Volume 27, Issue 3

Owing to the strong relationship between fat-free mass (FFM) and resting energy expenditure (REE), the preservation of FFM is often emphasized in the treatment of adolescent obesity. Typical treatment regimens including an increased dietary consumption of protein and participation in resistance training are common components of adolescent weight management programs, despite limited evidence of a positive influence of FFM on weight loss outcomes in adolescents. Given the larger volume of FFM in obese relative to normal weight adolescents and the common treatment goals of both maximizing weight loss and attenuating the loss of FFM, a better understanding of the influence of FFM on energy balance is needed to determine whether strategies to preserve lean tissue or maximize absolute weight loss should be most emphasized. We review the associations among FFM, REE, and weight loss outcomes, focusing on how these relationships might influence energy balance in obese adolescents.

Background: Adolescents are in their formative years, and they experience several changes including anthropometric changes. Significant weight gain occurs in adolescence, and increasingly, obesity and consequent increase in blood pressure (BP) are found in adolescents. Objective: This study compared anthropometric and BP measurements in male and female adolescents. Methods: A cross-sectional study of 1000 adolescents (510 males and 490 females) were selected by multi-stage sampling from eight secondary schools. Pertinent information was collected with the aid of a structured questionnaire, anthropometric and blood pressure measurements. Data were analyzed using SPSS 16.0 version, and the means of anthropometric indices and blood pressures in males and females were compared using independent t-test. Results: The mean age for male respondents was 13.83 years (SD 2.12) and for females 13.62 (SD 1.96). Generally, anthropometric indices gradually increased from the lower ages to the higher ages in both males and females. The mean height was the same for both males and females (1.54 m), while the mean weight, body mass index (BMI), and waist circumference were significantly higher in females than in males (p<0.05). A significantly higher proportion of females compared with males were overweight (10.2%, 5.3%) and obese (3.9%, 2.0%), respectively. The overall prevalence of “hypertension,” was 4.1% and more females (70.7%) had “hypertension” than males (29.3%). Conclusion: Females were heavier and constituted the greater proportion of those who had elevated BP. Adequate attention needs to be given to the challenging problems of overweight and obesity to forestall development of hypertension in adolescents, especially female adolescents.

Purpose: To examine the role of perceived social support and parental education on physical activity and eating behaviour of Ghanaian adolescents. Methods: Seven hundred and seventy Senior High School students (504 boys and 266 girls) between the ages of 14–21 years participated by completing questionnaires on perceived social support, physical activity and eating behaviour. The highest education attained by either parent or guardian was also obtained. Multivariate analysis of covariance was the main statistical test used to analyse the data. Results: The results showed significant gender differences in physical activity and eating behaviour combined, with boys more likely to engage in physical activity than girls, and girls also more likely to engage in healthy eating behaviour than boys, albeit the effect was not statistically significant. While perceived social support had a significant positive effect on eating behaviour and physical activity, parental education had a significant effect only on eating behaviour but not physical activity. Conclusion: Perceived social support from family coupled with parental education provides more opportunities for adolescents to engage in healthy eating behaviour. Also, parents’ educational attainment alone does not necessarily guarantee that adolescents will engage in physical activity; providing the needed social support and conducive home environment is more likely to induce physical activity behaviours. Finally, physical activity and eating behaviour should not be construed as alternative health behaviours as suggested by gender differentials in these health behaviours.

Objective: This pilot experimental study tested the feasibility and intended effect of an educational intervention for parents to help them assist their adolescent child with chronic illness (CI) in becoming autonomous. Methods: A two-phase pre-post pilot intervention study targeting parents of adolescents with CI was conducted. Parents were allocated to group 1 and 2 and received the four-module intervention consecutively. Intended effect was measured through online questionnaires for parents and adolescents before, at 2 months after, and at 4–6 months after the intervention. Feasibility was assessed through an evaluation questionnaire for parents. Results: The most useful considered modules concerned the future of the adolescent and parents and social life. The most valued aspect was to exchange with other parents going through similar problems and receiving a new outlook on their relationship with their child. For parents, improvement trends appeared for shared management, parent protection, and self-efficacy, and worsening trends appeared for coping skills, parental perception of child vulnerability, and parental stress. For adolescents, improvement trends appeared for self-efficacy and parental bonding and worsening trends appeared for shared management and coping skills. Conclusion: Parents could benefit from peer-to-peer support and education as they support the needed autonomy development of their child. Future studies should test an online platform for parents to find peer support at all times and places.

This study assessed whether clinic attendance was related to health outcomes for youth with type 2 diabetes mellitus (type 2 DM). Medical records of pediatric patients with type 2 DM were retrospectively reviewed. Clinic attendance was much more infrequent than recommended by physicians, and 42% of the sample withdrew from medical care. Patients who had a history of not showing during appointments had higher HbA1c levels than those who attended regularly scheduled visits; however, contrary to our hypotheses, average number of clinic visits was not associated with HbA1c levels or zBMI. Given the increased risk for health complications, new strategies are needed to keep patients engaged with medical care.

Background: Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents’ or children’s reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication. Objective: The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics. Subjects: A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study. Methods: The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents. Results: Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (p<0.05 for father-adolescent dyads and p<0.001 for mother-adolescent dyads). Conclusion: Our findings suggest a low congruence between parents’ and adolescents’ reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.

Background: Acquired immunodeficiency syndrome (AIDS) is a major health problem worldwide. The number of infected people is increasing daily. Knowledge and awareness toward prevention and control of the disease is necessary among both educated and illiterate people. Objective: This study is aimed at assessing the knowledge and awareness about human immunodeficiency virus (HIV)/AIDS among undergraduate students studying in a technical institute in Gorakhpur, Uttar Pradesh, India. Methods: A community-based cross-sectional study was conducted among youths aged 15–30 years studying in a technical institution in Gorakhpur. Data were collected using a semistructured questionnaire developed with the help of existing literature, from 250 participants (students). Results: The main source of information was the television; knowledge about the difference between HIV/AIDS was satisfactory. The findings showed that the knowledge about modes of prevention (blood checkup, needle/syringe sterilization) was satisfactory. There were several misconceptions about the modes of transmission of the disease, such as through mosquito bites, eating/drinking, and kissing. Conclusion: The knowledge of the study population was satisfactory, and there is a need for innovation and comprehensive education to impart better knowledge and understanding about HIV/AIDS.

Introduction: Widespread tobacco use, along with its induced diseases and subsequent deaths, comprise one of the biggest threats to public health in the world. Thus, we aimed to investigate the prevalence of cigarette and water pipe smoking and their predictors among Iranian adolescents. Materials and methods: A total of 1524 adolescent students aged 14–18 years (764 boys and 760 girls) were randomly selected. The participants attended governmental, semi-governmental, and non-governmental schools in the city of Sanandaj, Iran in 2013. Data were collected using the “Sherer General Self-efficacy” and demographic questionnaire. Multivariate Logistic binary regresion analysis was conducted to determine the predictors. Results: The prevalence rates of cigarette and water pipe smoking were 9.5% and 10.4%, respectively. About 3.7% of the adolescents used both cigarette and water pipe and 16% used at least one of these. Compared with girls, prevalence of both cigarette (13.1% vs. 6.4%) and water pipe (13.7% vs. 7.1%) smoking was higher among the boys. Male sex, father’s education of secondary school, and use of water pipe were identified as cigarette smoking risk factors, while technical and commercial educational fields and attending non-governmental school were its protective factors. Risk factors of the use of water pipe were currently working, higher age and cigarette smoking, father’s education of high school, father’s occupation of employee and mother’s education of a diploma degree, while higher self-efficacy and attending non-governmental school were its protective factors. Conclusion: The high prevalence of cigarette and water pipe smoking in adolescents continues to rise. Therefore, it is necessary to conduct further studies on effective factors on the onset and continuation of tobacco use.

Objective: This study aimed to explore the socio-demographic and dietary factors that may be associated with obesity among female university students in Jordan. Methods: A cross-sectional survey was carried out among 406 female students recruited from two universities in Jordan. Data were collected through self-reporting, using a previously validated questionnaire. Weight and height were measured and body mass index was calculated to determine the weight status of the participants. Results: High educational level of mothers [odds ratio (OR)=1.25] and monthly pocket money of more than 200 Jordanian Dinars (OR=1.67) were found to be risk factors for obesity, whereas a sibling ranking of more than six was a protective factor (OR=0.31). Those who were eating from the university cafeteria had double the risk for obesity (OR=2.41) than those who did not. Regular eating of meals and snacking between meals were found to be protective factors (OR ranged from 0.42 to 0.79). Regular consumption of milk products, fruit, canned fruit juices, bakery products and legumes were found to be protective factors. In contrast, the regular consumption of potato chips (OR=1.35), chicken (OR=1.51), and fish (OR=1.45) were found to be risk factors for obesity. Using a chi-square test, none of the factors studied showed significant association with obesity. Conclusion: A program to promote healthy eating among university students in Jordan should consider the local socio-demographic and food behavior factors that could be related to obesity to ensure the effectiveness of such a program.

Background: Internet addiction (IA) is a common disorder among adolescents throughout most of the industrialized world. The purpose of this study was to compare mental states between Japanese undergraduates with IA and those without IA. Methods: In a cross-sectional survey, 165 healthy participants were assessed for IA using the Internet Addiction Test (IAT), for the frequency and quality of flow experiences in daily life using the Flow Experience Checklist (FEC), and for depressive symptoms using the Patient Health Questionnaire (PHQ-9), Beck Depression Inventory-II (BDI-II), and Zung Self-Rating Depression Scale (SDS). Results: The results showed that the prevalence of IA in the participants of this study was 15% and the frequencies of flow experience and depressive symptoms were significantly higher in the IA group. Conclusion: The results indicate that IA affects a significant number of Japanese university students and is associated with higher rates of depressive symptoms, suggesting a need for intervention programs as part of student mental health services.

Background: This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of self-esteem, and the possible connection with eating habits of adolescents under orthodontic treatment. Methods: Sixty-one adolescents, aged between 12 and 22 years (mean=15.6±2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire. Results: Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student’s t-test and using Pearson’s correlation analysis. Conclusion: Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.

Background: A better understanding is needed of the contextual factors that influence HIV risk behaviors among female adolescents in sub-Saharan Africa. The objectives of this study were to assess the influence of family structure on lifetime sexual partners and on the number of sexual partners in the last year among female adolescents in rural Rakai, Uganda. In addition, the study assessed whether the influence of family structure on these outcomes differed by the school attendance status of the adolescents. Methods: The sample consisted of 2337 unmarried adolescent girls, aged 15–19, enrolled in the Rakai Community Cohort Study. The last survey interview within the time period of 2001–2008 available for each girl was used. Analyses were stratified by age (15–17 year olds and 18–19 year olds) and school status. Multinomial logistic and poisson regressions were used. Results: Living in a household with a biological father was protective against both outcomes. Family structure was not associated with the outcomes among in-school adolescents but it was significantly associated with the outcomes among out-of-school adolescents. Conclusion: The findings suggest that understanding the familial context in which female adolescents develop, as well as its interaction with school attendance, is important for HIV prevention efforts. Both research and programmatic initiatives must consider the interplay between the family and school domains when considering ways to reduce HIV acquisition among adolescent women.

The theory of reasoned action (TRA) is one of the most common models in predicting health-related behaviors and is used more often in health education studies. This study aimed to add two control constructs (perceived behavioral control – PBC and self-efficacy – SE) to the TRA and compare them using the structural equation modeling (SEM) for substance use avoidance among Iranian male adolescents in order to find out which model was a better fit in predicting the intention. This was a cross-sectional study carried out in Tehran, Iran. Data were collected from a random sample of high school male students (15–19 years of age) using a questionnaire containing items related to the TRA plus items reflecting two additional constructs (SE and PBC). In all, 433 students completed the questionnaires. The results obtained from SEM indicated a better fit to the data for the TRA with SE compared to the TPB (TRA with PBC) and TRA (χ 2 /df=2.55, RMSEA=0.072, CFI=0.96, NFI=0.94, NNFI=0.95, SRMR=0.058). Comparing SE and PBC, the results showed that self-efficacy was a better control construct in improving the TRA and predicting substance use avoidance intention (41%). The TRA with SE had a better model fit than TPB and the original version of the TRA.

Purpose: The threat of childhood obesity has never been greater. Behavior changes implemented during childhood and adolescence are believed to be the most successful means of thwarting the progression of this epidemic. The American Academy of Pediatrics has developed a public health campaign that promotes awareness of clinical guidelines for nutrition and physical activity. The campaign is based on a concept developed by the Maine Center for Public Health referred to as “5-2-1-0 Healthy”. The simple clear message of this concept outlines steps families can take to help prevent and treat childhood obesity. The purpose of the present study is to determine the current level of compliance and health education needs of a middle school population related to the “5-2-1-0” concept. Methods: A modified version of the 2010 National Youth Physical Activity and Nutrition Survey (developed by the Centers for Disease Control and Prevention) was distributed to students at a private, nonsectarian, middle school in New York City. The school is located in the borough of Manhattan, but includes youngsters from all five boroughs of the city. The questions were grouped and analyzed according to “5-2-1-0” categories. Surveys were scored, and the association between targeted questionnaire items and demographic variables (i.e., sex and grade) was examined. Results : All 140 students completed the survey, and there was great variability in their responses to both the nutrition and physical activity questions. Of all students, 65% reported eating one cup or more of fruit daily, and 38% reported eating one cup or more of vegetables daily. There was no statistically significant difference reported in consumption of fruits or vegetables by gender or grade. Over 60% of students indicated <2 h of DVD/video or computer/video game time per day, while 10% indicated more than 3 h per day for each. A significant difference existed in the screen time reported between grades (more screen time by the older students) and a statistically significant difference also existed in the amount of physical activity reported by gender and grade (more physical activity by males and younger students). There was no difference in the reported consumption of sugar-sweetened beverages by gender or grade. Conclusion: In a cohort of middle school students in New York City, there was great variability in compliance with the principles represented by the “5-2-1-0” concept. Changes in health behaviors were noted as students went from 6th to 7th to 8th grade, with physical activity decreasing and screen time increasing. Consequently, health curriculum topics for middle school students should focus on physical activity and screen time, while continuing to emphasize the need for proper nutrition.

Purpose: Assessment of the influence of gender and increasing years at university on sleep health of students. Methods: Four hundred and eighteen students from different streams across years of undergraduate to postgraduate courses participated. Descriptive statistics, test of differences, and correlation were used. The sleep health data comprised of subjective evaluation using a questionnaire and personal interviews. Results: Overall, 43.1% had sleep problems, females were more affected (51.67% vs. 48.33% in males) but were early bed goers. The prevalence of circadian rhythm sleep disorder (11.6% vs. 9.5%) and delayed sleep phase syndrome (4.5% vs. 2.7%) was slightly higher in males. The daytime dysfunction and hypnotic use significantly differed in students of the same class among gender. Bedtime got significantly delayed along years [H(2)=29.769, p<0.001], and hypnotic use [H(2)=8.807, p=0.012] differed significantly among them. The moderate-very strong correlational statistics among sleep health elements was very similar across gender and years of university education. However, more pronounced influence of years of university education than gender was seen in the significant differences for correlated correlation among sleep health parameters. Conclusion: Gender and years of university education influence sleep among university students both separately and concomitantly.

Anorexia nervosa is a medical and psychological disorder classically seen in young women who present with significant weight loss, a distorted body image, and an intense fear of gaining weight despite being underweight. A rare diagnosis that is also associated with weight loss is a trichobezoar, a collection of hair or hair-like fibers in the gastrointestinal tract, primarily in the stomach. In this report, we present the case of a 14.5-year-old girl with weight loss caused by a trichobezoar, initially thought to be due to anorexia nervosa, and we review the details of both disorders.

The use of contraband cigarettes is a serious public health problem. We present a case of atrial fibrillation in a healthy adolescent suspected to be caused by smoking contraband cigarettes. A 15-year-old man was admitted to our emergency department experiencing syncope and palpitations. He was a cigarette smoker, but he had never smoked any illicit tobacco products before. He had finished a pack of counterfeit cigarettes (20 pieces) in 1.5 h. His electrocardiogram showed atrial fibrillation with a rapid ventricular response and irregular RR intervals. The patient had no history of alcohol use, surgery, palpitations, hypertension, chronic bronchitis, or any infectious diseases. His atrial fibrillation was converted to a normal sinus rhythm after the cardioversion treatment. Our patient was discharged from the pediatric cardiology service and advised to quit smoking cigarettes, strictly warning against illicit tobacco products. In conclusion, intensive smoking of counterfeit cigarettes may lead to occurrences of atrial fibrillation.

Background: Initiation of smoking behavior during adolescence is associated with negative health outcomes. Understanding initiation of smoking behavior in adolescents in relation to other behavioral, health, and environmental factors is essential for effective behavioral modification. Objective: The aim of this study was to describe tobacco use behaviors among adolescents in Riyadh, Saudi Arabia, and related demographic and social factors. Subjects: A total of 1430 students aged 14–19 from high schools across the city of Riyadh participated in the study. Methods: A comprehensive adolescent health survey was administered to students in high school classrooms across Riyadh. Data were analyzed primarily via contingency tables with χ 2 -tests. Results: One in five students reported having ever smoked cigarettes, with a significantly higher proportion of boys than girls reporting tobacco use. Students who smoked had significantly lower school connectedness compared with those who never smoked. Tobacco use by family members was common, and students with at least one family member who smoked were significantly more likely to use tobacco themselves. Conclusion: Improving school connectedness among students by fostering supportive and safe school environments could be a potential strategy for reducing adolescent smoking. Reducing smoking in the general population and educating families about being better role models for youth are also critical.