Differences by School Location in Summer and School Monthly Weight Change: Findings from a Nationally Representative Sample

Objectives: To examine changes in accelerations of Body Mass Index (BMI), age-and-sex specific body mass index (zBMI), and 95th percentile of BMI (%BMIp95) during the summer months and school year by school location designation (i.e., urban, suburban, exurban). This study utilized the Early Childhood Longitudinal Study Kindergarten Class of 2010–2011. Methods: Of the 18,174 children in the ECLS-K:2011 dataset, I restricted participants to those with at least two consecutive measures that occurred August/September or April/May. Mixed-effect regression analyses estimated differences in monthly change in BMI, zBMI, and %BMIp95 between the summer and school year while accounting for the ECLS-K complex sampling design. Models also examined differences in the magnitude of BMI, zBMI, and %BMIp95 change between the summer and school year by school location. Post-hoc Benjamini–Hochberg (BH) procedure set at 10% false discovery was incorporated to account for multiple comparisons. Results: A total of 1549 children (48% female, 42% White) had at least two consecutive measures that occurred in August/September or April/May. Among all locale classifications (i.e., urban, suburban, and exurban), children from high-income households comprised the largest proportions for each group (31%, 39%, and 37%), respectively. Among urban and suburban locations, Hispanic children comprised the largest proportions for both groups (43% and 44%), respectively. Among exurban locale classifications, White children comprised the largest proportion of children (60%). Children from suburban and exurban schools experienced significantly less accelerations in monthly zBMI gain when compared to their urban counterparts −0.038 (95CI = −0.071, −0.004) and −0.045 (95CI = −0.083, −0.007), respectively. Children from exurban schools experienced significantly less acceleration in monthly %BMIp95 during the summer months when compared to the school year −0.004 (95CI = −0.007, 0.000). Conclusions: This is one of the first studies to examine summer weight gain by school location. Summer appears to impact children more negatively from urban schools when compared to their suburban and exurban counterparts.

On the Use of Regression Calibration in a Complex Sampling Design With Application to the Hispanic Community Health Study/Study of Latinos

Regression calibration is the most widely used method to adjust regression parameter estimates for covariate measurement error. Yet, its application in the context of a complex sampling design, for which the common bootstrap variance estimator can be less straightforward, has been less studied. We propose two variance estimators for a multi-stage probability-based sampling design, a parametric and a resampling-based multiple imputation approach, where a latent mean exposure needed for regression calibration is the target of imputation. This work was motivated by the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), data from 2006 to 2011, for which relationships between several outcomes and diet, an error-prone self-reported exposure, are of interest. We assessed the relative performance of these variance estimation strategies in an extensive simulation study built on the HCHS/SOL data. We further illustrate the proposed estimators with an analysis of the cross-sectional association of dietary sodium intake with hypertension-related outcomes in a subsample of the HCHS/SOL cohort. We provide investigators guidelines for the application of regression models with regression-calibrated exposures. Practical considerations for implementation of these two variance estimators in the setting of a large multi-center study are also discussed. Code to replicate the presented results is available online.

Cross-Sectional Association Between Exclusive and Concurrent Use of Cigarettes, ENDS, and Cigars, the Three Most Popular Tobacco Products, and Wheezing Symptoms Among U.S. Adults

Introduction This study assessed the association of exclusive and concurrent use of cigarettes, electronic nicotine delivery systems (ENDS), and cigars with ever and past 12-month wheezing symptoms among a nationally representative sample of US adult current tobacco users. Methods Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. The weighted prevalence of self-reported ever and past 12-month wheezing symptoms for noncurrent users compared with users of cigarettes, ENDS, cigars, and any combination of these products (polytobacco use of these tobacco products) were presented for 28 082 adults. The cross-sectional association of tobacco use with self-reported wheezing symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design. Results Significantly higher odds of ever had wheezing or whistling in the chest at any time in the past were observed among current cigarette (adjusted odds ratio: 2.62, 95% confidence intervals [CI]: 2.35, 2.91), ENDS (1.49, 95% CI: 1.14, 1.95), and polytobacco users (2.67, 95% CI: 2.26, 3.16) compared with noncurrent users. No associations were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared with exclusive ENDS (1.61, 95% CI: 1.19, 2.17) and exclusive cigar use (2.87, 95% CI: 1.93, 4.26), but not exclusive use of cigarettes. Conclusions Ever wheezing is associated with the use of cigarettes, ENDS, and polytobacco use of cigarettes, ENDS, and/or cigars, but not cigar use. The association of polytobacco use and wheezing appears to be driven by cigarette use. Implications Cross-sectional associations with ever and past 12-month wheezing symptoms were found to be the strongest among cigarette users, exclusively or in combination. Future longitudinal research is needed to better understand how cigarette use interacts with other tobacco and nicotine products and contributes to respiratory symptoms.

Testing for measurement error in survey data analysis using paradata

Summary Paradata refers to survey variables which are not of direct interest themselves, but are related to the quality of data on survey variables which are of interest. We focus on a categorical paradata variable, which reflects the presence of measurement error in a variable of interest. We propose a quasi-score test of the hypothesis of no measurement error bias in the estimation of regression coefficients under models for paradata. We also propose a regression-based test, analogous to a simple test proposed by Fuller for instrumental variables. The methods developed can take account of a complex sampling design. In an application with data from the British Household Panel Survey, all tests provide clear evidence of measurement bias in the estimated coefficient of gross pay. In a simulation study, all tests have rejection rates close to the nominal level under the null hypothesis; the quasi-score tests display more power than the regression-based test. The size of the quasi-score test is shown to be robust to some forms of misspecification of the paradata model, both by a theoretical argument and in findings of the simulation study.

Variance Estimation by Linearisation for the At Risk of Poverty or Social Exclusion (AROPE) Rate

The At Risk of Poverty or Social Exclusion (AROPE) Rate is the key indicator for monitoring the European Commissions 2020 Strategy poverty target. But the variance of the AROPE Rate is not straightforward to estimate. Re-sampling methods can be used, but they are difficult to adapt to complex sampling design, that are often used for the surveys that provide the data source for estimating the AROPER. The presented work fills a methodological gap by providing a linearisation of the AROPE Rate estimator that can be used with well known variance estimators and therefore facilitate the reporting of appropriate inference for this important indicator. The precision of the developed variance estimators based on linearisation is assessed via simulation studies and compared with a bootstrap variance estimator, as an alternative.

Cessation of E-Cigarette Use Among Adolescents and Its Associated Factors

We assessed the prevalence of cessation of e-cigarette and its associated factors among adolescents in Malaysia. This study analyzed data from the Tobacco and E-Cigarette Survey among Malaysian Adolescent (TECMA) in 2016, a cross-sectional study with 2-stage stratification cluster sampling. A total of 14 832 school-going adolescents aged 10 to 19 years participated in this survey. A complex sampling design and multiple logistic regression analysis were applied. Nearly half of the adolescents (49.9%; 95% confidence interval [CI] = 44.9-55.0) who had ever used e-cigarette ceased the usage. Based on multivariate analysis, adolescents were more likely to quit e-cigarette because they could not afford the e-cigarette (adjusted odds ratio [aOR] = 2.39, 95% CI = 1.78-3.20), if they are aged 13 year and older (aOR = 1.80, 95% CI = 1.25-2.61), and those who claimed their e-cigarette does not contain nicotine (aOR = 1.35, 95% CI = 1.03-1.78). E-cigarette prevention efforts among adolescents could consider the cessation factors described in this study.

The Prevalence of E-Cigarette Use Among Adults in Malaysia

Electronic cigarettes (e-cigarettes) are a new method for the consumption of nicotine. A nationwide survey among 4288 Malaysian adults was conducted in 2016 to measure the prevalence and to describe the population characteristics of e-cigarette users. A complex sampling design was used, and data were collected using a face-to-face questionnaire. The overall prevalence of current, ever, former, and dual users of e-cigarettes in Malaysia were 3.2% (95% confidence interval [CI] = 2.5-4.1), 11.9% (95% CI = 10.5-13.5), 8.6% (95% CI = 7.5-9.8), and 2.3% (95% CI = 1.8-3.1), respectively. The prevalence of all type of e-cigarette use was higher in urban than in rural areas. Current e-cigarette users were likely to be younger, males, and with higher education level. Among current e-cigarette users, 74% (95% CI = 64-82) also smoked conventional cigarettes (dual user). E-cigarette use is prevalent in Malaysia. It is common among younger adults, males, and cigarette smokers.

ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents

ABSTRACT OBJECTIVE To describe the length of exposure to screens and the prevalence of consumption of meals and snacks by Brazilian adolescents in front of screens. METHODS We evaluated 74,589 12 to 17-year old adolescents from 1,247 schools in 124 Brazilian municipalities. A self-administered questionnaire was used. Its segment regarding nutrition contained questions about using TV, computers, and video game systems, having meals while watching TV, and consuming snacks in front of screens. Consumption of meals and snacks in front of screens was analyzed according to the following variables: geographical region, gender, age range, type of school (public or private), and school shift. The prevalences and their respective 95% confidence intervals were estimated under a complex sampling design. RESULTS A great deal of the adolescents (73.5%, 95%CI 72.3-74.7) reported spending two or more hours a day in front of screens. That habit was more frequent among male adolescents, private school students, morning shift students, and students from Brazil’s South region. More than half of the adolescents (56.6%, 95%CI 55.4-57.8) reported almost always or always having meals in front of TV, and 39.6% (95%CI 38.8-40.5) of them said they consumed snacks in front of screens exactly as often. Both situations were the most prevalent ones among the girls, who attended public schools and were from Brazil’s Midwest region. CONCLUSIONS Length of exposure to screens and consumption of meals and snacks almost always or always in front of screens are high among Brazilian adolescents. It is necessary to develop strategies aiming to reduce the length of screen use, considering the media reality that children and adolescents have been experiencing from earlier and earlier ages. That context must therefore be analyzed in an indissociable way.