Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals

Background: Unhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents. Methods: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection. Results: Of the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95% CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95% CI 2.58-8.07, p value &lt;0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63–6.08, p value &lt;0.001) as compared to those who had not adopted any unhealthy behaviors. Conclusions: This study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.</p

Automated Identification of Unhealthy Drinking Using Routinely Collected Data: A Machine Learning Approach

Background: Unhealthy drinking is prevalent in the United States and can lead to serious health and social consequences, yet it is under-diagnosed and under-treated. Identifying unhealthy drinkers can be time-consuming for primary care providers. An automated tool for identification would allow attention to be focused on patients most likely to need care and therefore increase efficiency and effectiveness. Objectives: To build a clinical prediction tool for unhealthy drinking based solely on routinely collected demographic and laboratory data. Methods: We obtained demographic and laboratory data on 89,325 adults seen at the University of Vermont Medical Center from 2011-2017. Logistic regression, support vector machines (SVM), k-nearest neighbor, and random forests were each used to build clinical prediction models. The model with the largest area under the receiver operator curve (AUC) was selected. Results: SVM with polynomials of degree 3 produced the largest AUC. The most influential predictors were alkaline phosphatase, gender, glucose, and serum bicarbonate. The optimum operating point had sensitivity 31.1%, specificity 91.2%, positive predictive value 50.4%, and negative predictive value 82.1%. Application of the tool increased the prevalence of unhealthy drinking from 18.3% to 32.4%, while reducing the target population by 22%. Limitations: Universal screening was not used during the time data was collected. The prevalence of unhealthy drinking among those screened was 60% suggesting the AUDIT-C was administered to confirm rather than screen for unhealthy drinking. Conclusion: An automated tool, using commonly available data, can identify a subset of patients who appear to warrant clinical attention for unhealthy drinking

An Unhealthy Case of Mold

Mold is a serious problem which threatens the well-being of both collections and staff. Preventative maintenance and a good disaster plan are the most effective way of handling mold. However, unforeseen circumstances can infect a library; in which case, librarians must be able to recognize and treat the problem immediately. Finances can affect the manner in which the mold is cleaned. Librarians need to be aware of a variety of options open to them, as well as, a variety of resources upon whom to call in the event of a breakout. A low budget process is presented as an alternative to professional remediation services

When feeling attractive matters too much to women: a process underpinning the relation between psychological need satisfaction and unhealthy weight control behaviors

This study examined a process model linking psychological need satisfaction to unhealthy weight control behaviors. Female University students (N = 220; M age = 20.47; SD = 5.07) completed questionnaires measuring need satisfaction, appearance-contingent self-worth, weight-related appearance anxiety and unhealthy weight control behaviors. Structural equation modeling revealed that need satisfaction indirectly related to engagement in unhealthy weight control behaviors through appearance-contingent self-worth and weight-related appearance anxiety. The results indicate that appearance-contingent self-worth might help to explain how low levels of psychological need satisfaction are related to maladaptive weight-related outcomes in young women

SOCIODEMOGRAPHIC DETERMINANTS OF MENTAL HEALTH OUTCOMES AMONG UNHEALTHY WEIGHT YOUTH IN THE UNITED STATES

Background The prevalence of unhealthy weight (defined as a body mass index ≥ 85th %ile for age and sex) among children and adolescents in the United States remains unacceptably high. In parallel, the prevalence of mental health issues in youth is rising as well. Current research shows a strong association between overweight/obesity and poor mental health outcomes. Specifically, youth of unhealthy weight have higher rates of anxiety and depression. The objective of this study is to evaluate the specific the current (2016-17) population-level prevalence of unhealthy weight, mental health issues and the sociodemographic (e.g. sex, age, race, ethnicity, household income) differences in (1) both of these health issues independently, and (2) as they relate to each other. Methods This is a retrospective, cross-sectional study utilizing the National Survey of Children’s Health (NSCH), a representative sample of all youth in the United States ages 10 to 17. The NSCH is designed to produce national and state-level data on the physical and emotional health of American children 10 - 17 years old. A total of 35,221 youth were included in this survey from 2016-2017. Descriptive statistics will be generated to determine the population prevalence of unhealthy weight and mental health issues by age, sex and race/ethnicity. Bivariate analyses including Chi square analyses were generated to explore relationships between healthy/unhealthy weight and the prevalence/non-prevalence of reported depression or anxiety. Finally, logistic regression models were generated to compute the odds of having mental health outcome (depression or anxiety) by healthy/unhealthy weight, and each sociodemographic characteristic. All statistical analysis were performed using Stata 15. Results The prevalence of unhealthy youth and the prevalence of depression or anxiety in youth vary by age, sex, race/ethnicity, food insecurity, parental divorce, and parental concern about their child’s weight. After adjusting for these characteristics, overweight youth had 1.32 odds (95% CI: 0.62-2.81) of current depression or anxiety as compared to healthy weight youth. Obese youth had 0.74 odds (95% CI: 0.31-1.76) of current depression or anxiety as compared to healthy weight youth. Conclusions The results of this study will be used to inform programs and interventions focused both on unhealthy weight and/or mental health issues in youth. Future research could build on these conclusions to rigorously test whether certain socioeconomic groups have better outcomes as a result of targeted intervention strategies. Finally, as this is a cross-sectional study, a causal relationship cannot be inferred

Latino and Non-Latino Perceptions of the Air Quality in California's San Joaquin Valley.

The San Joaquin Valley (SJV) of California has poor air quality, high rates of asthma, and high rates of obesity. Informational campaigns aimed at increasing awareness of the health impacts of poor air quality and promoting behavior change need to be tailored to the specific target audiences. The study examined perceptions of air quality, perceived health impacts, and methods of accessing information about air quality between Latinos and other groups in the SJV. Residents of the SJV (n = 744) where surveyed via one of three methods: community organizations (256), public locations (251), and an internet panel (237). The results suggest that people perceive the air quality in their region to be generally unhealthy, particularly for sensitive groups. The air quality is more likely to be reported as being unhealthy by people with health problems and less unhealthy by Latinos and people who report regularly exercising. Latinos are more likely to report working outdoors regularly, but also more likely to report being able to reduce their exposure if the air quality is unhealthy. The results report differences in informational sources about air quality, suggesting that informational campaigns should target high risk groups using a variety of media

Cash Incentives and Unhealthy Food Consumption

The costs associated with unhealthy food consumption are not only paid by those suffering from overweight but by all members of society in terms of higher costs for social security systems. With this in mind, we study the effectiveness of a tax, a subsidy and cash incentives in reducing unhealthy food consumption. Using an inter-temporal rational choice model with habit, we calibrate and simulate the effect of those policies to US and UK data.  Our findings suggest that cash incentives may be the most effective policy in reducing unhealthy food consumption yet it can be the most costly one. Taxes are relatively ineffective in reducing unhealthy food consumption. Subsidies have the best balance between effectiveness and monetary benefits to the society.    Habit; Junk Food; Overweight; Public Policy; Rational Addiction

Primary Care Validation of a Single-Question Alcohol Screening Test

BACKGROUND Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings. OBJECTIVE To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). DESIGN Cross-sectional study. PARTICIPANTS Adult English-speaking patients recruited from primary care waiting rooms. MEASUREMENTS Participants were asked the single screening question, "How many times in the past year have you had X or more drinks in a day?", where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method. MAIN RESULTS Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics. CONCLUSIONS. The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.National Institute on Alcohol Abuse and Alcoholism (R01-AA010870

Adding a reward increases the reinforcing value of fruit

Adolescents' snack choices could be altered by increasing the reinforcing value (RV) of healthy snacks compared with unhealthy snacks. This study assessed whether the RV of fruit increased by linking it to a reward and if this increased RV was comparable with the RV of unhealthy snacks alone. Moderation effects of sex, hunger, BMI z-scores and sensitivity to reward were also explored. The RV of snacks was assessed in a sample of 165 adolescents (15.1 (SD 1.5) years, 39.4% boys and 17.4% overweight) using a computerised food reinforcement task. Adolescents obtained points for snacks through mouse clicks (responses) following progressive ratio schedules of increasing response requirements. Participants were (computer) randomised to three experimental groups (1: 1: 1): fruit (n 53), fruit + reward (n 60) or unhealthy snacks (n 69). The RV was evaluated as total number of responses and breakpoint (schedule of terminating food reinforcement task). Multilevel regression analyses (total number of responses) and Cox's proportional hazard regression models (breakpoint) were used. The total number of responses made were not different between fruit + reward and fruit (b -473; 95% CI -1152, 205, P=0.17) or unhealthy snacks (b 410; 95% CI -222, 1043, P = 0.20). The breakpoint was slightly higher for fruit than fruit + reward (HR 1.34; 95% CI 1.00, 1.79, P=0.050), whereas no difference between unhealthy snacks and fruit + reward (HR 0.86; 95% CI 0.62, 1.18, P=0.34) was observed. No indication of moderation was found. Offering rewards slightly increases the RV of fruit and may be a promising strategy to increase healthy food choices. Future studies should however, explore if other rewards, could reach larger effect sizes