to help promote their frequency. Helping families learn to cook healthful, quick meals may reduce dependency on less healthful meal options, reduce the frequency of eating outside of the home, and promote greater nutritional intake.

Background Cross-sectional research in adolescents has found that eating family meals is associated with better nutritional intake.
Objective To describe meal patterns of young adults and determine if family meal frequency during adolescence is associated with diet quality, meal frequency, social eating, and meal structure during young adulthood.
Design Population-based, 5-year longitudinal study in Minnesota.
Subjects/setting Surveys and food frequency questionnaires were completed by 946 female students and 764 male students in high school classrooms at Time 1 (1998-1999; mean age 15.9 years) and by mail at Time 2 (2003-2004; mean age 20.4 years).
Statistical analyses performed Multiple linear regression models were used to predict mean levels of young adult outcomes from adolescent family meal frequency. Probability testing of trends in each outcome across ordered categories of family meal frequency used linear contrasts.
Results Family meal frequency during adolescence predicted higher intakes of fruit (P<0.05), vegetables (P<0.01), dark-green and orange vegetables (P<0.001), and key nutrients and lower intakes of soft drinks (P<0.05) during young adulthood. Frequency of family meals also predicted more breakfast meals (P<0.01) in females and for both sexes predicted more frequent dinner meals (P<0.05), higher priority for meal structure (P<0.001), and higher priority for social eating (P<0.001). Associations between Time 1 family meals and Time 2 dietary outcomes were attenuated with adjustment for Time 1 outcomes but several associations were still statistically significant.
Conclusions Family meals during adolescence may have a lasting positive influence on dietary quality and meal patterns in young adulthood.

Objective: To examine associations between watching television during family meals and dietary intake among adolescents.
Design: Cross-sectional study using survey data from a diverse sample of adolescents.
Setting: Data were collected from a school-based survey during the 1998-1999 school year.
Participants: Middle and high school students (N=4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%.
Variables Measured: Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals.
Analysis: General linear modeling comparing dietary intake across 3 groups.
Results: 33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals.
Conclusions and Implications: Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.

Objective: To examine 5-year longitudinal associations between family meal frequency and disordered eating behaviors in adolescents.
Design: Longitudinal study.
Setting: Participants from 31 Minnesota schools completed in-class assessments in 1999 (time 1) and mailed surveys in 2004 (time 2). Participants: Adolescents (N=2516) who completed Project EAT (Eating Among Teens)-I (time 1) and -II (time 2) assessments.
Main Outcome Measures: Time 1 family meal frequency and time 2 disordered eating behaviors, including extreme weight control behaviors (self-induced vomiting and use of laxatives, diet pills, or diuretics), less extreme unhealthy weight control behaviors (eating very little, fasting, using food substitutes, skipping meals, or smoking), binge eating, and chronic dieting.
Results: Among adolescent girls, time 1 regular family meals (≥ 5 meals/wk) were associated with lower prevalences of time 2 extreme weight control behaviors (odds ratio, 0.71; 95% confidence interval, 0.52-0.97), even after adjusting for sociodemographic characteristics, body mass index, family connectedness, parental encouragement to diet, and extreme weight control behaviors at time 1. Associations with other disordered eating behaviors were also suggestive of a protective effect of family meals in unadjusted analyses but were not statistically significant in adjusted analyses. Among adolescent boys, regular family meals did not predict lower levels of disordered eating behaviors.
Conclusions: The high prevalence of disordered eating behaviors among adolescent girls and the protective role of family meals suggest a need for interventions aimed at promoting family meals. Further exploration of predictors of disordered eating behaviors in adolescent boys and the role of family meals is warranted.

Purpose: To examine 5-year longitudinal associations between family meal patterns and subsequent substance use in adolescents.
Methods: A total of 806 Minnesota adolescents were surveyed in public schools in 1998–1999 (mean age, 12.8 years) and again by mail in 2003–2004 (mean age, 17.2 years) as part of a longitudinal population-based study. Logistic regression was used to estimate the odds of tobacco, alcohol, and marijuana use at follow-up for adolescents reporting regular family meals at baseline compared with those without regular family meals, adjusting for family connectedness and prior substance use.
Results: Family meal frequency at baseline was associated with significantly lower odds of cigarette smoking, alcohol use, and marijuana use at follow-up among female adolescents, even after adjusting for baseline substance use and additional covariates. Family meals were not associated with use of any substance at follow-up for male adolescents after adjusting for baseline use.
Conclusions: Results from this study suggest that regular family meals in adolescence may have a long-term protective association with the development of substance use over 5 years among females. Parents should be encouraged to establish a pattern of regular family meals, as this activity may have long lasting benefits

This study examined cross-sectional and 5-year longitudinal associations between the frequency of family meals and overweight status (>85th percentile for age and gender) in a large, diverse population of adolescents (n = 2,516). The population included two cohorts (midadolescence to young adulthood, n = 1,710, and early adolescence to midadolescence, n = 806). Logistic regression models tested cross-sectional and longitudinal (1999–2004) associations between family meal frequency and overweight status. Two sets of models are presented: (i) models adjusted only for baseline demographic characteristics and (ii) models also adjusted for physical activity, sedentary behaviors, and energy intake. Longitudinal models adjusted for baseline overweight status. Although significant inverse associations between family meal frequency and overweight status were observed for early adolescent females in all cross-sectional models (P < 0.001), longitudinal associations were not significant. Neither cross-sectional nor longitudinal associations were significant for males of either cohort and older females in any models. Young adolescent females who do not eat meals with their families may be at risk for overweight; however, the increased risk may not persist over a 5-year period. Eating family meals during high school may not protect against overweight during young adulthood. Although previous longitudinal research has suggested significant dietary and psychosocial benefits related to family meal frequency, the weight-related benefits of family meals may be more complex and deserving of further study, including an examination of the quality and quantity of food consumed at family meals.

Objective: To examine longitudinal associations of participation in regular family meals (≥ 5 meals/week) with eating habits and dietary intake during adolescence.
Design: Population-based, longitudinal study (Project EAT: Eating Among Teens). Surveys were completed in Minnesota classrooms at Time 1 (1998-1999) and by mail at Time 2 (2003-2004).
Setting: Baseline surveys were completed in Minneapolis/St. Paul, Minnesota, schools and by mail at follow-up.
Participants: 677 adolescents (303 males and 374 females) who were in middle school at Time 1 (mean age = 12.8 ± 0.74 years) and high school at Time 2 (mean age = 17.2 ± 0.59 years).
Main outcome measures: Dietary intake, frequency of meals, and fast-food intake patterns. ANALYSIS: Generalized linear modeling stratified by gender and adjusted for race/ethnicity, socioeconomic status, and the Time 1 outcome.
Results: Regular family meals were positively associated with Time 2 frequency of breakfast, lunch, and dinner meals for males and breakfast and dinner meals for females. Among males, regular family meals were negatively associated with Time 2 fast-food intake. Regular family meals were also positively associated with Time 2 mean daily intakes of vegetables, calcium-rich food, fiber, calcium, magnesium, potassium, iron, zinc, folate, and vitamins A and B6 among both genders.
Conclusions and Implications: Regular family meals during early adolescence may contribute to the formation of healthful eating habits 5 years later. Parents should be made aware of the importance of shared mealtime experiences.

Objective: Family meals are important to adolescent health, but relatively little is known about TV viewing during family meals. The present paper examines the role that TV viewing during family meals may have on substance use behaviors among adolescents.
Methods: A diverse sample of 806 Minnesota high school students (mean age 17.2 years) provided survey data in 2003-2004 regarding family meal frequency, substance use behavior and general family connectedness. General linear modeling was used to compare substance use across three family meal/TV categories in a cross-sectional analysis.
Results: 28.6% of participants ate regular family meals without TV, and 27.5% had regular family meals while watching TV. Significant differences in cigarette smoking, alcohol and marijuana use were found for females reporting regular family meals versus no regular family meals, but did not differ significantly by TV viewing. No significant differences were found across groups of males.
Conclusions: Results from this study indicate that TV viewing during family meals does not appear to attenuate the previously observed protective relationship between family meals and substance use for females. Benefits of family meals may be derived simply from having adolescents at home during mealtimes.

Objective: The purpose of the present paper is to provide an integrated overview of the research methodology and key findings from a decade of research on family meals as part of Project EAT (Eating Among Teens), a large, population-based study of adolescents.
Design: Focus groups conducted with 141 middle-school and high-school adolescents suggested the importance of family meals in influencing adolescents’ food choices. These findings led to the inclusion of questions on family meals in the Project EAT-I survey, completed by 4746 middle-school and high-school students, and in the Project EAT-II longitudinal survey, completed by 2516 of the original participants five years later. A subset of 902 parents also participated in telephone interviews as part of Project EAT-I.
Results: Findings indicate that many adolescents and parents view family meals in a positive light, but there is great diversity in the context and frequency of family meal patterns in the homes of adolescents. Findings further suggest that family meals may have benefits in terms of dietary intake, disordered eating behaviours, substance use and psychosocial health.
Conclusions: Findings from Project EAT, in conjunction with other research studies on family meals, suggest the importance of working with families to increase the frequency and improve the quality of family meals. Further research is needed in order to elucidate the pathways that underpin the relationships between family meals and health outcomes. Suggestions for a future research agenda based on what was learned from Project EAT are provided.

Background Research on family meals in the past decade has shown a positive association between family meal frequency and adolescent healthy dietary intake. However, less is known about factors within the home environment, such as parenting style, that may be associated with family meal patterns.
Objective The purpose of this study is to test cross-sectional and 5-year longitudinal associations between parenting styles (authoritative, authoritarian, permissive, and neglectful) and the frequency of family meals among adolescents.
Study design Data were from Project Eating Among Teens, a population-based study comprised of youth from diverse ethnic/racial and socioeconomic backgrounds. Two cohorts of adolescents (middle school and high school) completed in-class surveys in 1999 (Time 1) and mailed surveys in 2004 (Time 2). Multiple linear regression models were used to predict mean frequency of family meals at Time 1 and Time 2 from adolescent report of parenting style (both mother and father) at Time 1. Cross-sectional analyses included both adolescent cohorts (n=4,746) and longitudinal analyses included only the younger cohort (n=806) because family meal frequency was not assessed in the older cohort at Time 2.
Results Cross-sectional results for adolescent girls indicated a positive association between maternal and paternal authoritative parenting style and frequency of family meals. For adolescent boys, maternal authoritative parenting style was associated with more frequent family meals. Longitudinal results indicated that authoritative parenting style predicted higher frequency of family meals 5 years later, but only between opposite sex parent/adolescent dyads.
Conclusions Future research should identify additional factors within the home environment that are associated with family meal frequency to develop effective interventions that result in increased family meals for youth. Also, future research should investigate the mealtime behaviors of authoritative parents and identify specific behaviors that dietetics practitioners and other health care providers could share with parents of adolescents to help them increase family meal frequency.

Purpose: To examine the prevalence of adolescents’ vegetarianism in a multiethnic, urban population, and its correlates with demographic, personal, weight-related, and behavioral factors.
Methods: Self-report and anthropometric data were collected from a representative sample of 4746 adolescents from 31 public middle schools and high schools in the Twin Cities area of Minnesota. Students answered questions concerning vegetarianism, food and weight, and health behaviors. Height and weight were directly measured. Comparisons were made between self-reported vegetarians and nonvegetarians; these analyses also assessed gender and race/ethnicity interactions. In the second set of analyses, demographic and behavioral characteristics of more restricted and semi-vegetarians were examined. Analyses were done by logistic regression.
Results: Teenage vegetarians comprise about 6% of the sample. The vegetarians were more likely than nonvegetarians to be female, not black, weight- and body-conscious, dissatisfied with their bodies, and involved in a variety of healthy and unhealthy weight control behaviors. Vegetarians more often reported having been told by a physician that they had an eating disorder and were more likely to have contemplated and attempted suicide. Vegetarian males were found to be an especially high risk group for unhealthy weight control practices. Few ethnic group differences among vegetarians were noted. Adolescents who did not eat chicken and fish were at lower risk than those who also ate chicken and fish.
Conclusions: Adolescent vegetarians are at greater risk than others for involvement in unhealthy and extreme weight control behaviors. Vegetarian males are at particularly high risk. Vegetarianism among adolescents may therefore be a signal for preventive intervention. Adolescents who choose to become vegetarians may also need to learn how to healthfully do so.

Objectives: To examine whether adolescent vegetarians were more likely than nonvegetarian peers to meet the dietary recommendations of the Healthy People 2010 objectives and to examine differences in other nutrients between these 2 groups.
Design: A total of 4746 adolescents from 31 middle and high schools in the Twin Cities area of Minnesota. Data were collected via self-report surveys, with a student response rate of 81.5%.
Setting: Urban secondary schools.
Participants: Participants were equally divided by sex. The mean age was 14.9 years; 34.3% were in junior high school and 65.7% in high school. The racial/ethnic distribution was 48.5% white, 19.0% African American, 19.2% Asian American, 5.8% Hispanic, 3.5% American Indian, and 3.9% mixed or other.
Main Outcome Measures: Questions on vegetarian status and whether particular foods (eggs, dairy foods, chicken, fish) were excluded. Dietary intake was assessed using the Youth and Adolescent Food Frequency Questionnaire.
Results: Vegetarian adolescents were significantly more likely than nonvegetarian adolescents to meet the Healthy People 2010 objectives. This was particularly noteworthy for total fat (70% vs 48%), saturated fat (65% vs 39%), daily servings of vegetables (26% vs 14%), and 5 or more servings of fruits and vegetables (39% vs 28%). Vegetarians were also less likely to eat fast food or drink regular soda and fruit drinks. Vegetarians consumed less vitamin B-12, more diet soda, more caffeine, and more iron.
Conclusion: Adolescent vegetarians have a dietary pattern that is more likely than nonvegetarians to meet the Healthy People 2010 objectives.

Objective: Examine characteristics of current and former adolescent and young adult vegetarians and investigate the relationships between vegetarianism, weight, dietary intake, and weight-control behaviors.
Design: Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT-II: Eating Among Teens).
Setting: Participants completed a mailed survey and food frequency questionnaire in 2004.
Participants: Males and females (n=2,516), ages 15-23 years.
Main outcome measures: Weight status, dietary intake (fruit, vegetables, fat, calories), unhealthful weight-control behaviors.
Analysis: Multiple regression models controlling for socioeconomic status and sex were used to test for significant differences between current, former, and never vegetarians within the younger and older cohort.
Results: Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Current vegetarians in the younger and older cohorts had healthier dietary intakes than nonvegetarians with regard to fruits, vegetables, and fat. Among young adults, current vegetarians were less likely than never vegetarians to be overweight or obese. Adolescent and young adult current vegetarians were more likely to report binge eating with loss of control when compared to nonvegetarians. Among adolescents, former vegetarians were more likely than never vegetarians to engage in extreme unhealthful weight-control behaviors. Among young adults, former vegetarians were more likely than current and never vegetarians to engage in extreme unhealthful weight-control behaviors.
Conclusions and Implications: Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults may experience the added benefit of decreased risk for overweight and obesity. However, current vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors. It would be beneficial for clinicians to inquire about current and former vegetarian status when assessing risk for disordered eating behaviors.

Objective: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 4746 adolescent students.
Design: A survey was administered to students in classrooms at 31 secondary schools in a large metropolitan area in Minnesota, United States. Height and body weight were measured.
Subjects: Students in grades 7-12 who were enrolled in participating schools, had parental consent and were in attendance on the day of data collection.
Measurements: Frequency of fast food restaurant use (FFFRU), dietary intake, and demographic and behavioral measures were self-reported. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Height and body weight were directly measured.
Results: FFFRU was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and was inversely associated with daily servings of fruit, vegetables and milk. FFFRU was positively associated with student employment, television viewing, home availability of unhealthy foods, and perceived barriers to healthy eating, and was inversely associated with students’ own and perceived maternal and peer concerns about healthy eating. FFFRU was not associated with overweight status.
Conclusions: FFFRU is associated with higher energy and fat intake among adolescents. Interventions to reduce reliance on fast food restaurants may need to address perceived importance of healthy eating as well as time and convenience barriers.

Objective: The purpose of the present study was to examine the prevalence of fast-food purchases for family meals and the associations with sociodemographic variables, dietary intake, home food environment, and weight status in adolescents and their parents.
Design: This study is a cross-sectional evaluation of parent interviews and adolescent surveys from Project EAT (Eating Among Teens).
Subjects: Subjects included 902 middle-school and high-school adolescents (53% female, 47% male) and their parents (89% female, 11% male). The adolescent population was ethnically diverse: 29% white, 24% black, 21% Asian American, 14% Hispanic and 12% other.
Results: Results showed that parents who reported purchasing fast food for family meals at least 3 times per week were significantly more likely than parents who reported purchasing fewer fast-food family meals to report the availability of soda pop and chips in the home. Adolescents in homes with fewer than 3 fast-food family meals per week were significantly more likely than adolescents in homes with more fast-food family meals to report having vegetables and milk served with meals at home. Fast-food purchases for family meals were positively associated with the intake of fast foods and salty snack foods for both parents and adolescents; and weight status among parents. Fast-food purchases for family meals were negatively associated with parental vegetable intake.
Conclusions: Fast-food purchases may be helpful for busy families, but families need to be educated on the effects of fast food for family meals and how to choose healthier, convenient family meals.

Purpose: Frequent fast food intake is associated with poorer diet quality and greater weight gain. The aims of this study were to describe changes in fast food intake during the transition from middle adolescence to young adulthood, and to identify baseline correlates of this eating behavior in early young adulthood.

Methods: Data were drawn from Project EAT, a population-based, longitudinal study in Minnesota. Surveys were completed by 935 females and 751 males in high school classrooms at baseline (1998-1999; mean age = 15.9 years) and by mail at follow-up (2003-2004; mean age = 20.5 years).

Results: Frequent intake of fast food (≥ or =3 times/week) was reported by 24% of males and 21% of females during adolescence. At follow-up, in early young adulthood the eating behavior increased among males (33%, p < .001), and there was no further increase among females (23%; p = .16). Baseline snack frequency was positively associated with frequency of fast food intake at follow-up among both genders. Baseline peer support for healthy eating among males and both concern about health and self-efficacy for healthy eating among females were inversely related to follow-up fast food intake. Among females, baseline perceptions of time and taste barriers to healthy eating, lunch frequency, television viewing, and unhealthy food availability at home were also positively associated with follow-up fast food intake.

Conclusions: Interventions are needed to address the high prevalence of frequent fast food intake among adolescents and young adults. Health professionals should help young people identify convenient and healthful food choices for meals and snacks consumed away from home.

Objectives To examine secular and longitudinal changes (1999-2004) in fast food intake among adolescents.
Methods: Adolescents from Minnesota participating in Project EAT (n=2516) were surveyed in 1999 and 2004. Mixed-model regressions were used to assess secular and longitudinal changes in percentage reporting frequent fast food intake (> or =3 times/week) and weekly fast food intake.
Results: Between 1999 and 2004, a secular increase in the percent of adolescents of middle (high school-aged) adolescents reporting frequent fast food consumption was observed (females: 18.9% to 27.3%, p<.01, males: 23.6% to 30.2%, p=.06). Longitudinal increases in frequent fast food consumption were seen from early to middle adolescence (females: 15.8% to 27.3%, p<.01, males: 16.8% to 30.2%, p<.01), and among males, from middle to late adolescence (23.6% to 32.0%, p<.01).
Conclusions: The secular increase in fast food consumption among middle adolescents suggests that socio-environmental changes between 1999 and 2004 may have contributed to adolescents’ fast food intake, while the longitudinal trends indicate the importance of developmental influences on fast food intake. The transition from early to middle adolescence, and for males, from middle into late adolescence, are key periods during which efforts to reduce fast food consumption are needed.

Objective: To identify the socio-environmental, personal and behavioural factors that are longitudinally predictive of changes in adolescents’ fast-food intake.
Design: Population-based longitudinal cohort study.
Setting: Participants from Minnesota schools completed in-class assessments in 1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while in high school.
Subjects: A racially, ethnically and socio-economically diverse sample of adolescents (n 806).
Results: Availability of unhealthy food at home, being born in the USA and preferring the taste of unhealthy foods were predictive of higher fast-food intake after 5 years among both males and females. Among females, personal and behavioural factors, including concern about weight and use of healthy weight-control techniques, were protective against increased fast-food intake. Among males, socio-environmental factors, including maternal and friends’ concern for eating healthy food and maternal encouragement to eat healthy food, were predictive of lower fast-food intake. Sports team participation was a strong risk factor for increased fast-food intake among males.
Conclusions: Our findings suggest that addressing socio-environmental factors such as acculturation and home food availability may help reduce fast-food intake among adolescents. Additionally, gender-specific intervention strategies, including working with boys’ sports teams, family members and the peer group, and for girls, emphasizing the importance of healthy weight-maintenance strategies and the addition of flavourful and healthy food options to their diet, may help reduce fast-food intake.

Background:
Young adults report frequent away-from-home eating; however, little is known regarding what types of restaurants are patronized or whether associations with dietary intake and weight status differ according to restaurant type.
Objective:
This cross-sectional study in a diverse sample of young adults examines sociodemographic differences in the frequency of eating at different types of fast-food and full-service (server brings food to table) restaurants. In addition, this study examines whether associations between away-from-home eating, dietary intake, and weight status differ according to restaurant type.
Design:
There were 1,030 men and 1,257 women (mean age=25.3 years) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). Participants were members of a longitudinal cohort who completed baseline surveys at schools in Minneapolis/St Paul, MN, and completed the EAT-III surveys online or by mail in 2008-2009.
Main outcome measures:
Height, weight, and usual dietary intake were self-reported.
Statistical Analyses Performed:
Regression models adjusted for sociodemographic characteristics were used to examine associations between frequency of restaurant use, dietary intake, and weight status.
Results:
More frequent use of fast-food restaurants that primarily served burgers and french fries was associated with higher risk for overweight/obesity; higher intake of total energy, sugar-sweetened beverages, and fat; and with lower intake of healthful foods and key nutrients. For example, those who reported burger-and-fries restaurant use on three or more occasions per week consumed nearly one additional sugar-sweetened beverage per day compared to those who reported burger-and-fries restaurant use on less than one occasion per week. More frequent use of fast-food restaurants that primarily served sandwiches/subs was related to a few markers of poorer diet quality, but unrelated to weight status. More frequent use of full-service restaurants was also unrelated to weight status and related to higher intake of vegetables.
Conclusions:
There may be a need for interventions to promote healthier food choices among young adults who report frequent burger-and-fries restaurant use.

This study assessed whether the correlates related to physical activity and television viewing differed across gender, grade, and racial groups. Adolescents (n=4746) from 31 junior and senior high schools completed a self-administered survey. Adolescents’ physical activity was related to their families’ and friends’ fitness concerns. Adolescents’ physical activity was also related to their own fitness and health concerns. Few correlates of physical activity differed by gender, age, or race. Television viewing was negatively related to the family’s fitness concerns and health concerns; however, these factors accounted for a small amount of the variance in adolescents’ television viewing. None of the factors related to television viewing differed by age or race groups. Future studies will need to identify the factors related to physical activity and television viewing among adolescents who are at greatest risk for inactivity.

Purpose: To evaluate relationships between parents’ and adolescents’ physical activity and television usage and whether these relationships differed among adolescents from different racial/ethnic backgrounds.
Methods: Adolescents and their parents were separately asked to report information about their eating, exercising, and weight-related behaviors. Among the 900 adolescents, 477 were girls and 423 were boys; 60% were in high school; 29% were white, 23% were black, 21% were Asian, 14% were Hispanic, and 13% were considered mixed or other race/ethnicity.
Results: Parents’ reported encouragement was positively related to physical activity in white (r = 0.39; p < .001) and black boys (r = 0.26; p = .007), and girls (all race/ethnic groups combined: r = 0.15; p < .001). Parents’ television time was positively related to television time in Hispanic boys (r = 0.40; p = .009) but negatively related to television time in black boys (r = -0.23; p = .036). Parents’ concern about their own fitness was negatively related to television time in white girls (r = -0.19; p = .029) but positively related in black girls (r = 0.23; p = .030).
Conclusion: This study found significant, although modest, relationships between parents’ and adolescents’ physical activity attitudes and behaviors. Many of these relationships differed by race/ethnicity. Results from the present and previous studies suggest that factors other than parents’ behavior and support explain adolescents’ physical activity behaviors.

Objective: To describe the demographic characteristics of adolescent boys and girls who engage in three sedentary behaviors (television/video use, computer use, and reading/homework), and to explore how each sedentary activity is associated with body mass index (BMI), dietary behaviors, and leisure time physical activity.
Design: This study draws on data collected from Project EAT (Eating Among Teens), a school-based survey examining personal, behavioral, and socioenvironmental factors that are associated with nutritional intake among adolescents.
Subjects: The study sample consists of 4,746 middle and high school students from 31 public schools in a metropolitan area of the upper Midwest. All students were invited to participate. The overall response rate for Project EAT was 81.5%. Data collection was completed during the 1998-1999 school year.
Statistical analyses: Multivariate linear regression was used for examining associations between independent and dependent variables, controlling for age, race/ethnicity, and socioeconomic status. All differences were considered statistically significant at P<.05.
Results: Among boys, television/video use and time spent reading/doing homework were positively associated with BMI (P<.05), whereas for girls television/video and computer use were positively associated with BMI (P<.05). High television/video use among boys and girls was associated with more unhealthful dietary behaviors (e.g., increased consumption of soft drinks, fried foods, and snacks) (P<.05). In contrast, time spent reading/doing homework was associated with more healthful dietary behaviors (e.g., increased consumption of fruits and vegetables) (P<.05). Leisure time physical activity was not associated with television/video use among boys or girls, but was positively associated with computer use and time spent reading/doing homework (P<.05).
Applications/Conclusions: Messages and advice aimed at reducing time spent in sedentary activities should be targeted at television/video use instead of time spent reading, doing homework, or using a computer. Nutrition education should incorporate messages about the influence of the media and advertising on dietary behaviors.

Objective: To examine eating habits and energy and nutrient intake among adolescents participating in weight-related and power team sports and non-sport-involved adolescents.
Design: Data were drawn from Project EAT (Eating Among Teens), which was conducted with 4,746 adolescents from 31 middle and high schools in the Minneapolis/St Paul metropolitan area.
Setting: Urban secondary schools.
Subjects: Adolescents reporting participation in a weight-related sport, a power team sport, or no consistent participation in a sport.
Main outcome measures: Meal and snack frequency, mean energy and nutrient intake, and mean physical activity.
Statistical analyses performed: Analyses were conducted by sex across the three groups. General linear models were used to compare mean energy and nutrient intake, composite nutrient adequacy, and mean physical activity across the three groups. Percentages of youth meeting nutrient recommendations were compared across the three groups using Χ2 tests.
Results: For both males and females, youth involved in weight-related sports ate breakfast more frequently than non sport-involved peers (females: 3.6 and 3.2 times per week, respectively, P<0.01; males: 4.7 and 3.7 times per week, respectively, P<0.01). Weight-related and power team sport-involved youth also had higher mean protein, calcium, iron, and zinc intakes than non-sport-involved peers. However, adolescent females had low calcium intake, regardless of sports involvement (weight-related sports 1,091 mg/day, power team sports 1,070 mg/day, and non sport-involved 1,028 mg/day, P<0.05).
Conclusions: Sport-involved adolescents have better eating habits and nutrient intake than their non sport-involved peers. However, they are still in need of nutrition interventions, particularly around calcium intake.

Objective: There is little epidemiologic research on longitudinal and secular trends in weight-related health behaviors throughout the stages of adolescence. In particular, few data are available to assess secular trends in various sedentary behaviors. The objective of this research was to investigate longitudinal and secular trends in physical activity and sedentary behavior in a large, diverse cohort of adolescents.
Methods: Project EAT-II is a 5-year longitudinal study (N=2516) that includes 2 cohorts that allow for the observation of longitudinal changes from early to
midadolescence (junior high to high school; n 806; mean baseline age: 12.8±0.8 years) and mid- to late adolescence (high school to post–high school; n=1710; mean baseline age: 15.8±0.8 years). EAT-II also examined secular trends in health behavior from 1999 to 2004 in midadolescence. The main outcome measures of the mixed-model regression analyses used in this research were selfreported weekly hours of moderate to vigorous physical activity, television/video viewing, and leisure-time computer use.
Results: Our findings indicate substantial longitudinal changes in moderate to vigorous physical activity, particularly among girls (decreasing 5.9–4.9 hours/week from early to midadolescence and 5.1–3.5 hours/week from mid- to late adolescence), and leisure-time computer use, particularly among boys (increasing 11.4–15.2 hours/week from early to midadolescence and 10.4–14.2 hours/week from mid- to late adolescence). Secular trends further indicate dramatic increases in midadolescent computer use from 1999 to 2004; girls increased from 8.8 to 11.1 hours/week, and boys increased from 10.4 to 15.2 hours/week.
Conclusions: These adolescents experienced unfavorable shifts in activity patterns, such as longitudinal decreases in moderate to vigorous physical activity, coupled with longitudinal and secular increases in leisure-time computer use. Developing effective health promotion strategies that address a wide array of changing behavioral patterns will be important in promoting long-term health and active lifestyles among adolescents and young adults.

Background: The long-term role that parental encouragement and attitudes about fitness and exercise play in adolescents’ physical activity and sedentary behavior habits remains unclear. This paper aims to longitudinally examine how parental encouragement to be physically active and parental concern about staying fit are associated with adolescents’ physical activity and sedentary behavior habits five years later.
Methods: Project EAT-II adolescent and young adult participants (1130 male, 1386 female) completed surveys while in middle school or high school (1998–1999), and again 5 years later. Participants were asked whether their mother and father encourage them to be physically active and care about staying fit and exercising. Adolescent moderate and vigorous physical activity (MVPA) and TV/video watching (hours/week) were assessed. Linear regression models adjusted for socio-demographic characteristics and baseline behavior were used to examine the association of Time 1 parental factors with behavioral outcomes among adolescents and young adults five years later (Time 2).
Results: After adjustment for socio-demographic characteristics and baseline MVPA, adolescent-reported maternal and paternal encouragement to be active, and paternal care for fitness, were positively associated with weekly hours of MVPA after five years in young adult males (p for trend ≤ .01). The positive relationship between maternal encouragement and MVPA approached significance among high-school aged females (p for trend = .06), and paternal encouragement was positively related to MVPA among high school aged males (p for trend = .02). While maternal encouragement to be active was associated with decreased TV/video time among younger females (p for trend = .02), other parental factors were not associated with lower TV/video time among the other groups.
Conclusion: Parental encouragement to be active was associated with increased physical activity among males and younger females 5 years later. Younger adolescents appear to be especially influenced by their same-sex parent. These findings suggest that encouragement may be more influential than parental concern for fitness on adolescents’ physical activity habits. Further research is needed to determine how parents can help adolescents decrease sedentary behavior time.

Purpose: To examine cross-sectional and longitudinal associations between socioeconomic status (SES), gender, sports participation and moderate-to-vigorous physical activity (MVPA) in adolescents.
Methods: Project EAT (Eating Among Teens), a population-based longitudinal study followed a socioeconomically and ethnically diverse sample of 1709 adolescents in 1998–1999 (Time 1) and 2003–2004 (Time 2). Mixed model regression analyses were used to examine longitudinal trends in MVPA as a function of SES and previous sports involvement.
Results: For both genders, participation in organized sports and weekly hours of MVPA were positively associated with SES. On average, MVPA decreased between high school and young adulthood for both genders. Adolescents who participated in sports during high school showed a steeper decline in weekly hours of MVPA than their non–sports-participating counterparts. SES had a significant moderating effect on the change in MVPA over time for boys who participated in organized sports, with low SES boys showing a steeper decline in MVPA between time periods than higher SES boys. Although on average, a statistically significant difference in MVPA between previous sports participants and nonparticipants remained at Time 2, for all SES groups and both genders, the gap between hours of MVPA was either overcome or significantly narrowed by young adulthood.
Conclusions: Increased dependence on organized sports for MVPA may be insufficient to meet the needs of youth following high school, especially for low SES youth. Designing physical activity promotions that reach and address the unique needs of lower SES youth and families is a public health priority.

Background: Although parenthood is a common life event in early adulthood, little is known about whether parenthood is associated with weight and weight-related health behaviors, including dietary intake and physical activity.
Objective: In this article we examine whether parents of young children (aged ≤5 years) report different dietary intake, physical activity, and BMIs compared with young adults without children.
Methods: Data for this analysis were drawn from the second and third waves of Project EAT (Eating and Activity in Teens and Young Adults), a longitudinal population-based cohort study. Young adults (838 women, 682 men) from diverse ethnic and socioeconomic backgrounds were included. Gender-stratified linear regression models were used to examine associations between parental status and dietary intake, hours of physical activity, and BMI. Results were adjusted for each health behavior outcome level 5 years earlier (time 2).
Results: Results indicate that although many dietary behaviors were the same between parents and nonparents, mothers reported greater consumption of sugar-sweetened beverages, total energy, and percent saturated fat compared with women without children. Both mothers and fathers had lower amounts of physical activity compared with nonparents. Mothers had higher mean BMIs than women without children. No difference was observed in BMIs between fathers and men without children.
Conclusions: Our findings suggest that pediatricians and health care providers may want to consider discussing dietary intake and physical activity with new parents to identify ways to engage in healthful behaviors given the daily demands of parenthood, both to improve parents’ own health and to help them model healthful behavior for their children.

Purpose:
Parental encouragement for healthy eating and physical activity has been found to be associated with the long-term healthy habits of adolescents, whereas parental encouragement to diet has been associated with disordered eating behaviors among adolescents. However, little is known about how parental encouragement changes as adolescents grow older (longitudinal trends), or how parental encouragement has changed over time (secular trends). This study examined 5-year longitudinal and secular trends in adolescents’ report of their parents’ encouragement to eat healthily, be physically active, and diet.
Methods:
Project Eating Among Teens surveyed a cohort of Minnesota adolescents (n = 2,516) in the years 1999 and 2004. Mixed-model regressions were used to assess changes in adolescents’ reports of parental encouragement from early to middle adolescence (middle school to high school) and from middle to late adolescence (high school to post-high school), and secular changes in parental encouragement among middle adolescents between the years 1999 and 2004.
Results:
Longitudinally, there were significant decreases in parental encouragement to eat healthy food, be active, and diet between early and middle adolescence. Between middle and late adolescence, among males parental encouragement for all behaviors decreased, whereas among females parental encouragement to diet increased. Few secular changes in parental encouragement were observed between 1999 and 2004.
Conclusion:
Given the importance of parental support for healthy eating and physical activity, efforts should be made to help parents maintain a high level of encouragement for their children’s healthy behavior throughout adolescence. Parents of late adolescent females should aim to decrease the pressure on their daughters to diet during these critical developmental years.

Objective: To determine whether adolescent attitudes towards sports, exercise, and fitness predict moderate-to-vigorous physical activity 5 and 10 years later.
Method: A diverse group of 1902 adolescents participating in Project Eating and Activity in Teens, reported weekly moderate-to-vigorous physical activity and attitudes toward sports, exercise, and fitness in Eating and Activity in Teens-I (1998-99), Eating and Activity in Teens-II (2003-04), and Eating and Activity in Teens-III (2008-09).
Results: Mean moderate-to-vigorous physical activity was 6.4, 5.1, and 4.0 hours/week at baseline, 5-year, and 10-year follow-up, respectively. Attitudes toward sports, exercise, and fitness together predicted moderate-to-vigorous physical activity at 5 and 10 years. Among the predictors of 5- and 10-year moderate-to-vigorous physical activity, attitude’s effect size, though modest, was comparable to the effect sizes for sports participation and body mass index. Adolescents with more-favorable attitudes toward sports, exercise, and fitness engaged in approximately 30%-40% more weekly moderate-to-vigorous physical activity at follow-up (2.1 hour/week at 5 years and 1.2 hour/week at 10 years) than those with less-favorable attitudes.
Conclusion: Adolescents’ exercise-related attitudes predict subsequent moderate-to-vigorous physical activity independent of baseline behavior suggesting that youth moderate-to-vigorous physical activity promotion efforts may provide long-term benefits by helping youth develop favorable exercise attitudes.

Purpose: To explore the prevalence and correlates of using steroids for the purpose of gaining muscle among adolescent males and females. More specifically, the study objectives were to: (a) assess the prevalence of anabolic steroid use in a large population-based sample of adolescent males and females; and (b) identify personal, socio-environmental, and behavioral factors related to the health of adolescents that use anabolic steroids.
Methods: The study population included 4746 middle and high school students from St. Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of a population-based study of eating patterns and weight concerns among teenagers (Project EAT: Eating Among Teens). Steroid use and a range of socio-environmental, personal, and behavioral factors hypothesized to be correlates of steroid use were assessed. Associations were examined separately among males and females through comparisons of means (unadjusted and adjusted for grade-level and race) for continuous variables, and percentages, and odds ratios for dichotomized variables.
Results: Steroid use was more common in males (5.4%, vs. 2.9% of females), non-Caucasians (especially Hmong, a subset of the Asian-American population), and in middle school students (as compared to high school). In males, steroid use was associated with poorer self-esteem and higher rates of depressed mood and attempted suicide, poorer knowledge and attitudes about health, greater participation in sports that emphasize weight and shape, greater parental concern about weight, and higher rates of disordered eating and substance use. Among females, steroid use was less consistent in its associations with other variables, although overall, a similar pattern of results emerged.
Conclusions: Anabolic steroid use in adolescence is associated with poorer health-related attitudes and behaviors and exposure to socio-environmental influences encouraging weight preoccupation. Attention needs to be directed toward youth who may be at increased risk for steroid use within clinical and community-based settings

Objective: We examined the prevalence, persistence, secular and longitudinal trends, and predictors of steroid use in a diverse sample of adolescents.
Participants and Methods: Data are from Project EAT-II (Eating Among Teens), a 5-year longitudinal study of eating, activity, weight, and related variables in 2516 middle and high school students. Data were collected in 1999 (time 1) and 2004 (time 2).
Results: Approximately 1.5% of adolescents reported steroid use at time 2. Use differed by ethnicity but not socioeconomic status. Steroid use was not stable across time, although the risk of use at time 2 was higher for girls and (marginally) for boys who used steroids at time 1. No secular trends were noted in middle adolescents’ steroid use between 1999 and 2004. Developmentally, steroid use decreased as adolescents grew older. Predictors of use for male adolescents included wanting to weigh more and reporting higher use of healthy weight-control behaviors. Female time 2 steroid users had higher BMIs and were less satisfied with their weight, had poorer nutrition knowledge and concern for health, and were marginally more likely to have participated in weight-related sports at time 1.
Conclusions: The prevalence of steroid use in adolescents was low but of concern. Although use was not persistent over 5 years, time 1 use was a risk factor for time 2 use in female adolescents. There was no change in the prevalence of steroid use by middle adolescents between 1999 and 2004 despite a great deal of public interest in steroids during this time period. Steroid use decreased as adolescents
grew older. Weight-related variables predicted adolescents’ steroid use 5 years later, and health and nutrition knowledge and concern and (marginally) participation in weight-related sports further predicted use in female adolescents. These findings suggest that early preventive efforts may be most useful.

Objective: To determine whether adolescents who participate in a weight-related sport are at increased risk for unhealthful weight-control behaviors and steroid use.
Design: This was a population-based study (Project EAT [Eating Among Teens]).
Subjects/setting: Subjects were 4,746 adolescents (50.2% males, 49.8% females) from 31 public middle and high schools in the Minneapolis/St Paul area of Minnesota.
Statistical analysis performed: Descriptive statistics, χ2 analyses, and multiple logistic regression were used. Data were adjusted for sociodemographic variables and body mass index.
Main outcome variables: Unhealthful weight-control behaviors and steroid use.
Results: More males (20.4%) than females (16.2%) reported participation in a weight-related sport. Males who reported participation in a weight-related sport had an increased risk of past-week vomiting (odds ratio [OR]=5.7), laxative use (OR=6.8), as well as past-year vomiting (OR=4.9), laxative use (OR=3.4), diuretic use (OR=6.0), and steroid use (OR=3.7), compared with those males who did not report participation. Females who reported participation in a weight-related sport had an increased risk of past week vomiting (OR=2.1), as well as past year vomiting (OR=2.0), laxative use (OR=2.6), and steroid use (OR=2.6), compared with those who did not report participation in a weight-related sport.
Conclusions: The current study shows that participation in a sport that adolescents perceive as emphasizing weight is strongly associated with unhealthful weight-control behaviors and steroid use. Preventive efforts, targeting parents, coaches, and adolescents are needed to decrease this risk.

Objectives: This study aimed to assess the prevalence of perceived weight-teasing and associations with unhealthy weight-control behaviors and binge eating in a population-based sample of youth. Particular focus was placed on overweight youth, who may be most vulnerable to weight-teasing.
Methods: The study population included 4746 adolescents from St Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of Project EAT, a population-based study of eating patterns and weight concerns among teens.
Results: There were statistically significant associations between perceived weight-teasing and weight status; both overweight and underweight youth reported higher levels of teasing than average weight youth. Very overweight youth (body mass index (BMI)≥95th percentile) were most likely to be teased about their weight; 63% of very overweight girls, and 58% of very overweight boys reported being teased by their peers, while weight-teasing by family members was reported by 47% of these girls and 34% of these boys. Youth who were teased about their weight, particularly overweight girls, reported that it bothered them. Perceived weight-teasing was significantly associated with disordered eating behaviors among overweight and non-overweight girls and boys. For example, among overweight youth, 29% of girls and 18% of boys who experienced frequent weight-teasing reported binge-eating as compared to 16% of girls and 7% of boys who were not teased.
Conclusions: Many adolescents, in particular those who are overweight, report being teased about their weight and being bothered by the teasing. Weight-teasing is associated with disordered eating behaviors that may place overweight youth at increased risk for weight gain. Educational interventions and policies are needed to curtail weight-related mistreatment among youth.

Background: Verbal harassment, such as bullying and hate speech, has received considerable attention recently, but less is known about weight-based teasing and its potential harmful effects on young people’s psychosocial well-being.
Objective: To determine the associations of weight-based teasing and body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts using a large sample of adolescents.
Design: Secondary analysis of survey and anthropometric data.
Setting: Ethnically and socioeconomically diverse communities in the urban and suburban school districts of the Minneapolis/St Paul metropolitan area.
Participants: A school-based sample of 4746 adolescents in grades 7 to 12 at 31 public middle schools and high schools.
Main Outcome Measures: Weight-based teasing from peers or family members, body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts.
Results: Of the eligible students, 81.5% participated; 30.0% of adolescent girls and 24.7% of adolescent boys were teased by peers, and 28.7% of adolescent girls and 16.1% of adolescent boys were teased by family members. Approximately 14.6% of adolescent girls and 9.6% of adolescent boys reported teasing from both of these sources. Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms, and thinking about and attempting suicide, even after controlling for actual body weight. These associations held for adolescent boys and girls, across racial, ethnic, and weight groups. Furthermore, teasing from 2 sources was associated with a higher prevalence of emotional health problems than either teasing from a single source or no teasing.
Conclusions: Physicians and other health care providers should recognize the importance of weight-based teasing for young patients. Policy, programs, and education should focus on increasing awareness of what constitutes weight-based teasing, its potentially harmful effects on adolescents’ emotional well-being, and reduction of this behavior.

This study described peer harassment in a large, multiethnic sample of adolescents, and explored the relationship between experiencing peer harassment and both school connectedness and achievement. Survey data came from 4,746 students in grades 7-12 at 31 public schools in ethnically and socieconomically diverse communities in a Midwestern state. Frequency of five types of harassment were analyzed with data on school connectedness and grades. Multivariate analysis controlled for gender, grade level, race/ethnicity, and socioeconomic status. Results indicate that most students periodically experience mistreatment; 10% to 17% report being treated disrespectfully, having others act superior, or being insulted at least once per week, and an additional 14% to 22% of students report suffering these behaviors a few times per month. Girls, Whites, Native Americans, and middle school students reported more harassment than boys, other ethnic groups, and high school students, respectively. Peer harassment related significantly to both aspects of school life: those who disliked school tended to suffer more mistreatment, and “B” students reported the least harassment on average. Young people mistreated by peers may not want to be in school and may thereby miss out on the benefits of school connectedness as well as educational advancement. The high prevalence of peer harassment and its association with school connectedness and school achievement provide justification for interventions aimed at prevention of peer harassment. A schoolwide approach using educational and policy components may provide an appropriate prevention strategy.

Purpose: To determine if weight-teasing predicts subsequent low self-esteem, poor body image, and depressive symptoms; and to examine two mechanisms through which early teasing may influence later emotional health.
Methods: A racially and socio-economically diverse sample of 2516 adolescents completed surveys for both Wave 1 (1998 –99) and Wave 2 (2003– 04) of the Project EAT study. Approximately one third of these were early adolescents who transitioned into middle adolescence, and two thirds were middle adolescents who transitioned into young adulthood. Multiple linear regression analysis was conducted in three stages to test Model A: the total effect of Time 1 teasing on Time 2 emotional health; Model B: Model A, mediated by Time 2 teasing and body mass index (BMI); and Model C: Model B, also mediated by Time 1 emotional health.
Results: Approximately one third of males and slightly under half of females reported that they had been teased about their weight at Time 1. Time 1 teasing predicted lower self-esteem, lower body image, and higher depressive symptoms at Time 2 for males and females in the older and younger age groups. This relationship was fully mediated, however, by Time 2 teasing and BMI, and by Time 1 emotional health. Adjusted R2 statistics for the final models ranged from .11 to .36.
Conclusions: Weight-teasing in adolescence affects emotional well-being at 5-year follow-up, and appears to function through two mechanisms. Reducing early teasing and its concurrent damages to emotional health may prevent longer-term emotional health consequences.

Purpose: To determine if weight-teasing predicts subsequent low self-esteem, poor body image, and depressive symptoms; and to examine two mechanisms through which early teasing may influence later emotional health.
Methods: A racially and socio-economically diverse sample of 2516 adolescents completed surveys for both Wave 1 (1998 –99) and Wave 2 (2003– 04) of the Project EAT study. Approximately one third of these were early adolescents who transitioned into middle adolescence, and two thirds were middle adolescents who transitioned into young adulthood. Multiple linear regression analysis was conducted in three stages to test Model A: the total effect of Time 1 teasing on Time 2 emotional health; Model B: Model A, mediated by Time 2 teasing and body mass index (BMI); and Model C: Model B, also mediated by Time 1 emotional health.
Results: Approximately one third of males and slightly under half of females reported that they had been teased about their weight at Time 1. Time 1 teasing predicted lower self-esteem, lower body image, and higher depressive symptoms at Time 2 for males and females in the older and younger age groups. This relationship was fully mediated, however, by Time 2 teasing and BMI, and by Time 1 emotional health. Adjusted R2 statistics for the final models ranged from .11 to .36.
Conclusions: Weight-teasing in adolescence affects emotional well-being at 5-year follow-up, and appears to function through two mechanisms. Reducing early teasing and its concurrent damages to emotional health may prevent longer-term emotional health consequences.

Objective: To examine 5-year longitudinal and secular trends in weight-related teasing among adolescents.
Methods and Procedures: Project EAT-II (Eating Among Teens–II) followed 2,516 adolescents (females = 1,386, 55.1%) prospectively from 1999 to 2004. EAT-II included two cohorts allowing the observation of longitudinal changes in reported weight-related teasing as participants transitioned from early to mid-adolescence (middle school to high school) and from mid- to late-adolescence (high school to post–high school). EAT-II also allowed the examination of secular trends in reported teasing among middle adolescents in 1999 and 2004.
Results: In 1999, approximately one-quarter of adolescents in the total sample (including both overweight and nonoverweight youth) reported being teased about their weight in early adolescence and mid-adolescence. Prevalence rates of teasing were higher among overweight youth (early adolescence: females 42.4%, males 44.6%; mid-adolescence: females 31.2%, males 40.8%). Longitudinal trends suggest that weight-related teasing decreased among overweight males and females in the younger cohort as they transitioned from early adolescence to midadolescence. In the older cohort of youth, teasing decreased in the total sample of females as they transitioned from mid-adolescence to older adolescence. Analyses of age-matched secular trends among middle adolescents showed that the prevalence of weight-related teasing remained stable among most adolescent subgroups and declined among overweight males between 1999 and 2004.
Discussion: Weight-related teasing is prevalent through the various stages of adolescence. Our findings point to a need for ongoing interventions, throughout adolescence, which focus on reducing weight-related teasing and improving social supports for affected youth.

Objective: The current study examined general, peer, and family weight teasing across race/ethnicity and weight status (average weight, overweight, obese) in adolescents. For those participants who reported peer or family weight teasing, the extent to which this teasing bothered them was also reported.
Methods and Procedures: Data were from the first wave of Project EAT (Eating Among Teens), a longitudinal study of eating and weight-related variables in 4,746 adolescent boys and girls. Participants completed a survey and their height and weight were measured.
Results: Prevalences of general weight teasing were similar across race/ethnicity. Asian-American boys, black boys, and Asian-American girls reported lower prevalences of peer teasing than whites. Hispanic, Asian-American, and mixed/other girls reported higher prevalences of family weight teasing than did white girls. In nearly all racial/ethnic groups for all three teasing variables, obese adolescents were significantly more likely to report having been teased, compared to average-weight adolescents. In some racial/ethnic groups overweight adolescents were also significantly more likely than average-weight adolescents to report having been teased. Among girls who were teased, fewer black and mixed/other girls were bothered by peer teasing, compared to white girls. Similarly, fewer girls from most racial/ethnic groups were bothered by family weight teasing, compared to white girls.
Discussion: The results of the current study suggest that weight-based teasing is a problem for all youth, and especially so for overweight and obese youth, regardless of racial/ethnic group. Asian-American adolescents may experience somewhat less weight teasing from peers, and possibly more weight teasing from family members. One-quarter to one-half of those teased by family or peers were bothered by it, and more white girls were bothered than
other groups. Efforts to eradicate weight stigmatization could provide benefits to a sizable number of adolescents across a variety of racial and ethnic groups.

Weight teasing is common among adolescents, but less is known about the continuation of this experience during young adulthood. The present study uses survey data from a diverse sample of 2287 young adults, who participated in a 10-year longitudinal study of weight-related issues to examine hurtful weight comments by family members or a significant other. Among young adults, 35.9% of females and 22.8% of males reported receiving hurtful weight-related comments by family members, and 21.2% of females and 23.8% of males with a significant other had received hurtful weight-related comments from this source. Hispanic and Asian young adults and overweight/obese young adults were more likely to report receiving comments than those in other groups. Weight teasing during adolescence predicted hurtful weight-related comments in young adulthood, with some differences by gender. Findings suggest that hurtful weight talk continues into young adulthood and is predicted by earlier weight teasing experiences.

Research has found that weight-teasing is associated with disordered eating in adolescents. This study expands on the existing research by examining associations between hurtful weight comments by family and a significant other and disordered eating in young adults. Data come from 1,902 young adults (mean age 25) who completed surveys in 1998, 2003 and 2009. Correlations were examined between receiving hurtful comments from family and significant others, and four disordered eating behaviors in young adulthood, adjusting for prior disordered eating and prior teasing. Disordered eating behaviors were common in young adulthood, and were associated with hearing hurtful weight-related comments from family members and a significant other, for both females and males. Disordered eating prevention activities, which include messages about the potential harm associated with hurtful weight-related comments, should be expanded to address young adults, and programs may want to target relationship partners.

PURPOSE: Dieting is a well-established risk factor for binge eating, yet the majority of dieters do not develop binge eating problems. The purpose of the current study was to examine psychosocial factors involved in the relation between dieting and binge eating over a 10-year follow-up period. METHODS: A population-based sample (n = 1,827) completed surveys assessing eating habits, psychological functioning, and weight status at 5-year intervals spanning early/middle adolescence (time 1), late adolescence/early young adulthood (time 2), and early/middle young adulthood (time 3). Dieting, along with depression symptoms, self-esteem, and teasing experiences at time 1 and time 2, was used to predict new onset binge eating at time 2 and time 3, respectively. Interactions between dieting status and varying degrees of these psychosocial factors in relation to binge eating onset were also tested. RESULTS: Dieters were two to three times more likely than nondieters to develop binge eating problems over 5-year follow-ups. At most time points, depression symptoms and self-esteem predicted binge eating onset beyond the effects of dieting alone. Detrimental levels of these factors among dieters (relative to nondieters) increased the likelihood of binge eating onset only during the later follow-up period. CONCLUSIONS: Depression and self-esteem appear to be particularly salient factors involved in the relation between dieting and binge eating onset among adolescents and young adults. Early identification of these factors should be a priority to prevent the development of binge eating problems among already at-risk individuals.

Objective: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls.
Methods: The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating).
Results: In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys.
Conclusions: Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.

Objective: To assess the relationships between mothers’ reports of dieting and encouraging adolescents to diet and adolescents’ reports of their own dieting practices and weight-related concerns.
Design: Cross-sectional study of parent interviews and adolescent surveys in an ethnically-diverse sample.
Subjects: A total of 810 adolescents (n=381 boys and n=429 girls) and their mothers.
Results: Mothers’ dieting was associated with their adolescent girls’ weight-related concerns and behaviors, but these associations were not significant after adjusting for girls’ body mass index (BMI). In contrast, mothers’ encouragement for sons to diet was associated with sons’ binge eating, dieting and other weight-control behaviors, even after controlling for sons’ BMI. Compared with mothers who did not encourage their child to diet, mothers who encouraged their child to diet were significantly heavier women and were more likely to view their child as overweight. Forty-three percent of boys and 46% of girls who were encouraged by their mothers to diet were classified as nonoverweight by federal guidelines.
Conclusions: Boys who are encouraged by their mothers to diet may be at risk for health-compromising eating and dieting behaviors, particularly binge-eating, fasting, eating a little bit of food and skipping meals. Parents who are concerned about their children’s weight should be educated to encourage healthy eating habits and physical activity to promote their children’s health, including healthy weight control.

Objectives: This study sought to determine whether adolescents engaging in weight control behaviors are at increased risk for tobacco, alcohol, and marijuana use; suicide ideation and attempts; and unprotected sexual activity.
Methods: Data were collected on a nationally representative sample of 16,296 adolescents taking part in the 1993 Youth Risk Behavior Survey.
Results: Adolescents using extreme weight control behaviors were at increased risk for health-compromising behaviors, while associations with other weight control behaviors were weak and inconsistent.
Conclusion: The findings have relevance to clinical work with youth, provide a better understanding of disordered eating, and open up a number of opportunities for future research.

Objective: To examine associations between healthful and unhealthful weight-control behaviors and dietary intake among adolescents.
Design: Cross-sectional survey (Project EAT [Eating Among Teens]).
Subjects/Setting: The study population included 4,144 middle and high school students from Minneapolis/St. Paul public schools from diverse racial and socioeconomic backgrounds.
Statistical Analyses: Dietary intake patterns were compared across adolescent girls and boys reporting unhealthful, only healthful, or no weight-control behaviors in unadjusted analyses and analyses adjusted for sociodemographic factors and energy intake.
Results: Among girls, mean intakes differed across weight-control behaviors for all foods and nutrients examined. P values ranged from P=.006 to P<.001. Girls using unhealthful weight-control behaviors had significantly lower intakes of fruit; vegetables; grains; calcium; iron; vitamins A, C, and B-6; folate; and zinc than girls using only healthful weight-control behaviors. Compared with girls reporting no weight-control behaviors, girls using unhealthful weight-control behaviors had lower intakes of grains, calcium, iron, vitamin B-6, folate, and zinc. In contrast to the girls, boys reporting unhealthful weight-control behaviors did not have poorer dietary intakes than boys not using weight-control behaviors or using only healthful behaviors. Among boys, there were no significant differences in mean intakes of vegetables; grains; calcium; iron; vitamins A, C, and B-6; folate; and zinc. Furthermore, boys using unhealthful weight-control behaviors had higher fruit intakes (P=.002) than boys reporting no weight-control behaviors.
Conclusions: Adolescent girls who engage in unhealthful weight-control behaviors are at increased risk for dietary inadequacy. The findings demonstrate a need for interventions to prevent unhealthful weight-control behaviors in adolescent girls, and to promote healthful weight-control behaviors when indicated.

Dieting is common among adolescent girls and may place them at risk of using unhealthyweight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, maybe associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends’ dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends’ involvement with dieting, using χ2 analysis and multivariate logistic regression, controlling for demographic factors and clustering bys chool. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends’ dieting behavior was significantly associated with UWCBs for average weight girls (OR=1.57, CI=1.40–1.77) and moderately overweight girls (OR=1.47, CI=1.19–1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th–85th percentile; OR=1.17, CI=1.01–1.36), and marginally associated for modestly overweight girls (85th–95th percentile; OR=1.21, CI=.97–1.50), even after controlling for friends’ dieting behaviors. The social influences examined here were not associated with UWCBs among underweight (<15th percentile) or overweight (>95th percentile) girls. Findings suggest that social norms, particularly from within one’s peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.

Objective: To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later.
Design: Population-based 5-year longitudinal study.
Participants Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).
Main outcome measures: Weight status, binge eating, extreme weight control, and self-reported eating disorder.
Statistical analysis: Multiple linear and logistic regressions.
Results: Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors.
Conclusions: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Purpose: To examine correlates of dieting behavior in overweight and non-overweight youth.
Methods: Data came from Project EAT (Eating Among Teens), a study of eating and weight-related attitudes, behaviors, and psychosocial variables among 4746 adolescents in public schools. Logistic regression was used to compare dieters and non-dieters, and to examine interactions of dieting and overweight status.
Results: Approximately one third (31.8%) of the sample was overweight. Dieting in the previous year was reported by 55.2% of girls and 25.9% of boys. Dieting was associated with similarly elevated rates of extreme weight control behaviors, body dissatisfaction, and depression in both the non-overweight and overweight groups for both boys and girls. Girls reporting dieting behavior in both the non-overweight and overweight groups had similarly elevated risk for cigarette use, alcohol use, and marijuana use.
Conclusions: The negative correlates of dieting are similarly common among teens of varying weight status. These data suggest that dieting may not be a preferred method of weight management, even for overweight adolescents. Regardless of weight status, dieting may be a marker for other unhealthy behaviors and depressed mood in adolescents.

Objective: The purpose of this study was to explore the relationship between maternal and adolescent weight-related behaviors and concerns in a population-based sample.
Methods: Participants were 810 adolescents (n=429 girls and n=381 boys) and their mothers/guardians. Adolescents were part of the Project EAT (Eating Among Teens) study, which was a comprehensive study of eating patterns and weight concerns among adolescents in Minnesota. Outcome variables included child’s body dissatisfaction, weight concerns, dieting, and use of healthy and unhealthy weight control behaviors.
Results: Adolescents reported lower rates of maternal dieting than mothers. Maternal self-report of dieting was not significantly associated with children’s weight-related concerns. Children’s perceptions of their mothers’ behaviors were significantly related to their level of weight concerns and use of weight control behaviors.
Conclusion: Adolescents’ perceptions of maternal behavior affect their weight-related concerns and behaviors. This suggests that mothers who choose to diet should model healthy choices in the areas of nutrition and physical activity.

Objective: Dieting has been found to predict weight gain in adolescents, but reasons for this association remain unclear. This study aimed to explore potential mechanisms by which dieting predicts weight gain over time in adolescents.
Design: Population-based, 5-year longitudinal study.
Participants: Adolescents (n=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).
Main outcome measure: Body mass index (BMI) change over 5 years.
Statistical analysis: Multiple regressions were used to examine associations between Time 1 dieting and Time 2 binge eating, breakfast consumption, fruit and vegetable intake, and physical activity. Associations were then examined between these behaviors and BMI change. Finally, to test for mediating effects, associations between dieting and BMI change were examined with and without the inclusion of these behaviors, and regression coefficients were compared.
Results: In female adolescents, dieting predicted increased binge eating (P<0.001) and decreased breakfast consumption (P=0.030). In male adolescents, dieting predicted increased binge eating (P<0.001), decreased physical activity (P=0.006), and a trend toward decreased breakfast consumption (P=0.064). These behaviors were also associated with increases in BMI. The association between dieting and BMI increase was weakened, but still remained significant, after binge eating, breakfast consumption, fruit/vegetable intake, and physical activity were included in the model being tested. Thus, the longitudinal association between dieting and BMI increase was partially mediated by these behaviors.
Conclusions: In part, dieting may lead to weight gain via the long-term adoption of behavioral patterns that are counterproductive to weight management.

Objective: To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a populationbased
sample of youth.
Subjects: A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT).
Method: Participants completed surveys and anthropometric measurements of height and weight.
Results: Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes.
Conclusions: Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.

Associations between stressful life events and disordered eating behaviors were examined in 1708 older adolescents. Stressful life events were positively associated with extreme weight control behaviors and binge eating in both male and female respondents, emphasizing the importance of screening for disordered eating behaviors among adolescents who report experiencing stressful life events.

Objective: The objective of this study is to identify predictors of prevalence and incidence of disordered eating (binge eating and extreme weight control behaviors) among overweight adolescents.

Method: Five-year longitudinal associations were examined in 412 overweight adolescents who participated in Project EAT-I and II.

Results: Among both overweight males and females, risk factors for disordered eating included exposure to weight loss magazine articles, higher weight importance, and unhealthy weight control behaviors, while family connectedness, body satisfaction, and regular meals were protective factors, although there were some differences in predictors of prevalence (total cases) versus incidence (new cases) of disordered eating. Among males, poor eating patterns, including fast food and sweetened beverage intake, increased risk for disordered eating, and the use of healthy weight control behaviors was protective.

Discussion: Attention should be directed toward decreasing disordered eating among overweight adolescents. Findings suggest the importance of promoting positive family relationships, psychological health, and regular meals, and steering adolescents away from overemphasizing weight and using unhealthy weight control behaviors.

Background: Cross-sectional research has found that dieting during adolesence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships.
Objective: To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults.
Design: Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004.
Subjects/Setting: The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2.
Outcome Measures and Statistical Analyses Performed: Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting).
Results: Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior.
Conclusions: Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.

Background: Unhealthy weight control behaviours (UWCB) among adolescents have significant health and weight consequences. The current longitudinal study aimed to identify personal and socio-environmental predictors of initiation or persistence of adolescent UWCB, in order to inform development of programs aimed at both preventing and stopping UWCB.
Methods: A diverse sample included 1106 boys and 1362 girls from 31 middle schools and high schools in the United States who were enrolled in Project EAT (Eating Among Teens). Project EAT explored personal, behavioural, and socio-environmental factors associated with dietary intake and body weight in adolescence. Participants completed questionnaires to assess demographics, UWCB (including several methods of food restriction, purging by vomiting or medications, smoking to control weight, or food substitutions) and personal and socio-environmental variables at two time points, five years apart, between 1998 and 2004. Logistic regression models examined personal and socio-environmental predictors of initiation and persistence of UWCB among Project EAT participants.
Results: Results indicate that 15.5% of boys and 19.7% of girls initiated UWCB by Time 2, and 15.9% of boys and 43.3% of girls persisted with these behaviours from Time 1 to Time 2. After controlling for race/ethnicity and weight status changes between assessments, logistic regression models indicated that similar factors and patterns of factors were associated significantly with initiation and persistence of UWCB. For both boys and girls, personal factors had more predictive value than socio-environmental factors (Initiation models: for boys: R2 = 0.35 for personal vs. 0.27 for socio-environmental factors; for girls, R2 = 0.46 for personal vs. 0.26 for socio-environmental factors. Persistence models: for boys: R2 = 0.53 for personal vs. 0.33 for socio-environmental factors; for girls, R2 = 0.41 for personal vs. 0.19 for socio-environmental factors). The weight concerns model was the strongest predictor among all individual models [Initiation odds ratios (ORs) and 95% confidence interval (CI): 4.84 (3.32-7.01) for boys and 5.09 (3.55-7.30) for girls; persistence OR (CI): 4.55 (2.86-7.14) for boys and 3.45 (2.50-4.76) for girls].
Conclusion: In general, predictors of initiation and persistence of UWCB were similar, suggesting that universal and selective prevention programs can target similar risk factors.

Objective: To examine associations between participating in mind-body activities (yoga/Pilates) and body dissatisfaction and disordered eating (unhealthy and extreme weight control practices and binge eating) in a population-based sample of young adults.

Method: The sample included 1,030 young men and 1,257 young women (mean age: 25.3 years, SD = 1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults).

Results: Among women, disordered eating was prevalent in yoga/Pilates participants and nonparticipants, with no differences between the groups. Men participating in yoga/Pilates were more likely to use extreme weight control behaviors (18.6% vs. 6.8%, p = .006) and binge eating (11.6% vs. 4.2%, p = .023), and marginally more likely to use unhealthy weight control behaviors (49.1% vs. 34.5%; p = .053), than nonparticipants after adjusting for sociodemographics, weight status, and overall physical activity.

Discussion: Findings suggest the importance of helping yoga/Pilates instructors recognize that their students may be at risk for disordered eating.

Background:
Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood.
Objective:
To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood.
Design:
Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010).
Participants/Setting:
The study population included 2,287 young adults (55% girls, 52% nonwhite). The sample included a younger group (mean age 12.8±0.7 years at baseline and 23.2±1.0 years at follow-up) and an older group (mean age 15.9±0.8 at baseline and 26.2±0.9 years at follow-up).
Statistical Analyses Performed:
Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline.
Results:
In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors 10 years later. Tracking was particularly consistent for the older girls and boys transitioning from middle adolescence to middle young adulthood.
Conclusions:
Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts before the onset of harmful behavioral patterns as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.

Background: Dieting and unhealthy weight control behaviors are common among adolescents and questions exist regarding their long-term effect on weight status.

Objective: To examine 10-year longitudinal associations between dieting and unhealthy weight control behaviors and changes in body mass index (BMI) from adolescence to young adulthood.

Methods and Procedures: A diverse population-based sample of middle school and high school adolescents participating in Project EAT (Eating and Activity in Teens and Young Adults) was followed up for 10 years. Participants (N = 1,902) completed surveys in 1998-1999 (Project EAT-I), 2003-2004 (Project EAT-II), and 2008-2009 (Project EAT-III). Dieting and unhealthy weight control behaviors at Time 1 and Time 2 were used to predict 10-year changes in BMI at Time 3, adjusting for sociodemographic characteristics and Time 1 BMI.

Results: Dieting and unhealthy weight control behaviors at both Time 1 and Time 2 predicted greater BMI increases at Time 3 in males and females, as compared with no use of these behaviors. For example, females using unhealthy weight control behaviors at both Time 1 and Time 2 increased their BMI by 4.63 units as compared with 2.29 units in females not using these behaviors (p < .001). Associations were found in both overweight and nonoverweight respondents. Specific weight control behaviors at Time 1 that predicted larger BMI increases at Time 3 included skipping meals and reporting eating very little (females and males), use of food substitutes (males), and use of diet pills (females).

Conclusions: Findings clearly indicate that dieting and unhealthy weight control behaviors, as reported by adolescents, predict significant weight gain over time.

The purpose was to examine the sociodemographic characteristics of adolescents who read magazine articles about dieting/weight loss and the relationship between reading these types of magazine articles and psychosocial well-being and weight control behaviors. Dieting-related magazine exposure was associated with indicators of psychosocial distress and unhealthy dieting; interventions that address media consumption should reach out to all youth regardless of ethnic and social backgrounds.

Objective: The purpose of this study was to evaluate the association between frequent reading of magazine articles about dieting/weight loss and weight-control behaviors and psychological outcomes 5 years later in a sample of adolescents.
Participants and Methods: Data are from Project EAT (Eating Among Teens), a 5-year longitudinal study of eating, activity, weight, and related variables in 2516 middle and high school students. In 1999 (time 1), participants completed surveys and had their height and weight measured. In 2004 (time 2), participants were resurveyed.
Results: For female adolescents, the frequency of healthy, unhealthy, and extreme weight-control behaviors increased with increasing magazine reading after adjusting for time 1 weight-control behaviors, weight importance, BMI, and demographic covariates. The odds of engaging in unhealthy weight-control behaviors (such as fasting, skipping meals, and smoking more cigarettes) were twice as high for the most frequent readers compared with those who did not read magazine articles about dieting and weight loss. The odds of using extreme weight-control behaviors (such as vomiting or using laxatives) were 3 times higher in the highest frequency readers compared with those who did not read such magazines. There were no significant associations for either weight-control behaviors or psychological outcomes for male adolescents.
Conclusions: Frequent reading of magazine articles about dieting/weight loss strongly predicted unhealthy weight-control behaviors in adolescent girls, but not boys, 5 years later. Findings from this study, in conjunction with findings from previous studies, suggest a need for interventions aimed at reducing exposure to, and the importance placed on, media messages regarding dieting and weight loss.

This study examined the role of media body comparison as a mediator of the relationships between psychological factors and sociocultural pressures to be thin and body dissatisfaction in both females and males. Participants were 1,386 females (mean age = 19.37 years) and 1,130 males (mean age = 19.46) from diverse backgrounds who completed a self-report questionnaire. Path analysis was used to test a cross-sectional model in which media body comparison mediated the impact of self-esteem, depressive mood, parent dieting environment, friend dieting, TV exposure, magazine message exposure, weight teasing and body mass index (BMI) on body dissatisfaction. In females, media body comparison partially or fully mediated relationships between self-esteem, depressive mood, friend dieting, magazine message exposure and BMI, and body dissatisfaction. In males, media body comparison was not a significant predictor of body dissatisfaction. This research particularly highlights the need to further examine processes that are involved in the development of body dissatisfaction in males.

Objectives The goals were to examine the prevalence of adolescents having a television in their bedroom and to describe associated personal, social, and behavioral characteristics.
Methods: Participants included 781 adolescents (mean age: 17.2 years) who completed a mailed Project Eating Among Teens II questionnaire. The relationships between adolescents having a television in their bedroom and sociodemographic, behavioral, and personal characteristics were examined.
Results: Nearly two thirds (62%) of participants had a bedroom television. Gender, race/ethnicity, socioeconomic status, and age were associated with the presence of a bedroom television. Compared with girls without a bedroom television, girls with a bedroom television reported less time spent in vigorous activity (1.8 vs 2.5 hours/week), more time spent watching television (20.7 vs 15.2 hours/week), lower vegetable intake (1.7 vs 2.0 servings per day), greater sweetened beverage consumption (1.2 vs 1.0 servings per day), and fewer family meals (2.9 vs 3.7 meals per week). Compared with boys without a bedroom television, boys with a bedroom television reported more time spent watching television (22.2 vs 18.2 hours/week), lower fruit intake (1.7 vs 2.2 servings per day), fewer family meals (2.9 vs 3.6 meals per week), and lower grade point average (2.6 vs 2.9). Twice as many youths with a television in their bedroom were heavy television users (watched >5 hours/day), compared with youths without a television in their bedroom (16% vs 8%).
Conclusions: Adolescents with a bedroom television reported more television viewing time, less physical activity, poorer dietary habits, fewer family meals, and poorer school performance. Refraining from placing a television in teenagers’ rooms may be a first step in helping to decrease screen time and subsequent poor behaviors associated with increased television watching.

Objectives: To assess weight-related concerns and behaviors in a population-based sample of adolescents and to compare these concerns and behaviors across sex and weight status.
Design: The study population included 4746 adolescents from St Paul or Minneapolis, Minn, public schools who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers.
Main Outcome Measures: Measured weight status, weight-related concerns (perceived weight status, weight disparity, body satisfaction, and care about controlling weight), and weight-related behaviors (general and specific weight control behaviors and binge eating).
Results: Weight-related concerns and behaviors were prevalent among the study population. Although adolescents were most likely to report healthy weight control behaviors (adolescent girls, 85%; and adolescent boys, 70%), also prevalent were weight control behaviors considered to be unhealthy (adolescent girls, 57%; and adolescent boys, 33%) or extreme (adolescent girls, 12%; and adolescent boys, 5%). Most overweight youth perceived themselves as overweight and reported the use of healthy weight control behaviors during the past year. However, the use of unhealthy and extreme weight control behaviors and binge eating were alarmingly high among overweight youth, particularly adolescent girls. Extreme weight control practices (taking diet pills, laxatives, or diuretics or vomiting) were reported by 18% of very overweight adolescent girls, compared with 6% of very overweight adolescent boys (body mass index, ≥ 95th percentile).
Conclusion: Prevention interventions that address the broad spectrum of weight-related disorders, enhance skill development for behavioral change, and provide support for dealing with potentially harmful social norms are warranted in light of the high prevalence and co-occurrence of obesity and unhealthy weight-related behaviors.

Objective: To evaluate the accuracy of mothers’ perceptions of adolescents’ weight status.
Research Methods and Procedures: Parent interviews and adolescent surveys (755) were conducted in an ethnically diverse sample from Project EAT (Eating among Teens).
Results: Adolescent weight status was accurately assessed by 60% of mothers, underestimated by 35% of mothers, and overestimated by 5% of mothers. In multivariate analyses, mothers of female adolescents were about half as likely to underestimate their adolescent’s weight status as mothers of male adolescents. Nonoverweight mothers were about half as likely as overweight mothers to underestimate their adolescent’s weight status.
Discussion: Most mothers are able to accurately assess their adolescent’s weight status; however, adolescent gender and mothers’ weight status are related to accuracy. Mothers were more likely to underestimate their sons’ weights than their daughters’ weights, and overweight mothers were more likely to be inaccurate in their assessments than nonoverweight mothers. Findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide support for healthy weight management.

Purpose: Obtaining stature, weight, and body mass index (BMI) from self-reports rather than by direct measurements is highly attractive economically and logistically, but there are few data available for adolescents that allow evaluation of potential sources of reporting bias. Because self-reports are based on self perceptions, personal characteristics of youth may be related to errors in reporting.
Methods: Differences between self-reported and measured stature, weight, and BMI were investigated for a sample of 3797 Minnesota youth, 12 to 18 years of age. Gender, age, race/ethnicity, socioeconomic status (SES), and measured body size were examined as potential factors associated with errors in self reports.
Results: Self-reported stature, weight, and BMI were generally highly correlated with corresponding measured dimensions, although adolescents of both genders systematically overestimated their statures, underestimated their weights, and underestimated BMI. Significant associations of errors in self-reports with age, race/ethnicity, and socioeconomic status suggested that differences in self perceptions or value ascribed to body size varies according to these personal characteristics. Systematic errors in self-reported stature, weight, and BMI were negatively associated with the corresponding measured dimension when adjusted for age, race/ethnicity and SES, such that prevalences of overweight based on BMI from self-reported measures were systematically underestimated relative to measured values.
Conclusions: Self-reports of stature, weight, and BMI are on the average, valid representations of their measured counterparts; nevertheless, errors in the self-reports are systematically related to characteristics of youth. Consequently, findings from these studies should be interpreted carefully.

Background: This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents.

Methods: Project EAT-II followed 2516 adolescents from Minnesota longitudinally from 1999 to 2004. The population included two cohorts allowing for the observation of transitions from early to middle adolescence (junior high school to high school) and from middle to late adolescence (high school to post-high school).

Results: The prevalence of overweight (females: 28.7%; males: 28.0%) was high in early adolescence and remained high throughout adolescence. In females, between early and middle adolescence, there were steep longitudinal increases in the use of unhealthy weight control behaviors (48.6% to 58.8%, P = 0.001) and extreme weight control behaviors (9.4% to 17.9%, P < 0.001), and between middle and late adolescence, extreme weight control behaviors increased from 14.5% to 23.9% (P < 0.001). In males, extreme weight control behaviors doubled from middle to late adolescence (3.4% to 6.3%, P = 0.023). Use of diet pills doubled from 7.5% to 14.2% from 1999 to 2004 (P = 0.004) in high school females. One fifth (19.9%) of females in late adolescence reported taking diet pills.

Conclusions: Overweight status and unhealthy weight control behaviors in adolescents are major public health concerns that warrant interventions addressing both problems.

Purpose: This study addresses the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviors over a 5-year period among adolescent females and males?
Methods: Project EAT is a 5-year population-based longitudinal study. Participants completed surveys exploring factors associated with eating and weight concerns. Participants included 2516 adolescents who were transitioning from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort).
Results: In the older cohort of females and in both cohorts of males, frequent self-weighing at Time 1 was not associated with weight changes at Time 2 (5 years later), after adjusting for Time 1 weight status and sociodemographic characteristics. In the younger cohort of females, Time 1 frequent self-weighing predicted weight increases at Time 2. In both cohorts of females, but not in males, Time 1 frequent self-weighing predicted higher prevalences of Time 2 disordered eating behaviors, including unhealthy weight control behaviors and binge eating, after adjusting for Time 1 behavioral outcomes, weight status, and sociodemographic characteristics.
Conclusions: Frequent self-weighing was not associated with weight change, with the exception of predicting weight increases in younger females. In females, but not males, self-weighing predicted a higher frequency of binge eating and unhealthy weight control behaviors. Although further research is needed to explore the potential merits and problems associated with regular self-weighing, the findings suggest that population-based obesity prevention strategies targeting adolescents should avoid messages likely to lead to frequent self-weighing.

Background: Weight-related problems, including obesity, eating disorders, and disordered eating, are major public health problems in adolescents. The identification of shared risk and protective factors for these problems can guide the development of relevant interventions to a broad spectrum of weight-related problems. This paper examines the prevalence and co-occurrence of overweight, binge eating, and extreme weight-control behaviors (vomiting, diet pills, laxatives, and diuretics) in adolescents and identifies shared risk and protective factors from within the socioenvironmental, personal, and behavioral domains for these three adverse weight-related outcomes.
Methods: Data were collected at Time 1 (1998-1999) and Time 2 (2003-2004) on 2516 adolescents participating in Project EAT (Eating Among Teens). Data were analyzed in 2006-2007.
Results: Weight-related problems were identified in 44% of the female subjects and 29% of the male subjects. About 40% of overweight girls and 20% of overweight boys engaged in at least one of the disordered eating behaviors (binge eating and/or extreme weight control). Weight-teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors strongly and consistently predicted overweight status, binge eating, and extreme weight-control behaviors after 5 years. Family meals, regular meal patterns, and media exposure to messages about weight loss were also associated with weight-related outcomes, although the strength and consistency of associations differed across outcomes and gender.
Conclusions: Weight-specific socioenvironmental, personal, and behavioral variables are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence. These findings support the need for research to determine if decreasing weight-related social pressures, personal weight concerns, and unhealthy weight-control behaviors can contribute to reductions in obesity in children and adolescents.

Objective: The objective was to examine a breadth of personal, behavioral, and socio-environmental factors as potential risk and protective factors of overweight among male and female adolescents.
Research Methods and Procedures: A longitudinal study was conducted with an ethnically and socio-economically diverse sample of 2516 adolescents who completed surveys at both Time 1 (1998 to 1999) and Time 2 (2003 to 2004) of the Project Eating Among Teens (EAT) study.
Results: In 1998 to 1999, 335 (25.7%) girls and 282 (26.4%) boys met the age-adjusted criteria for overweight. During the 5-year study period, 236 (70.5%) of the overweight girls and 185 (65.7%) of the overweight boys remained overweight and 115 (12.0%) girls and 77 (9.9%) boys originally not overweight became overweight. Although differences by sex were found, a number of personal, behavioral, and socio-environmental factors were associated with overweight among both male and female adolescents. Body dissatisfaction and weight concerns at Time 1 predicted overweight at Time 2 for both male and female adolescents. Dieting and use of unhealthy weight control behaviors at Time 1 also predicted overweight at Time 2. Greater frequency of breakfast consumption at Time 1 was protective against overweight. Higher levels of weight-related teasing and parental weight-related concerns and behaviors at Time 1 were positively associated with Time 2 overweight.
Discussion: Body dissatisfaction, weight concerns, use of unhealthy weight control behaviors, weight-related stigmatization, and parental concern about the child’s weight may increase risk for adolescent overweight. Interventions that enhance adolescents’ body satisfaction while providing
them with skills to avoid dieting and to engage in more effective weight-control behaviors should be developed and tested.

Objective: Breakfast-eating frequency declines through adolescence and has been inversely associated with body weight in cross-sectional studies, with few prospective studies on this topic. This study was conducted to examine the association between breakfast frequency and 5-year body weight change in 2216 adolescents.
Patients and Methods: Project EAT (Eating Among Teens) was a 5-year longitudinal study of eating patterns and weight concerns among adolescents. Surveys were completed in 1998-1999 (time 1) and 2003-2004 (time 2). Multivariable linear regression was used to examine the association between breakfast frequency and change in BMI, with adjustment for age, socioeconomic status, race, physical activity, time 1 BMI and breakfast category, and time 1 dietary and weight-related variables.
Results: At time 1, frequency of breakfast was directly associated with intake of carbohydrate and fiber, socioeconomic status, white race, and physical activity and inversely associated with smoking and alcohol consumption and dieting and weight-control behaviors. In cross-sectional analyses at times 1 and 2, inverse associations between breakfast frequency and BMI remained largely independent of all of the confounding and dietary factors. Weight-related factors (concerns, behaviors, and pressures) explained little of the breakfast-BMI association. In prospective analyses, frequency of breakfast was inversely associated with BMI in a dose-response manner. Further adjustment for confounding and dietary factors did not seem to explain the association, but adjustment for weight-related variables seemed to partly explain this finding.
Conclusions: Although experimental studies are needed to verify whether the association between breakfast and body weight is of a causal nature, our findings support the importance of promoting regular breakfast consumption among adolescents. Future studies should further examine the role of breakfast habits among youth who are particularly concerned about their weight.

Objective. Our goal was to explore whether parents of overweight adolescents who recognize that their children are overweight engage in behaviors that are likely to help their adolescents with long-term weight management.
Methods. The study population included overweight adolescents (BMI ≥ 85th percentile) who participated in Project EAT (Eating Among Teens) I (1999) and II (2004) and their parents who were interviewed by telephone in Project EAT I. Crosssectional analyses were conducted with 314 adolescent-parent dyads, and longitudinal analyses were completed with 170 dyads.
Results. Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children’s weight status did not predict child weight status 5 years later.
Conclusions. Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet. Instead of focusing on weight per se, it may be more helpful to direct efforts toward helping parents provide a home environment that supports healthful eating, physical activity, and well-being.

Introduction: Although socioeconomic differences in prevalence of obesity are well documented, whether patterns of weight gain during key periods of growth and development differ among youth from different socioeconomic backgrounds is unknown. This study examines socioeconomic disparities in overweight status and 5-year weight gain among adolescents.
Methods: Project EAT (Eating Among Teens)-II followed a socioeconomically and ethnically diverse sample of 2,516 adolescents from 1999 through 2004. Mixed-model regression analyses examined longitudinal trends in overweight status as a function of socioeconomic status (SES).
Results: Girls and boys in the low-SES category were more likely to be overweight than were those in the high-SES category. Boys in the high-SES category showed a significant decrease (P = .006) in overweight prevalence between 1999 and 2004, whereas boys in the low- and middle-SES categories showed no significant change. Girls in the low-SES category showed a significant 5-year increase (P = .004) in overweight prevalence compared with a stable prevalence of overweight among girls in the middle- and high-SES categories.
Conclusion: Our data show continued and, in some cases, increasing socioeconomic disparities in risk for overweight. Youth from low-SES backgrounds are at increased risk for overweight and are more likely to remain overweight (boys) or become overweight (girls). Designing obesity prevention and treatment interventions that reach and address the unique needs of youth and families from less-advantaged socioeconomic backgrounds is a public health priority.

This article describes five research-based recommendations for health care providers to help prevent both obesity and eating disorders among adolescents that they see within clinical, school, or other settings. The recommendations are based primarily upon findings from Project EAT, a large, population-based study of eating and weight-related issues in adolescents. Recommendations include the following: 1) discourage unhealthy dieting; instead encourage and support the use of eating and physical activity behaviors that can be maintained on an ongoing basis; 2) promote a positive body image; 3) encourage more frequent, and more enjoyable, family meals; 4) Encourage families to talk less about weight and do more at home to facilitate healthy eating and physical activity; and 5) assume that overweight teens have experienced weight mistreatment and address this issue with teens and their families. These recommendations stress the importance of helping adolescents and their families focus less on weight and more on sustained behavioral change.

Background: Obesity in adolescence has been increasing in the past several decades. Beverage habits among adolescents include increased consumption of sugar-sweetened beverages and decreased consumption of milk. OBJECTIVE: This study aimed to examine the association between beverage consumption and 5-y body weight change in 2294 adolescents.
Design: Project EAT (Eating Among Teens) is a 5-y longitudinal study of eating patterns among adolescents. Surveys were completed in 1998-1999 (time 1) and in 2003-2004 (time 2). Multivariable linear regression was used to examine the association between beverage consumption at time 2 and change in body mass index from time 1 to time 2, with adjustments for age, socioeconomic status, race, cohort, physical activity, sedentary behavior, coffee, tea, time 1 body mass index, and beverage variables.
Results: In prospective analyses, consumption of beverages was not associated with weight gain, except for consumption of low-calorie soft drinks (positive association, P = 0.002) and white milk (inverse association, P = 0.03), but these associations did not appear to be a monotonic linear dose-response relation. The positive association with low-calorie soft drinks was no longer present after adjustment for dieting and parental weight-related concerns, which suggests that the use of low-calorie soft drinks is a marker for more general dietary behaviors and weight concerns.
Conclusions: We showed no association between sugar-sweetened beverage consumption, juice consumption, and adolescent weight gain over a 5-y period. A direct association between diet beverages and weight gain appeared to be explained by dieting practices. Adolescents who consumed little or no white milk gained significantly more weight than their peers who consumed white milk. Future research that examines beverage habits and weight among adolescents should address portion sizes, adolescent maturation, and dieting behaviors.

Parenting style and parental support and modeling of physical activity and healthy dietary intake have been linked to youth weight status, although findings have been inconsistent across studies. Furthermore, little is known about how these factors co-occur, and the influence of the coexistence of these factors on adolescents’ weight. This article examines the relationship between the co-occurrence of various parenting characteristics and adolescents’ weight status. Data are from Project EAT (eating among teens), a population-based study of 4,746 diverse adolescents. Theoretical and latent class groupings of parenting styles and parenting practices were created. Regression analyses examined the relationship between the created variables and adolescents’ BMI. Having an authoritarian mother was associated with higher BMI in sons. The co-occurrence of an authoritarian mother and neglectful father was associated with higher BMI for sons. Daughters’ whose fathers did not model or encourage healthy behaviors reported higher BMIs. The co-occurrence of neither parent modeling healthy behaviors was associated with higher BMIs for sons, and incongruent parental modeling and encouraging of healthy behaviors was associated with higher BMIs in daughters. Although, further research into the complex dynamics of the home environment is needed, findings indicate that authoritarian parenting style is associated with higher adolescent weight status and incongruent parenting styles and practices between mothers and fathers are associated with higher adolescent weight status.

We examined the association between sleep duration and BMI in young adults, and, specifically, in possible gender differences. The population-based sample included 955 young men and 1051 young women (mean age = 25.3 years, s.d. = 1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults)-III. In 2008-2009, study participants completed a survey, on which they reported their weight, height, and typical bed and awakening times. Gender-specific regression models estimated cross-sectional associations between sleep duration and weight status, adjusting for age, race, SES, family structure, depressive symptoms, physical activity, and sedentary and dietary behaviors. In multivariable-adjusted linear regression models, an hour increase in sleep was associated with a -0.38 (-0.70, -0.048) BMI in men. Men who slept <7 h had a 1.4 unit higher mean BMI (27.9; 95% confidence interval (CI): 26.9, 28.9) than men who slept 7-9 h/day (26.5; 95% CI: 26.1, 27.0). Prevalence estimates of overweight (BMI ≥25) and obesity (BMI ≥30) were also inversely associated with sleep duration among men. Sleep duration was not associated with BMI, overweight, or obesity in women. Among women, but not men, there was a statistically significant positive association between trouble falling or staying asleep and mean BMI. Sleep may be an important modifiable risk factor for obesity, particularly in young adult men.

Objective: To examine secular trends from 1999 to 2010 in weight status and weight-related attitudes and behaviors among adolescents.
Methods: A repeated cross-sectional design was used. Participants were from Minneapolis/St. Paul middle schools and high schools and included 3072 adolescents in 1999 (mean age14.6±1.8) and 2793 adolescents in 2010 (mean age14.4±2.0). Trends in weight-related variables were examined using inverse probability weighting to control for changes in socio-demographics over time.
Results: The prevalence of obesity among boys increased by 7.8% from 1999 to 2010, with large ethnic/racial disparities. In black boys the prevalence of obesity increased from 14.4% to 21.5% and among Hispanic boys, obesity prevalence increased from 19.7% to 33.6%. Trends were more positive among girls: weight status did not significantly increase, perceptions of overweight status were more accurate, the use of healthy weight control behaviors remained high, dieting decreased by 6.7%, unhealthy weight control behaviors decreased by 8.2% and extreme weight control behaviors decreased by 4.5%.
Conclusions: Trends indicate a need to intensify efforts to prevent obesity and other weight-related problems, particularly for boys from ethnic/racial minorities. The decreases in unhealthy weight control behaviors among girls are encouraging.

Objective: To assess the relationships between mothers’ reports of dieting and encouraging adolescents to diet and adolescents’ reports of their own dieting practices and weight-related concerns.
Design: Cross-sectional study of parent interviews and adolescent surveys in an ethnically-diverse sample.
Subjects: A total of 810 adolescents (n=381 boys and n=429 girls) and their mothers.
Results: Mothers’ dieting was associated with their adolescent girls’ weight-related concerns and behaviors, but these associations were not significant after adjusting for girls’ body mass index (BMI). In contrast, mothers’ encouragement for sons to diet was associated with sons’ binge eating, dieting and other weight-control behaviors, even after controlling for sons’ BMI. Compared with mothers who did not encourage their child to diet, mothers who encouraged their child to diet were significantly heavier women and were more likely to view their child as overweight. Forty-three percent of boys and 46% of girls who were encouraged by their mothers to diet were classified as nonoverweight by federal guidelines.
Conclusions: Boys who are encouraged by their mothers to diet may be at risk for health-compromising eating and dieting behaviors, particularly binge-eating, fasting, eating a little bit of food and skipping meals. Parents who are concerned about their children’s weight should be educated to encourage healthy eating habits and physical activity to promote their children’s health, including healthy weight control.

Background: Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample.
Methods: Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups.
Results: Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males.
Conclusions: Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents.

Using a cross-sectional comparison group design, 4,746 ethnically diverse middle and high school students from 31 public schools in a metropolitan area were surveyed about their health, emotional factors (self-esteem, depressive symptoms, suicidality), and behaviors (tobacco, alcohol and drug use). Based on regression analyses that adjusted for gender, race, school level and SES, adolescents with chronic health conditions were significantly more likely to report depressive symptoms and low self-esteem than adolescents without chronic health conditions; they were almost twice as likely to have considered suicide and over three and a half times more likely to have attempted suicide. They also reported greater use of cigarettes, marijuana, and illicit drugs. Given the extent of behavioral and emotional problems among adolescents with chronic health conditions, appropriate referrals and mental health services for these adolescents are warranted.

Background: This study sought to examine teen perceptions of mother–child and father–child connectedness, with focus on valuing parental opinions and perception of parental communication and caring, and associations with behavioral and emotional health.
Methods: A population-based sample of 4746 students in public schools completed the 2001 Project EAT (Eating Among Teens) survey.
Results: Overall, the majority of girls and boys reported valuing their parents’ opinion when making serious decisions and believing that their parents cared about them. Yet, one fourth of girls and boys felt unable to talk to their mother about problems, and over half of girls and one third of boys felt unable to talk to their father. Valuing friends’ opinions over parents’ opinions, and perceiving low parental communication and caring were associated with unhealthy weight control, substance use, suicide attempts, body dissatisfaction, depression, and low self-esteem. Of significant concern, compared to their peers who reported feeling that their mother cared quite a bit or very much, youths who reported feeling as though their mother cared very little or not at all about them reported particularly high prevalence rates of unhealthy weight control behaviors (63.49% girls, 25.45% boys); suicide attempts (33.51% girls, 21.28% boys); low self-esteem (47.15% girls, 24.56% boys); and depression (63.52% girls, 33.35% boys).
Conclusions: Adolescents’ perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends’ opinions for serious decisions were significantly associated with compromised behavioral and emotional health. Interventions aimed at improving the parent–child relationship may provide an avenue toward preventing health risk behaviors in youth.

An ethnically diverse sample of at-risk-for-overweight and overweight youths (body mass index greater than the 85th percentile for age and gender; n=667 male participants, and n=684 female participants) completed a school-based survey measuring family variables (connectedness, mealtime environment, and weight commentary), psychosocial well-being (depressed mood, body satisfaction, and self-esteem), and unhealthy weight-control behaviors; all measures were assessed concurrently. Hierarchical linear regression analyses revealed that measures of general family connectedness, priority of family meals, and positive mealtime environment were significantly positively associated with psychological well-being and inversely associated with depressive symptoms and unhealthy weight-control behaviors. Familial weight commentary (i.e., weight-based teasing and parental encouragement to diet) was associated with many indicators of poor psychological health. The authors conclude that greater psychosocial well-being and fewer unhealthy weight-control behaviors are associated with making family time at meals a priority, creating a positive mealtime atmosphere, and refraining from weight commentary.

This study investigates the relationships among social isolation, psychological health, and protective factors in adolescents. Feelings of social isolation may influence psychological health in adolescents, but protective factors such as family connectedness, school connectedness, and academic achievement may also play a key role. The sample included 4,746 adolescents from 31 middle and high schools. Participants responded to 221 survey questions regarding peer relationships, psychological health, school connectedness, family relationships, and academic achievement. The findings revealed that social isolation was associated with an increased risk for depressive symptoms, suicide attempts, and low self-esteem. Protective factors influenced associations between social isolation and psychological health. Implications for prevention such as building healthy peer relationships, promoting family connectedness, and developing school-based interventions are discussed.

Objective: To evaluate the long-term impact of adolescent dating violence (ADV) on behavioral and psychological health.
Study design: From a diverse sample of older adolescents who completed Project EAT in 1999 (wave 1) and 2004 (wave 2; mean age 20.4), 23 male and 102 female adolescents reporting ADV were compared with 671 male and 720 female adolescents reporting no ADV.
Results: ADV was positively associated with cigarette smoking and suicide attempts for both sexes, binge-eating and suicidal ideation in male adolescents, and smoking marijuana and high depressive symptoms in female adolescents in analyses unadjusted for wave 1 outcomes. In analyses adjusted for wave 1, in female adolescents, ADV was significantly associated with smoking cigarettes, marijuana use, and high depressive symptoms and marginally associated with suicide attempts; in male adolescents, ADV was significantly associated with smoking cigarettes and marginally associated with binge-eating and suicidal ideation. ADV was significantly associated with an overall high-risk profile (presence ≥3 health outcomes) for both sexes; results remained significant in female adolescents after adjusting for wave 1.
Conclusions: ADV is associated with greater likelihood of problematic health factors and increases nonspecific risk toward behavioral and psychological impairment in youth, particularly female adolescents.

Objective: Suicide is associated with full syndromal eating disorders, but it is unclear whether subsyndromal eating disorders carry the same risk. This study examined associations between suicidal behaviors and extreme and less extreme weight control behaviors (EWCB and LWCB, such as fasting, vomiting, meal skipping, etc.), body dissatisfaction, and weight status in adolescents.

Method: Data on body dissatisfaction, depressive symptoms, suicidal ideation and attempts, and body mass index (BMI) were drawn from Project EAT, a survey of 4,746 7th-12th grade students. Multivariate logistic regression examined associations between eating- and weight-related variables and suicidality.

Results: Suicidal ideation and suicide attempts were more commonly observed in adolescents with EWCB (boys: ideation OR = 2.12, attempts OR = 4.10; girls: ideation OR = 1.66, attempts OR = 2.29), LWCB (boys: ideation OR = 1.33, attempts OR = 1.76; girls: ideation OR = 1.77, attempts OR = 1.80), as well as body dissatisfaction (boys: ideation OR = 1.75, attempts OR = 2.23; girls: ideation OR = 1.77, attempts OR = 1.81), even after controlling for depressive symptoms. No association was observed between BMI and suicidal attempts or ideation.

Conclusion: Thus, it appears that suicidal behavior in adolescents is associated even with low-level eating disorder symptoms.

This research examined whether body dissatisfaction prospectively predicted depressive mood and low self-esteem in adolescent girls and boys 5 years later. Participants were early-adolescent girls (n = 440, Time 1 M age = 12.7 years) and boys (n = 366, Time 1 M age = 12.8 years) and midadolescent girls (n = 946, Time 1 M age = 15.8 years) and boys (n = 764, Time 1 M age = 15.9 years). After controlling for Time 1 of the relevant dependent variable, ethnicity, socioeconomic status, and body mass index, Time 1 body dissatisfaction was a unique predictor of Time 2 depressive mood and low self-esteem in early-adolescent girls (depressive mood: F = 4.80, p < .05; self-esteem: F = 9.64, p < .01) and midadolescent boys (depressive mood: F = 12.27, p < .001; self-esteem: F = 9.38, p < .01) but not in early-adolescent boys or midadolescent girls. These findings are consistent with the hypothesis that body dissatisfaction is a risk factor for depressive mood and low self-esteem in both girls and boys but in different phases of adolescence.

Purpose: The purpose of this study was to evaluate the reciprocal relationship between parent-child connectedness and depressive symptoms, self-esteem, and body satisfaction over 5 years in a diverse sample of 2516 male and female adolescents.
Methods: Youth completed Project Eating Among Teens surveys at Time 1 (1998-1999) and Time 2 (2003-2004). Multiple linear regression analysis was conducted to evaluate relationships between parent-child connectedness and adolescents’ emotional functioning, controlling for baseline parent-child connectedness. The reciprocal relationship was also evaluated using the same methods.
Results: Parent-child connectedness was associated with increased body satisfaction for females, increased self-esteem for males, and decreased depressive symptoms for both males and females. The reciprocal relationship results showed that, among females, self-esteem was associated with increased parent-child connectedness while depressive symptoms predicted decreased parent-child connectedness. In males, body satisfaction was associated with increased parent-child connectedness.
Conclusions: Parent-child connectedness and youth emotional functioning reciprocally influenced each other over the 5-year period of this study. Interventions aimed at strengthening the parent-child relationship throughout adolescence may protect emotional health and prevent longer-term emotional consequences in young adults.

Context: Speculation in public discourse suggests that sexual encounters outside a committed romantic relationship may be emotionally damaging for young people, and federal abstinence education policy has required teaching that sexual activity outside of a marital relationship is likely to have harmful psychological consequences.
Methods: In 2003-2004, a diverse sample of 1,311 sexually active young adults (mean age, 20.5) participating in a longitudinal study in Minnesota completed a survey including measures of sexual behavior and psychological wellbeing. Chi-square tests were used to compare the prevalence of recent casual partnerships by selected demographic and personal categories. General linear modeling was then used to compare mean levels of each psychological wellbeing measure between those reporting recent casual partners and those reporting committed partners; partner type was measured both dichotomously and categorically.
Results: One-fifth of participants reported that their most recent sex partner was a casual partner (i.e., casual acquaintance or close but nonexclusive partner). Casual partnerships were more common among men than among women (29% vs. 14%), and the proportions of male and female respondents reporting a recent casual partner differed by race or ethnicity. Scores of psychological well-being were generally consistent across sex partner categories, and no significant associations between partner type and well-being were found in adjusted analyses.
Conclusions: Young adults who engage in casual sexual encounters do not appear to be at greater risk for harmful psychological outcomes than sexually active young adults in more committed relationships.

Background: Previous studies have found that higher physical activity levels are associated with greater academic achievement among students. However, it remains unclear whether associations are due to the physical activity itself or sports team participation, which may involve requirements for maintaining certain grades, for example. The purpose of this study is to examine the associations between sports team participation, physical activity, and academic outcomes in middle and high school students.
Methods: Data were drawn from Project EAT (Eating Among Teens), a survey of middle and high school students (n = 4746). Students self-reported their weekly hours of physical activity, sports team participation, and academic letter grades. Two statistical models were considered: first, 2 separate regression analyses with grade point average (GPA) as the outcome and either sports team participation or physical activity as the predictor; second, a single regression with GPA as the outcome and both sports team participation and physical activity as the simultaneous predictors.
Results: For high school girls, both physical activity and sports team participation were each independently associated with a higher GPA. For high school boys, only sports team participation was independently associated with a higher GPA. For middle school students, the positive association between physical activity and GPA could not be separated from the relationship between sports team participation and a higher GPA.
Conclusions: Regardless of whether academic success was related to the physical activity itself or to participation on sports teams, findings indicated positive associations between physical activity involvement and academic achievement among students.

Background: Most research regarding sport participation and suicide risk found protective relationships. However, all studies in this area were based on cross-sectional designs.
Objective: To fill a gap in research by exploring associations between sport involvement and suicide ideation and attempts (suicidality) based on a 5-year longitudinal, population-based study.
Study Group: Participants (n = 739) completed surveys in middle school and high school.
Methods: Logistic regression analysis compared suicidality during high school across four groups: youth who participated in sport in both middle and high school, youth who participated only in middle school or only in high school, and youth who did not participate in sport during adolescence.
Results: Compared to non-participants, youth involved in sport in both middle and high school had lower odds of suicidal ideation during high school. Youth who discontinued sport after middle school had higher odds of attempting suicide during high school than non-participants.
Conclusions: Remaining involved in sport throughout adolescence can offer mental health benefits. Future research should identify mechanisms that account for protective relationships between involvement in sport throughout adolescence and suicidality, and identify factors that explain deleterious relationships for youth who discontinue sport early in adolescence.

Objectives To learn more about how overweight is associated with emotional well-being in adolescents and examine change in associations over time.
Methods: A prospective study was conducted with a sample of 2,516 adolescents who participated in Project EAT-I (1999) and Project EAT-II (2004).
Results: At baseline, overweight participants had lower body satisfaction and decreased self-esteem as compared to normal weight participants. Additionally, an association was found between overweight and depressive symptoms among males during middle adolescence. Longitudinal findings suggest that the adverse impact of overweight on emotional well-being persists into young adulthood, including a marked increase in depressive mood among overweight males between early and middle adolescence.
Conclusions: The persistent nature of the association between overweight and emotional well-being suggests that the normal developmental process of adolescence will not “take care” of this association. Instead, clinicians should regularly screen overweight adolescents for markers of poor emotional well-being and consider intervention when appropriate.

This study examined associations among body satisfaction and physical and sedentary activities in 4,746 adolescents. Boys with lower body satisfaction reported significantly less physical activity and more TV viewing than boys with higher body satisfaction. In girls, trends were similar, but associations were not statistically significant. Associations were similar among overweight youth. In no instances, were lower levels of body satisfaction significantly associated with higher physical activity levels. These findings suggest that interventions that strive for increased physical activity in youth should avoid strategies that may lead to decreases in body satisfaction. Rather, programs should simultaneously strive to increase physical activity and improve body satisfaction. This type of approach may be effective in preventing obesity while avoiding increasing participants’ risk for a low body satisfaction, unhealthy weight control practices, and eating disorders.

Purpose: This study addresses the question, “Does body satisfaction matter?” by examining longitudinal associations between body satisfaction and weight-related health-promoting and health-compromising behaviors five years later among adolescents.
Methods: Project EAT-II followed an ethnically and socioeconomically diverse sample of 2516 adolescents from 1999 (Time 1) to 2004 (Time 2). Associations between body satisfaction at Time 1 and health behaviors at Time 2 were examined, adjusting for sociodemographic characteristics and Time 1 health behaviors, with and without adjustment for body mass index (BMI).
Results: In females, lower body satisfaction predicted higher levels of dieting, unhealthy and very unhealthy weight control behaviors and binge eating, and lower levels of physical activity and fruit and vegetable intake. After adjusting for BMI, associations between body satisfaction and dieting, very unhealthy weight control behaviors, and physical activity remained statistically significant. In males, lower body satisfaction predicted higher levels of dieting, healthy, unhealthy, and very unhealthy weight control behaviors, binge eating, and smoking, and lower levels of physical activity. After adjusting for BMI, associations between body satisfaction and dieting, unhealthy weight control behavior, and binge eating remained statistically significant.
Conclusions: The study findings indicate that, in general, lower body satisfaction does not serve as a motivator for engaging in healthy weight management behaviors, but rather predicts the use of behaviors that may place adolescents at risk for weight gain and poorer overall health. Interventions with adolescents should strive to enhance body satisfaction and avoid messages likely to lead to decreases in body satisfaction.

Purpose: The purpose of this study was 2-fold: (1) to determine the prevalence of high body satisfaction in a multi-ethnic, urban population of adolescent females, and (2) to examine the demographic, socioenvironmental, personal, and behavioral factors associated with high body satisfaction among adolescent girls.
Methods: The study population included 2,357 female middle and high school students who completed surveys in 1998–1999. High body satisfaction and its association with a range of socioenvironmental, personal, and behavioral factors were assessed. Associations were examined through comparisons of means (unadjusted and adjusted for grade level, race, socioeconomic status, and body mass index [BMI]) for continuous variables, and percentages and odds ratios for dichotomized variables.
Results: Over a quarter (26.7%) of adolescent girls reported high body satisfaction. High body satisfaction was most common among African-American (40.1%) and underweight girls (39.0%). In adjusted analyses, girls with high body satisfaction were more likely to report parental and peer attitudes that encouraged healthy eating and exercising to be fit (p .001) versus dieting, and less likely to report personal weight-related concerns and behaviors (p .001).
Conclusions: The immediate subculture in which adolescent girls exist may play an important role in fostering high body satisfaction. Parents and health care providers often struggle with how to address the topic of weight management in teens without causing further injury to body image. Findings from the present study suggest the importance of providing a social environment that focuses on health and fitness, rather than on weight control, to increase adolescent girls’ likelihood of being satisfied with their bodies.

This study investigated prospective risk factors for increases in body dissatisfaction in adolescent girls and boys in the Eating Among Teens Project. At the time of first assessment (Time 1), participants were a cohort of early adolescent girls (N=440) and boys (N=366) and a cohort of middle adolescent girls (N=946) and boys (N=764). Participants were followed up 5 years later (Time 2). Potential prospective risk factors examined included body mass index, socioeconomic status, ethnicity, parent dieting environment, peer environment, and psychological factors. Predictors of Time 2 body dissatisfaction were Time 1 body dissatisfaction, body mass index, socioeconomic status, being African American, friend dieting and teasing, self-esteem, and depression. However, the profile of predictors differed across the samples.

This research examined whether body dissatisfaction prospectively predicted depressive mood and low self-esteem in adolescent girls and boys 5 years later. Participants were early-adolescent girls (n = 440, Time 1 M age = 12.7 years) and boys (n = 366, Time 1 M age = 12.8 years) and midadolescent girls (n = 946, Time 1 M age = 15.8 years) and boys (n = 764, Time 1 M age = 15.9 years). After controlling for Time 1 of the relevant dependent variable, ethnicity, socioeconomic status, and body mass index, Time 1 body dissatisfaction was a unique predictor of Time 2 depressive mood and low self-esteem in early-adolescent girls (depressive mood: F = 4.80, p < .05; self-esteem: F = 9.64, p < .01) and midadolescent boys (depressive mood: F = 12.27, p < .001; self-esteem: F = 9.38, p < .01) but not in early-adolescent boys or midadolescent girls. These findings are consistent with the hypothesis that body dissatisfaction is a risk factor for depressive mood and low self-esteem in both girls and boys but in different phases of adolescence.

Objective: The present study uses longitudinal data to examine changes in body satisfaction among male and female adolescents from baseline to 5 years.
Methods: A diverse sample of 2516 adolescents completed surveys in 1999 and 2004, reporting satisfaction with 10 body parts or attributes, height/weight, and other characteristics. Multivariable general linear modeling was used to estimate change in body satisfaction from Time 1 to Time 2, by age group, race, and change in body mass index (BMI) category.
Results: Body satisfaction decreased over 5 years (mean satisfaction change= 0.79) in all groups except older adolescent females. Scores decreased significantly more among younger adolescents than older adolescents, among some racial/ethnic groups of males, and among those whose BMI increased. However, among males, change in body satisfaction depended on BMI category at baseline.
Conclusions: Different types of prevention programs addressing body image may be needed for males and females at different developmental stages and may need to address changes in BMI.

Does a moderate degree of body dissatisfaction motivate overweight adolescents to lose weight? We examined the relationship between body satisfaction and BMI 5 years later in overweight adolescent girls from Project EAT (Eating Among Teens), and found that girls with higher body satisfaction gained less weight over 5 years.

Purpose: The present study examined whether the cross-sectional association between body dissatisfaction and low self-esteem varies across gender, age, body weight status, race/ethnicity, and socioeconomic status (SES). We also examined the association longitudinally.
Methods: A school-based survey of eating, weight, and related attitudes was conducted with a diverse sample of adolescents aged 11-18 years (N = 4,746). Height and weight were measured in the schools at Time 1. Participants were resurveyed through mails 5 years later (Time, 2; N = 2,516).
Results: The relationship between body dissatisfaction and self-esteem was strong and significant in both boys and girls (all p values < .0001), and did not differ significantly between genders (p = .16), or between the middle school and high school cohorts in either boys (p = .79) or girls (p = .80). Among girls, the relationship between body dissatisfaction and self-esteem was strong, but did vary across weight status, race/ethnicity, and SES (all p values = .0001-.03). The relationship was nonsignificant in underweight girls (p = .36), and weaker but still significant among black, Asian, and low SES group girls (all p values < .0001) in comparison to white and high SES group girls. Among boys, the association did not differ significantly across demographic groups (all p values = .18-.79). In longitudinal analyses, the strength of the association did not change significantly as adolescents grew older.
Conclusions: Findings indicate that body dissatisfaction and self-esteem are strongly related among nearly all groups of adolescents. This suggests the importance of addressing body image concerns with adolescents of all backgrounds and ages.

Purpose: We tested the hypothesis that, at two different stages of adolescence, impairment in emotional well-being associated with obesity is mediated by body dissatisfaction (BD).

Methods: Self-reported measures of BD, emotional well-being (self-esteem, depressive mood), height and weight, and socio-demographic information were completed by the same female (n = 366) and male (n = 440) participants during early (mean age = 12.8 years) and late (17.3 years) adolescence. For each measure and at each time point, the hypothesis of mediation was tested using the methods suggested by Baron and Kenny (1986).

Results: The conditions of complete mediation were satisfied in all the six cases for which an effect of obesity on emotional well-being was observed. That is, in each of these cases, obesity was no longer associated with lower self-esteem or with higher depressive mood after the effects of BD were statistically controlled. Among females, there was no association between obesity and depressive mood at either time point.

Conclusion: Impairment in the emotional well-being of overweight adolescents, where this is observed, may be primarily due to the effects of weight-related BD. This appears to be the case for both boys and girls and during both early and late adolescence. The findings are consistent with the view that BD is central to the health and well-being of children and adolescents who are overweight and that distress associated with negative body image may warrant greater attention in the context of obesity prevention and treatment programs.

The current study examines how body satisfaction of pregnant women compares to that of nonpregnant women. The sample included 68 pregnant and 927 nonpregnant young women who participated in a population-based longitudinal study examining eating and weight concerns in young adults. Body satisfaction was assessed using a 10-item modified version of the Body Shape Satisfaction Scale. The longitudinal design allowed for the assessment of body satisfaction among women both prior to and during their pregnancy. Mean body satisfaction was higher in pregnant women (32.6, 95% CI: 30.7-34.5) than nonpregnant women (29.6, 95% CI: 29.1-30.1) with moderate effect size 0.32, after adjusting for body satisfaction and body mass index prior to pregnancy, indicating that pregnant women experienced a significant increase in body satisfaction from the time prior to their pregnancy (p=.003) despite weight gain. These findings have important implications for clinicians delivering weight-related messages to women during pregnancy.

Objective: To describe the development and psychometric properties of survey measures relevant to eating, physical activity, and weight-related behaviors among young adults.
Methods: Focus groups and reliability testing guided the development of the Project EAT-III survey. The final survey was completed by 2287 young adults.
Results: The systematic process employed led to a psychometrically sound and developmentally appropriate survey. Test-retest reliabilities for items included on the final survey were mostly moderate to good, and Cronbach alphas were >0.7 for 83% of developed scales.
Conclusions: Future studies may find the systematic process used to be helpful in creating other weight-related surveys.

Objective: Assessing changes in dietary intake during the transition from adolescence to adulthood is challenging given the need for age-appropriate tools at different developmental stages. The present study investigated the comparability of intake estimates as assessed with the youth/adolescent and adult forms of Willett’s FFQ.
Design: Young adults were first asked to complete the adult FFQ as part of a larger study, Project EAT-III (Eating and Activity in Teens and Young Adults). A stratified random sample of respondents was invited to complete the youth/adolescent FFQ by mail within a 3-week period.
Setting: Participants were members of a longitudinal cohort who completed baseline surveys (including the adolescent FFQ) at schools in Minneapolis/St. Paul, Minnesota and completed Project EAT-III surveys online or by mail in 2008-2009.
Subjects: There were ninety-one men and 103 women (median age = 24·6 years) who completed both forms of the FFQ.
Results: The adolescent and adult forms did not provide comparable absolute intake estimates. However, with few exceptions, correlation coefficients between intake estimates were moderate (r = 0·4-0·6). Furthermore, the percentage of individuals classified into the same quartile rank category based on their responses to the adolescent and adult forms was ≥50 % for fibre, vitamins A and E, and servings of fruit (excluding juice), vegetables, dairy, whole grains and soft drinks.
Conclusions: Although responses on the adolescent and adult FFQ cannot be compared to describe changes in absolute intake over time, these tools provide comparable intake rankings and may be used together in longitudinal studies to investigate influences on diet.