James Sargent

To examine the test characteristics of the capillary blood lead screening test as a predictor of elevated venous blood lead levels, using receiver operating characteristic (ROC) curves. To consider a rational capillary blood lead cutoff value in the context of what has been learned about the screening test and what is understood about the clinical course of children with elevated blood lead levels in the mild range (0.48-0.92 mumol/L [10-19 micrograms/dL]). In a clinical trial, 513 urban children aged 6 years and younger were screened for lead exposure. Paired samples of venous blood were drawn from all children. For these children we examine the ROC curves for capillary blood lead levels as a predictor of elevated venous blood lead levels above 2 thresholds, 0.48 and 0.97 mumol/L (10 and 20 micrograms/dL). Contaminated capillary specimens were defined as those in which the capillary result exceeded the venous result by 0.12 mumol/L (2.5 micrograms/dL) or more (n = 49). Test sensitivity and false-positive rate (equal to 1-specificity) as a function of the capillary screening cutoff value. Area under the ROC curve as a measure of screening test performance. Venous blood lead levels were 0.48 mumol/L (10 micrograms/dL) or more in 20.5% and 0.97 mumol/l (20 micrograms/dL) or more in 2.3% of children. Measurement of capillary blood lead levels performed very well as a screening test with an area under the ROC curve of 0.97 at the 0.48 mumol/L (10-micrograms/dL) threshold and 0.99 at the 0.97-mumol/L (20-micrograms/dL) threshold. For a capillary cutoff value of 0.39 mumol/L (8 micrograms/dL) and an elevated blood lead level threshold of 0.48 mumol/L (10 micrograms/dL), test sensitivity is 100% and the false-positive rate is 23%. Test sensitivity drops to 91%, 63%, and 45% at capillary cutoff values of 0.48, 0.58, and 0.68 mumol/L (10, 12, and 14 micrograms/dL), respectively. The false-positive rate drops to 8%, 2%, and 1% at capillary cutoff values of 0.48, 0.58, and 0.68 mumol/L (10, 12, and 14 micrograms/dL), respectively. Changing the contamination rate by appending or deleting contaminated capillary specimens from the data set had little effect on the area under the ROC curve at either threshold. In this sample of children, capillary blood lead measurement performed well as a screening test for elevated venous blood lead levels. Altering the capillary specimen contamination rate has little effect on the rest characteristics because much of the misclassification error resulted from random analytic error in the analysis of blood lead levels, which is high compared with the threshold of concern (0.48 mumol/L [10 micrograms/dL]). Because of lack of data on clinical outcomes for children with elevated blood lead levels in the 0.48- to 0.92-mumol/L (10- to 19-micrograms/dL) range, we suggest that the greatest utility be placed on avoiding false-positive misclassification. A clinical capillary screening cutoff value of 0.72 mumol/L (15 micrograms/dL) would avoid most false-positive results and would permit 100% sensitivity in detecting children with blood lead levels of 0.97 mumol/L (20 micrograms/dL) or higher.

The prevalence of adolescent obesity has increased dramatically over the past three decades, and research has documented that the number of television shows viewed during childhood is associated with greater risk for obesity. In particular, considerable evidence suggests that exposure to food marketing promotes eating habits that contribute to obesity. The present study examines neural responses to dynamic food commercials in overweight and healthy-weight adolescents using functional magnetic resonance imaging (fMRI). Compared with non-food commercials, food commercials more strongly engaged regions involved in attention and saliency detection (occipital lobe, precuneus, superior temporal gyri, and right insula) and in processing rewards [left and right nucleus accumbens (NAcc) and left orbitofrontal cortex (OFC)]. Activity in the left OFC and right insula further correlated with subjects' percent body fat at the time of the scan. Interestingly, this reward-related activity to f...

This study examines whether smoking portrayal in movies or antismoking advertisements affect smoking intensity among young adults. We conducted an experimental study in which 84 smokers were randomly assigned using a two (no-smoking versus smoking portrayal in the movie) by three (two prosocial ads, two antismoking ads or one of each) factorial design. Participants viewed a 60-minute movie with two commercial breaks and afterwards completed a questionnaire. Smoking during the session was allowed and observed. Exposure to the movie with smoking had no effect on smoking intensity. Those who viewed two antismoking ads had significantly lower smoking intensity compared with those who viewed two prosocial ads. There was no interaction between movie smoking and antismoking ads. Baseline CO (carbon monoxide) level had the largest effect on smoking intensity. These findings provide further evidence to support antismoking ads placed with movies because of their possible effect on young adult...

Although additional dietary calcium is recommended frequently to reduce the risk of lead poisoning, its role in preventing lead absorption has not been evaluated clinically. The objective was to determine the safety and to estimate the size of the effect of calcium- and phosphorus-supplemented infant formula in preventing lead absorption. One hundred three infants aged 3.5-6 mo were randomly assigned to receive iron-fortified infant formula (465 mg Ca and 317 mg P/L) or the same formula with added calcium glycerophosphate (1800 mg Ca and 1390 mg P/L) for 9 mo. There was no significant difference between groups in the mean ratio of urinary calcium to creatinine, serum calcium and phosphorus, or change in iron status (serum ferritin, total iron binding capacity). At month 4, the median (+/-SD) increase from baseline in blood lead concentration for the supplemented group was 57% of the increase for the control group (0.04 +/- 0.09 compared with 0.07 +/- 0.10 micromol/L; P = 0.039). Thi...

Little is known about the impact of viewing depictions of alcohol in entertainment media on adolescent drinking behavior. Our aims were to assess drinking in a sample of popular contemporary movies and to examine the association of movie alcohol exposure with early-onset drinking in an adolescent sample. We conducted a school-based cross-sectional survey (N=4655) with longitudinal follow-up of never-drinkers (N=2406) involving adolescents ages 10-14 years and recruited from 15 New Hampshire and Vermont schools. Screen depictions of alcohol use were timed for each of 601 popular contemporary movies. Each adolescent was asked if he/she had seen a unique list of 50 movie titles, randomly selected from the larger pool. Movie alcohol use was summed for movies the adolescent had seen, adjusted to reflect exposure to the larger pool and modeled as a continuous variable. Ninety-two percent of the movies in the sample depicted drinking; median screen time for movie alcohol use was 2.5 minute...

This study examines smoking patterns and predictors of change in smoking among 895 students from five universities who participated in a trial to reduce harms from high risk drinking. Baseline smoking rate was 46%. After two years, 39% of smokers quit, 19% reduced their smoking, 18% increased and 24% remained the same; 13% of non-smokers initiated tobacco use. Only 9% of those who quit were daily smokers at baseline, compared with 38% of those who continued to smoke (p<.001). Average baseline drinking level was the same in both groups, but those who quit smoking had reduced their drinking by 45%, compared with a 25% reduction among continuing smokers (p<.001). In regression analyses, smokers who were less tobacco dependent at baseline, increased weekly exercise, and decreased monthly alcohol intake were more likely to be quit (all p<.001). Among baseline non-smokers, predictors of smoking at follow-up included class year and past month drinking level (both p<.03). Gender...

Background: Alcohol outlets dictate many aspects of the sale of alcohol and may affect drinking behaviors. Limits on alcohol outlets could curtail consumption by limiting physical access to alcohol, increasing the cost of alcohol, limiting exposure to alcohol marketing, and affecting social aggregation in and around alcohol outlets. A recent systematic review found widely discrepant measures of alcohol outlet density, making it difficult to summarize effect sizes and rule out modifiable areal unit problem. Moreover, few of the existing studies are national in scope, making regional differences another likely contributor to the observed heterogeneity. Methods: We developed a national dataset from geocoded addresses of alcohol outlets from a commercial business information service. We calculated 21 different measures of alcohol outlet density using circular buffers, ZIP code areas, Census polygons and kernel density estimation techniques as well as Euclidian and network proximity arou...

To investigate whether exposure to alcohol use in films (AUFs) is associated with early alcohol use, binge drinking, and alcohol-related problems in British adolescents. Cross-sectional study with 5163 15-year-olds from the Avon Longitudinal Study of Parents and Children in the United Kingdom. We measured adolescent exposure to AUFs, age at onset of alcohol use, and binge-drinking behavior. We adjusted for early childhood social, family and behavioral factors, adolescent tobacco use, and peer drinking. After adjustment, adolescents with the highest exposure to AUFs were 1.2 (95% confidence interval [CI]: 1.1-1.3) times more likely to have tried alcohol compared with those least exposed and 1.7 (95% CI: 1.5-2.0) times more likely to binge drink. They were 2.4 (95% CI: 1.9-3.1) times more likely to drink weekly and 2.0 (95% CI: 1.7-2.4) times more likely to have alcohol-related problems than those least exposed. Exposure to AUFs is associated with higher risk of alcohol use and alcohol-related problems in UK adolescents. Our findings provide evidence to support the argument that a review of film-rating categories and alcohol ratings for all films may help reduce problem-related alcohol consumption in young people.

To assess whether a dose-response relation exists between the number of cigarette promotional items (CPIs) owned by an adolescent, and smoking behaviour. Voluntary, self administered survey of 1265 sixth through to 12th grade students (ages 10-19 years), representing 79-95% of all students attending five rural New Hampshire and Vermont public (state funded) schools in October 1996. The association between the number of CPIs owned by students and smoking behaviour was examined using multivariate regression methods. Adjusted odds of being a smoker (>/= 100 cigarettes lifetime) and, among never and experimental smokers, adjusted cumulative odds of having higher levels on a smoking uptake index given the number of CPIs owned. One third of students owned a CPI (n = 406). Among owners, 211 owned one, 82 owned two, 57 owned three, 24 owned four, 23 owned five, and 7 students owned six CPIs. The number of CPIs owned by students was not associated with grade in school but was significantl...

To describe programming themes and the inclusion of adolescents in the base audience for television channels with high levels of energy drink advertising airtime. Secondary analysis of energy drink advertising airtime over US network and cable television channels (n = 139) from March, 2012 to February, 2013. Programming themes and the inclusion of adolescents in each channel's base audience were extracted from cable television trade reports. Energy drink advertising airtime. Channels were ranked by airtime; programming themes and the inclusion of adolescents in the base audience were summarized for the 10 channels with the most airtime. Over the study year, 36,501 minutes (608 hours) were devoted to energy drink advertisements; the top 10 channels accounted for 46.5% of such airtime. Programming themes for the top 10 channels were music (n = 3), sports (n = 3), action-adventure lifestyle (n = 2), African American lifestyle (n = 1), and comedy (n = 1). MTV2 ranked first in airtim...

We examine the association between exposure to depictions of reckless driving in movies and unsafe driving, modeling inattentive and reckless driving as separate outcomes. Data were obtained by telephone from 1,630 US adolescents aged 10 to 14 years at baseline who were drivers at a survey 6 years later. Exposure to movie reckless driving was measured based on movies seen from a randomly selected list of 50 movie titles that had been content coded for reckless driving among characters. Associations were tested with inattentive and reckless driving behaviors in the subsequent survey-controlling for baseline age, sex, socioeconomic status, parental education, school performance, extracurricular activities, daily television and video/computer game exposure, number of movies watched per week, self-regulation and sensation seeking. Exposure to movie reckless driving was common, with approximately 10% of movie characters having driven recklessly. Confirmatory factor analysis revealed a si...

Many adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes. To assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking. We conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained whether respondents had smoked cigarettes, smoked water pipe tobacco, or used snus. At the 2-year follow-up (October 27, 2012, through March 31, 2013), we determined whether baseline non-cigarette smokers had subsequently tried cigarette smoking, were current (past 30 days) cigarette smokers, or were high-intensity cigarette smokers. We fit multivariable logistic regression models among baseline non-cigarette smokers to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with subsequent cigarette smoking initi...

To assess the association between energy drink use and hazardous alcohol use among a national sample of adolescents and young adults. Cross-sectional analysis of 3342 youth aged 15-23 years recruited for a national survey about media and alcohol use. Energy drink use was defined as recent use or ever mixed-use with alcohol. Outcomes were ever alcohol use and 3 hazardous alcohol use outcomes measured with the Alcohol Use Disorders Identification Test (AUDIT): ever consuming 6 or more drinks at once (6+ binge drinking) and clinical criteria for hazardous alcohol use as defined for adults (8+AUDIT) and for adolescents (4+AUDIT). Among 15-17 year olds (n = 1508), 13.3% recently consumed an energy drink, 9.7% ever consumed an energy drink mixed with alcohol, and 47.1% ever drank alcohol. Recent energy drink use predicted ever alcohol use among 15-17-year-olds only (OR 2.58; 95% CI 1.77-3.77). Of these 15-17-year-olds, 17% met the 6+ binge drinking criteria, 7.2% met the 8+AUDIT criteria,...

To investigate the association between having a favourite alcohol advertisement and binge drinking among European adolescents. Data were obtained from a longitudinal observational study on relationships between smoking and drinking and film tobacco and alcohol exposures. State-funded schools. Baseline survey of 12 464 German, Italian, Polish and Scottish adolescents (mean age 13.5 years), of whom 10 259 (82%) were followed-up 12 months later. Pupils were asked the brand of their favourite alcohol advertisement at baseline. Multi-level mixed-effects logistic regressions assessed relationships between having a favourite alcohol advertisement ('alcohol marketing receptivity') and (i) binge drinking at baseline; and (ii) initiating binge drinking during follow-up among a subsample of 7438 baseline never binge drinkers. Life-time binge drinking prevalence at baseline was 29.9% and 25.9% initiated binge drinking during follow-up. Almost one-third of the baseline sample (32.1%) and...

It is known that exposure to smoking cues increases urge to smoke (UTS), but little is known about other media factors that might also increase UTS. We hypothesized that horror/ thriller movies might also increase UTS by increasing negative affect. We surveyed 536 movie patrons who were smokers aged 18 years or older. Subjects had exited 26 movies, of which 12 contained smoking and two were horrorfilms, one with and one without smoking. We used random effects regression to assess the association between exposure to movie smoking, movie horror, both and UTS, controlling for confounding factors. Median age was 26 years and 52% were female. Mean UTS was 5.9, 6.6, 6.6, and 8.7 for smokers exiting movies without smoking, with smoking, horror without smoking and horror with smoking respectively. Smoking in movies was associated with a significantly higher UTS (0.63 [95% CI 0.31-0.94]). Horror with smoking increased UTS by 2.8 points (95% C.I. 2.3, 3.5); the horror without smoking estimate...

To test the hypothesis that viewing depictions of smoking in movies makes adolescents less responsive to parenting factors that prevent smoking. Cross-sectional survey of 4807 students (grades 5-8) through which we ascertained exposure to smoking in movies, parent smoking, and adolescents' perception of parental responsiveness (support), and parental demandingness (behavioral control). Adolescents attending randomly selected middle schools in the Northeastern U.S. ever tried smoking a cigarette. Exposure to movie smoking was ascertained by counting occurrences of tobacco use in 601 recent popular motion pictures; surveying students to identify films they had seen from a random subset of 50 films; and summing tobacco use occurrences for the films each adolescent reported seeing. We also measured adolescents' perceptions of parent smoking, parental responsiveness and demandingness. The overall prevalence of adolescent smoking was 17.4 percent. The prevalence of smoking increas...

Several studies have linked seeing smoking in movies with adolescent smoking, but none have determined how much movie smoking adolescents see. Our aim was to determine exposure to movie smoking in a representative sample of young US adolescents. METHODS. We surveyed 6522 nationally representative US adolescents aged 10-14 years. We content analyzed 534 contemporary box-office hits for movie smoking. Each movie was assigned to a random subsample of adolescents (mean: 613) who were asked whether they had seen the movie. Using survey weights, we estimated the total number of US adolescents who had seen each movie and then multiplied by the number of smoking depictions in each movie to obtain gross smoking impressions seen by adolescents. The 534 movies were mainly rated PG-13 (41%) and R (40%), and 74% contained smoking (3830 total smoking occurrences). On average, each movie was seen by 25% of the adolescents surveyed. Viewership was higher with increased age and lower for R-rated mov...

This review examines the evidence supporting an association between seeing smoking depictions in movies and adolescent smoking. The portrayal of tobacco use is common in movies and often modeled by movie stars who, from a social influences standpoint, should be powerful behavior change agents. The results of studies assessing audience responses to tobacco portrayal in movies are remarkably consistent in showing a moderate to strong association between seeing movie smoking and more positive attitudes toward smoking and adolescent smoking initiation. The population-based data include cross sectional samples from different regions of the United States, all supporting a movie smoking-teen smoking link. The 2 published longitudinal studies show an independent link between exposure to movie smoking at baseline and initiation in the future, with estimates of the effect size being remarkably consistent with their cross-sectional counterparts. Experimental research adds support by showing th...

This article examines the evidence that supports an association between seeing smoking depictions in movies and adolescent smoking. The portrayal of tobacco use is common in movies and often is modeled by stars, who, from a social influences standpoint, should be powerful behavior change agents. The results of studies that assess audience responses to tobacco portrayal in movies are remarkably consistent in showing a moderate to strong association between seeing movie smoking and more positive attitudes toward smoking and adolescent smoking initiation. The two published longitudinal studies show an independent link between exposure to movie smoking at baseline and initiation in the future, with estimates of the effect size being remarkably consistent with their cross-sectional counterparts. Pediatricians should support public health campaigns to pressure the movie industry to voluntarily reduce smoking in movies and encourage parents to adhere to the Motion Picture Ratings System to...

Viewing smoking and drinking in movies may prompt adolescents to initiate these behaviors. Movies with R ratings contain more smoking than do movies in all other rating categories. To evaluate the extent to which parents restrict the exposure of adolescents to R-rated movies and to determine whether such restrictions are associated with decreased tobacco and alcohol use in adolescents. Cross-sectional, self-administered survey. Students in grades 5 through 8 enrolled in New Hampshire and Vermont schools. SAMPLING STRATEGY: Fifteen schools in Vermont and New Hampshire were randomly selected from all middle schools with > or = 150 students. Students who had tried smoking cigarettes or tried drinking alcohol without parental knowledge. Of 4544 students surveyed, 18% had tried cigarettes and 23% had tried alcohol. Although 90% were younger than 14 years of age, only 16% were completely restricted from viewing R-rated movies. The prevalence of having tried smoking was 35% for those wi...

The clinical management of children with attention deficit/hyperactivity disorder (ADHD) requires measurement of behavioral outcomes at home and at school. This information is difficult to obtain. Could a Web site that facilitates exchange of information between parents, teachers, and health care professionals improve behavioral outcomes for children with ADHD? Designing a pragmatic intervention and evaluation strategy. Establish a secure Web site to share observations on a child with ADHD. Access to a child's electronic record will be limited to team members defined by the parents. The record will contain documentation of consent for team members to communicate both diagnostic and treatment information. The record will feature two methods of communication: 1) the ability to input and graphically view structured behavioral questionnaire data that measure levels of attention and hyperactivity/impulsivity, and 2) an electronic bulletin board that allows users to post and respond t...

... Weberg R, Berstad A, Ladehaug B, Thomassen Y. Are aluminum-containing antacids during pregnancy safe ... Edward H. Norman, MPH Tena H. Ward Division of Environmental Health Department of Environmental and Natural Resources PO Box 29534 Raleigh, NC 27626-0534 ...

One objective of this clinical trial was to determine whether calcium and phosphorus supplementation of infant formula affects the iron status of healthy full-term infants. One hundred three infants were randomly assigned to receive iron-fortified, cow milk-based infant formula (465 mg Ca and 317 mg P/L) or the same formula with added calcium glycerophosphate (1800 mg Ca and 1390 mg P/L) for 9 mo. Reported calcium intake for supplemented infants was about four times that of control infants, ranging from a mean of 1741 mg/d at baseline to 1563 mg/d at 9 mo. There was no difference by treatment group in mean or median change from baseline of serum ferritin, total-iron-binding capacity, erythrocyte protoporphyrin, or hematocrit at 4 and 9 mo after enrollment. Incidence of iron deficiency was similar for both groups and no infant developed iron deficiency anemia during the trial. This study indicates that the well-documented inhibitory effect of calcium and phosphorus on iron absorption...

Character-based video games do more than allow one to practice various kinds of behaviors in a virtual environment; they allow one to practice being a different kind of person. As such, we propose that games can alter self-perceptions of personal characteristics, attitudes, and values with broad consequences for behavior. In a multiwave, longitudinal study of adolescents, we examined the extent to which play of mature-rated, risk-glorifying (MRRG) games was associated with increases in alcohol use, cigarette smoking, aggression, delinquency, and risky sex as a consequence of its effects on personality, attitudes, and affiliations indicative of increased tolerance of deviance. Participants were selected with random-digit-dial procedures and followed for 4 years. Data were analyzed with linear mixed modeling to assess change over time and structural equation modeling with latent variables to test hypothesized mediational processes. Among those who play video games, playing MRRG games was associated with increases in all measures of behavioral deviance. Mediational models support the hypothesis that these effects are in part a consequence of the effects of such gameplay on sensation seeking and rebelliousness, attitudes toward deviant behavior in oneself and others, and affiliation with deviant peers. Effects were similar for males and females and were strongest for those who reported heavy play of mature-rated games and games that involved protagonists who represent nonnormative and antisocial values. In sum, the current research supports the perspective that MRRG gameplay can have consequences for deviant behavior broadly defined by affecting the personality, attitudes, and values of the player.

Little information is available about bicycle-mounted child seats despite their general use for a decade. We analyzed two existing data sets to gain information about frequency, trend, and characteristics of bicycle-mounted child seat injuries to children 5 years old and younger. Available data suggest an increased frequency of these injuries, with the rate of passenger injuries rising from 17% to 28% of all reported bicycle-related injuries to children in this age group in California during the years 1977 to 1986. In a detailed sample of 52 injuries related to the use of bicycle-mounted child seats, 42% occurred when the bicycle crashed or tipped over and 25% occurred when the child fell out of the seat. Sixty-five percent involved the head and face, and 27% of the head injuries were serious. Substantial morbidity associated with these injuries could be amellorated if children using these seats wore appropriate bicycle helmets.

As a preliminary step in the development of a school-based educational intervention to promote bicycle helmet use among children, focus group encounters were conducted with fourth, fifth, and sixth graders at three elementary schools in the Boston, Mass, area. Analysis of transcripts of encounter tape recordings indicated that (1) the prevalence of helmet ownership and use was low, (2) children were concerned that helmet use would invite derision from their peers, and (3) children tended to respect other children who wore helmets. We concluded that focus groups can be useful in conceptualizing health education interventions and suggest that school-based peer-led bicycle helmet programs may be effective in developing normative change toward helmet use among elementary schoolchildren.

1. Pediatr Ann. 1994 Nov;23(11):636-42. The role of nutrition in the prevention of lead poisoning in children. Sargent JD. Dartmouth-Hitchcock Medical Ctr, Lebanon, NH 03755. PMID: 7838616 [PubMed - indexed for MEDLINE]. Publication Types: Review. MeSH Terms. ...

The aim of this study was to determine if parental restriction regarding Restricted-rated movies (R movies) predicts lower rates of early-onset alcohol use. Students from 15 northern New England middle schools were surveyed in 1999, and never-drinkers were resurveyed 13-26 months later to determine alcohol use. Drinking was determined by the question, "Have you ever had beer, wine, or other drink with alcohol that your parents didn't know about?" R-movie restriction was assessed by the question, "How often do your parents allow you to watch movies that are rated R?" The sample included 2,406 baseline never-drinkers who were surveyed at follow-up, of whom 14.8% had initiated alcohol use. At baseline, 20% reported never being allowed to watch R movies, and 21% reported being allowed all the time. Adolescents allowed to watch R-rated movies had higher rates of alcohol initiation (2.9% initiation among never allowed, 12.5% once in a while, 18.8% sometimes, and 24.4% all the time). Controlling for sociodemographics, personality characteristics, and authoritative parenting style, the adjusted odds ratios for initiating alcohol use were 3.0 (95% CI [1.7, 5.1]) for those once in a while allowed, 3.3 [1.9, 5.6] for those sometimes allowed, and 3.5 [2.0, 6.0] for those always allowed to watch R-rated movies. Alcohol initiation was more likely if R-rated movie restriction relaxed over time; tightening of restriction had a protective effect (p < .001). A structural model was developed that modeled two latent parenting constructs: (a) authoritative parenting and (b) media parenting. Both constructs had direct inverse paths to trying alcohol and indirect paths through lower exposure to R-rated movies. After accounting for differences in authoritative parenting style, adolescents reporting lesser restrictions for R movies have higher odds of future alcohol use. The structural model suggests that media parenting operates independently from authoritative parenting and should be incorporated explicitly into parenting prevention programs.

We assess exposure to direct-to-consumer tobacco marketing and its association with ever having tried smoking, smoking within past 30 days (current), and smoking ≥100 cigarettes in lifetime (established) among adolescents and young adults. We surveyed a U.S. telephone sample of 3,342 15- to 23-year-olds and 2,541 respondents subsequently completed a web-based survey. Among respondents completing both the telephone and web-based surveys (N = 2,541 [75%]), we assessed their exposure to direct-to-consumer tobacco marketing (receiving direct mail from tobacco companies and seeing tobacco company websites) and their associations with ever having tried smoking, current smoking, and established smoking. Overall, 12% of 15- to 17-year-olds and 26% of 18- to 23-year-olds were exposed to direct-to-consumer tobacco marketing. Racial/ethnic minority nonsmoking respondents were more likely to see tobacco websites than nonsmoking whites. Respondents exposed to either form of direct-to-consumer to...

In the United States, the fast food companies McDonald's and Burger King participate in marketing self-regulation programs that aim to limit emphasis on premiums and promote emphasis of healthy food choices. We determine what children recall from fast food television advertisements aired by these companies. One hundred children aged 3-7 years were shown McDonald's and Burger King children's (MDC & BKC) and adult (MDA & BKA) meal ads, randomly drawn from ads that aired on national US television from 2010-11. Immediately after seeing the ad, children were asked to recall what they had seen and transcripts evaluated for descriptors of food, healthy food (apples or milk), and premiums/tie-ins. Premiums/tie-ins were common in children's but rarely appeared in adult ads, and all children's ads contained images of healthy foods (apples and milk). Participants were significantly less likely to recall any food after viewing the children's vs. the adult ad (MDC 32% [95% confidence interval 23, 41] vs. MDA 68% [59, 77]) p <0.001; BKC 46% [39, 56] vs. BKA 67% [58, 76] respectively, p = 0.002). For children's ads alone and for both restaurants, recall frequency for all food was not significantly different from premium/tie-ins, and participants were significantly more likely to recall other food items than apples or milk. Moreover, premiums/tie-ins were recalled much more frequently than healthy food (MDC 45% [35, 55] vs. 9% [3, 15] p<0.001; BKC 54% [44, 64] vs. 2% [0, 5] respectively, p<0.001). Children's net impressions of television fast food advertising indicate that industry self-regulation failed to achieve a de-emphasis on toy premiums and tie-ins and did not adequately communicate healthy menu choices. The methods devised for this study could be used to monitor and better regulate advertising patterns of practice.