Biomedical subjects

J A Fulkerson

Publications and source records attributed to J A Fulkerson.

At least 19 recordsLinked to original sources

PubMed2002

Weight-related attitudes and behaviors of adolescent boys and girls who are encouraged to diet by their mothers.

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.

Adolescent↗

PubMed2001

Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables.

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.

Adolescent↗

PubMed2000

The relative importance of social versus commercial sources in youth access to tobacco, alcohol, and other drugs.

BACKGROUND: Youth substance use began to increase in 1992 following a decade-long decline, leading to increased interest in controlling access to tobacco, alcohol, and other drugs. METHODS: The anonymous and voluntary Minnesota Student Survey was administered to 133,794 public school students in grades 6, 9, and 12. Questions addressed current frequency of use of tobacco, alcohol, and other drugs and how students obtained these substances. Data were analyzed to determine the relationship between grade level, gender, race/ethnicity, use frequency, and access to substances through social and commercial sources. (Tobacco analyses were limited to students under age 18 years.) RESULTS: Social sources (especially friends) predominate across all age groups and substances. Students are much more likely to obtain tobacco than alcohol from commercial sources but few rely exclusively on commercial sources for either. Females and infrequent users are more likely to depend on social sources exclusively while males and frequent users are more likely to use commercial sources. CONCLUSIONS: Because substances are easily accessible through social sources, prevention policies directed at retail outlets may not have the desired effect on reducing teen smoking and drinking. Greater attention to reducing access to all substances from social sources is needed.

Adolescent↗

PubMed2000

Increasing weight-bearing physical activity and calcium intake for bone mass growth in children and adolescents: a review of intervention trials.

OBJECTIVE: The purpose of this review is to evaluate the current state-of-the-science for interventions to increase bone mass gains in children and adolescents using weight-bearing physical activity or calcium supplementation. METHODS: Studies were located using computerized and manual searches of the empirical literature. Inclusion criteria were: (a) intervention study targeting weight-bearing physical activity or calcium intake; (b) inclusion of a control group; (c) subject age range under 18 years; and (d) outcome measured bone mineral density or bone mineral content. RESULTS: Weight-bearing physical activity and calcium supplement intervention studies both consistently show positive effects on bone mass gains in children and adolescents. The most consistent findings for both weight-bearing physical activity and calcium were for lumbar spine and total body bone sites. Only weight-bearing physical activity interventions had significant effects on the femoral neck sites. Low power may have contributed to the lack of statistically significant findings in several studies and also prevented proper evaluation of potential interactions between pubertal status and interventions on bone mass gains. CONCLUSIONS: Increases in weight-bearing physical activity or calcium intake have positive effects on bone mass gains in children and adolescents. Further research is needed to evaluate: (a) the long-term durability of these effects; (b) specific dose-response associations; (c) interactions between weight-bearing physical activity and calcium intake; and (d) interactions between pubertal development and weight-bearing physical activity or calcium intake on bone mass outcomes.

Adolescent↗

PubMed2000

Commitment to treatment goals in prediction of group cognitive-behavioral therapy treatment outcome for women with bulimia nervosa.

The purpose of this study was to investigate potential client variables that predict favorable response to group cognitive-behavioral therapy in a sample of women (N = 143) seeking treatment for bulimia nervosa. Similar to findings of previous studies, bulimic symptom remission at end of treatment was predicted by baseline degree of bulimic symptom severity but not by depressive symptomatology or perfectionism. After these variables were controlled for, both pretreatment ratings of desire to discontinue bulimic behaviors and expected success significantly added to prediction of treatment outcome. The primary variable found to predict longer term outcome was symptom remission at the end of treatment and at the 1-month follow-up.

Adult↗

PubMed1999

Eating-disordered behaviors and personality characteristics of high school athletes and nonathletes.

OBJECTIVE: To assess whether high school athletes are at risk for an eating disorder, whether personality characteristics differentiate athletes from nonathletes, and whether high levels of perfectionism put athletes at risk. METHOD: 318 high school athletes were randomly matched to 360 nonathletes. Comparisons were made by means of the Eating Disorders Inventory (EDI), Restraint Scale, Risk Symptom Checklist, Multidimensional Personality Questionnaire (MPQ), and body mass index (BMI). RESULTS: Athletes did not have higher levels of disordered eating behaviors and attitudes than their nonathletic counterparts. Athletes had less negative views of life than nonathletes. However, perfectionistic tendencies may put some athletes at risk. DISCUSSION: High school athletes are not at greater risk for the development of an eating disorder than other students. Athlete's positive outlook on life and high self-efficacy may serve as protective factors. Alternatively, athletes may not be at risk until they train for one particular sport in a highly competitive environment.

Adolescent↗

PubMed1999

DSM-IV substance abuse and dependence: are there really two dimensions of substance use disorders in adolescents?

AIM: To examine the distinctness of the DSM-IV substance abuse and dependence constructs in a large, general adolescent population. DESIGN: Data were collected using the 1995 Minnesota Student Survey. Survey items were designed to correspond to DSM-IV diagnostic criteria for substance abuse and dependence. SETTINGS: Public schools, alternative schools and area learning centers. PARTICIPANTS: Of the 78,800 students between the ages of 14 and 18 years who completed the survey, 18,803 reported substance use and at least one substance use disorder diagnostic criterion during the previous 12 months and were used for the analyses. The sample was divided randomly into two groups in order to conduct data analyses on one group (n = 9490) and confirm the findings in the other group (n = 9313). MEASUREMENTS: Confirmatory factor analyses were conducted to test three competing factor structure models consisting of a single factor model, a two-factor model of distinct dimensions and a two-factor model with interrelated dimensions. FINDINGS: The single factor and correlated two-factor models had similar parameter estimates and fit the data better than the competing two-factor model with distinct dimensions. Findings were confirmed in a second sample. CONCLUSIONS: The study findings indicate that DSM-IV substance abuse and dependence criteria may be more optimally structured as a unidimensional construct rather than as bidimensional constructs for adolescents.

Adolescent↗

PubMed1998

Disordered eating in adolescent males from a school-based sample.

OBJECTIVE: The authors sought to describe a sample of adolescent males who reported disordered eating, to explore whether males with disordered eating are overweight or obese, and to determine if patterns displayed by females would be replicated with a male sample. METHOD: Three school-based adolescent samples were selected. (1) 27 males reporting disordered eating (2) 27 physically matched controls, and (3) 27 randomly selected controls. RESULTS: Findings indicated that boys reporting disordered eating expressed greater body dissatisfaction, depression, restraint, and poorer interoceptive awareness compared to matched and randomly selected controls. Negative Emotionality and poor Interoceptive Awareness scores showed the strongest associations with eating pathology. Body mass index and Negative Emotionality scores showed the strongest relationships to restrained eating. DISCUSSION: Previous results for female adolescents were replicated, suggesting that findings for females can be generalized to males. Disordered eating appears to exist in the absence of significant weight problems in adolescent males.

Adolescent↗

PubMed1998

DSM-IV substance use disorder criteria for adolescents: a critical examination based on a statewide school survey.

OBJECTIVE: The DSM-IV criteria for substance use disorders were incorporated into the 1995 Minnesota Student Survey in order to estimate the need for alcohol/drug treatment among adolescents in the state. This study used data from the survey to examine the utility of individual diagnostic criterion items, diagnostic categories, and diagnostic thresholds in a general adolescent population. METHOD: The survey was administered to ninth- and 12th-grade public school students. Participation was voluntary, and survey questionnaires were anonymous. The survey included questions about the use of substances during the past year and the presence of DSM-IV criterion symptoms for substance abuse and dependence. This study was based on responses from 74,008 students who answered these questions. RESULTS: Of the students who reported any substance use in the past 12 months, 13.8% of the ninth graders and 22.7% of the 12th graders met the criteria for a substance abuse diagnosis, and 8.2% of the ninth graders and 10.5% of the 12th graders met the criteria for dependence. The presence of multiple criterion symptoms was strongly associated with the use of multiple drugs. Analyses of positive and negative predictive value, sensitivity, and specificity did not support the diagnostic distinction between dependence criteria and abuse criteria. CONCLUSIONS: A combined set of criteria, with empirically derived diagnostic threshold categories based on total number of symptoms, may be more suitable for estimates of substance use disorders and need for treatment among adolescents.

Adolescent↗

PubMed1997

Multiple substance use among adolescent physical and sexual abuse victims.

OBJECTIVE: This study was conducted to examine the relationship between substance use patterns among adolescents and their histories of physical and/or sexual abuse. METHOD: The Minnesota Student Survey was administered in 1995 to 122,824 public school students in Grades 6, 9, and 12. Substance user groups were created based on frequency of use and the number of substances used. Use of individual substances, use of multiple substances, age of first use, and reasons for use were examined with respect to histories of physical and/or sexual abuse. RESULTS: Physical and sexual abuse were associated with an increased likelihood of the use of alcohol, marijuana, and almost all other drugs for both males and females in the three grades surveyed. Use of multiple substances was highly elevated among victims of abuse, with the highest rates seen among students who reported both physical and sexual abuse. Abuse victims also reported initiating substance use earlier than their nonabused peers and gave more reasons for using, including use to cope with painful emotions and to escape from problems. CONCLUSION: Because of their increased vulnerability, young victims of physical and sexual abuse need improved prevention, early intervention, and treatment services related to substance use.

Adolescent↗

PubMed1997

The future of risk factor research in understanding the etiology of eating disorders.

This article explores whether particular risk factors are best seen as precursors or as symptoms. Psychological, cultural, family, developmental, and biological risk domains that may be important in the etiology of eating disorders are briefly reviewed. We describe a 4-year prospective study assessing a wide range of risk factors for development of eating disorders in a large school-based sample of adolescents. For subjects who were relatively asymptomatic, a personality or temperamental characteristic of negative affect/esteem measured at study entrance was the only significant predictor of later risk score for both girls and boys. The significant comorbidity demonstrated in a separate group that had high risk for eating disorders suggests that negative affectivity may be a vulnerability factor for overall psychopathology rather than a predisposition specifically for eating disorders. Following subjects through the young-adult years and later may further clarify the range of influences affecting disordered eating. Primary prevention and early intervention programs in the schools are also recommended.

Feeding and Eating Disorders↗

PubMed1996

Self-esteem and change in body mass index over 3 years in a cohort of adolescents.

Self-esteem has been hypothesized to be lower in obese adolescents relative to their normal weight peers and to be an important factor in preventing or reversing obesity. The present study examined the relationship between obesity and self-esteem cross-sectionally and prospectively over three years in a cohort of 1278 adolescents in grades 7 to 9 at baseline. Cross-sectional analyses revealed an inverse association between physical appearance self-esteem and body mass index in both males and females. In females, body mass index was inversely associated with global self-esteem, close friendship, and behavioral conduct self-esteem. In males, body mass index was inversely associated with athletic and romantic appeal self-esteem. Prospectively, in females, physical appearance and social acceptance self-esteem at baseline were inversely related to body mass index three years later. Baseline self-esteem was unrelated prospectively to change in body mass index in males. All associations were modest in magnitude. These results suggest that in a middle class white sample of adolescents, self-esteem specific to physical appearance is modestly associated with body mass index. Low self-esteem does not appear to predict the development of obesity over time.

Adolescent↗

PubMed1996

The development of patient profiles for Minnesota's treatment outcomes monitoring system.

Minnesota's treatment outcomes monitoring system is a cooperative effort between the State alcohol and drug abuse agency and 366 licensed treatment providers. A minimum dataset is required on all treatment admissions to provide a state-wide system profile. In addition, data are being collected on a sample of 30 patients from each program to measure patient characteristics and severity of problems, patient perceptions of needed assistance, actual nature and amount of services received, patient satisfaction and patient functioning 6 months following discharge from treatment. The dimensions measured include alcohol and other drug use, physical health, psychological well-being, employment and financial status, family and social relationships and criminality. The aggregated data will be analysed to determine what types of services are associated with more favorable outcomes for different types of patients. The findings will be used to develop standards for treatment placement and service delivery based on individual patient profiles. This report provides an overview of the plan and an illustration of how patient profiles can be developed for purposes of treatment service matching and outcomes monitoring.

Adult↗

PubMed1995

Changes in psychological variables and health behaviors by dieting status over a three-year period in a cohort of adolescent females.

PURPOSE: Psychologic and behavioral changes associated with frequent dieting were examined. Compared to nondieters, frequent dieters were hypothesized to show more adverse psychologic changes and increased use of unhealthy weight control behaviors, but possibly healthier eating and exercise behavior changes, over the three-year period of observation. METHODS: A prospective study of female students, in grades 7-10 at baseline completed a health behavior survey in school once a year for a total of three years. RESULTS: Restrained eating, body dissatisfaction and drive for thinness, self-induced vomiting, laxative use, diet pill use, and alcohol use, significantly increased, and physical appearance and self-concept significantly decreased among frequent dieters, compared to non-dieters. Changes in scores on five EDI subscales, eight self-esteem subscales, weight fluctuations, dietary intake, and physical activity patterns did not significantly differ over time by dieting status. CONCLUSION: Dieting may reflect a general pattern of unhealthy behaviors adopted in adolescence, rather than act as a causal factor in promoting psychologic distress.

Adolescent↗

PubMed1995

Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating.

This article presents the 2-year findings of a prospective investigation of the precursors to the later development of an eating disorder in adolescents. The sample consisted of 852 girls and 815 boys who began to study in Grades 7-10 and participated for 3 consecutive years. For both genders, the strongest predictors of Year 3 risk status were Years 1 and 2 risk scores. When the effects of Year 1 and Year 2 risk were controlled, race (Caucasian) and poor interoceptive awareness at Year 2 were significant predictors of disordered eating at Year 3 for girls. Previous risk status was the only significant predictor of Year 3 risk for boys. Gender difference evaluations in the risk score components indicated that a significantly greater proportion of girls than boys endorsed behaviors that were similar to eating disorder diagnostic criteria. Poor interoceptive awareness may provide a vulnerability for eating disorders; possible pathways were discussed.

Child↗

PubMed1995

Dieting behaviors and weight change history in female adolescents.

The prevalence of dieting, weight change history, and specific weight loss behaviors was examined in a population-based sample of 1,015 female 9th-12th graders. Healthy weight loss behaviors were reported much more frequently than unhealthy weight loss behaviors (e.g., healthy behaviors: exercise = 32.4%, decrease fat intake = 26.0%, reduce snacks = 25.0%, reduce kilocalorie intake = 22.4%; unhealthy behaviors: fasting = 8.1%, diet pills = 5.4%, vomiting = 4.4%). Obesity status and restrained eating scores were positively related to greater history of weight loss episodes, pounds lost, and weight fluctuations and to greater use of healthy weight loss methods and weight loss programs. Implications for public health recommendations regarding dieting and its associated behaviors in female adolescents are discussed.

Adolescent↗

PubMed1994

Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms.

PURPOSE: Food preferences, eating patterns, and physical activity patterns were examined in a cohort of adolescent females and males participating in a longitudinal study of the developmental antecedents of eating disorders. METHODS: All adolescents (n = 1494) in grades seven through ten in an entire school district completed a survey about their dieting behaviors, eating, and exercise patterns. RESULTS: Principal components analysis showed similar factor structures for food preferences and eating patterns among males and females. Gender differences were present in physical activity patterns. Sports participation was correlated with healthy food preference and was a significant predictor of eating disorders symptoms. Junk food preference was marginally inversely related to eating disorders symptoms in females. Preference for other types of foods and reported intake of foods were not related to eating disorders symptoms. The percent of variance in risk score accounted for by dietary intake and physical activity patterns was small. CONCLUSIONS: Psychological and social/environmental variables may explain a larger proportion of the variance in eating disorders risk than the dietary and physical activity variables examined in this study. Implications for understanding the etiology and behavioral expression of eating disorders are discussed.

Adolescent↗

PubMed1994

Weight concerns, dieting behavior, and smoking initiation among adolescents: a prospective study.

Students (n = 1705) in grades 7 through 10 were surveyed at baseline and 1 year later about their weight concerns, dieting behaviors, and smoking behavior. Three of six weight concerns and dieting behaviors assessed at baseline were prospectively related to smoking initiation in girls (trying to lose weight, eating disorder symptoms, constant thoughts about weight). Four of six weight concerns and dieting behaviors were cross-sectionally related to current smoking at baseline in girls (trying to lose weight, eating disorder symptoms, fear of weight gain, desire to be thin). Weight concerns and dieting behaviors were largely unrelated to current smoking in boys. Implications for smoking prevention efforts are discussed.

Adolescent↗