American Journal of Preventive Medicine
IntroductionBridging the Gap: Research Informing Practice and Policy for Healthy Youth Behavior
Introduction
A decade ago, youth tobacco use, drinking, and illicit drug use were on the rise, perceived risk from and disapproval of regular substance use was falling, and perceived availability of various licit and illicit substances was generally rising. These trends raised significant concerns in the public health community, among policymakers, and in the general public, given the significant health, social, and economic consequences caused by substance use and abuse. A wide variety of policy, programmatic, and other interventions were developed and implemented in efforts to reverse these trends, often with little or no evidence on their potential impact. To address this lack of knowledge and to build the evidence base on the effectiveness of various policies, practices, and programs, the Robert Wood Johnson Foundation (RWJF) created a new initiative, Bridging the Gap: Research Informing Practice and Policy for Healthy Youth Behavior (BTG). In the 10 years since its inception, BTG has considerably improved the understanding of the impact of policies, programs, practices, and other environmental influences on youth smoking, drinking, illicit drug use, and their related outcomes.
More recently, as evidence has emerged about the sharp increases in obesity rates among children, adolescents, and adults, a similarly wide variety of interventions with even less evidence on their effectiveness have begun to be adopted and implemented. Concurrently, it became apparent to both the BTG investigators and those working with them at the Foundation that the approaches successfully employed by BTG in its work on youth substance use could be adapted quite well to examining the policies, programs, and other environmental determinants of obesity among adolescents and of the physical inactivity and poor dietary practices that contribute to this growing problem. Of particular importance, many of the relevant outcome measures for this class of behaviors (such as height, weight, exercise habits, and eating habits) had been included for some years in the same study that provided most of the outcome measures on substance abuse—the Monitoring the Future (MTF) study—and relevant contextual measures could be added at little marginal cost to the ongoing surveys of school administrators that were underway as part of BTG.
This supplement to the American Journal of Preventive Medicine includes this introduction and a set of eleven papers1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 containing some of the first findings from BTG’s research on the environmental determinants of adolescent physical activity, healthy eating, and obesity, as well as two papers12, 13 from the National Cancer Institute (NCI)’s related efforts to identify, rate, and track state policies potentially affecting these behaviors. This paper provides an overview of this body of work, beginning with a brief description of BTG and the surveys and other data sets from which it has drawn its data, and it highlights some of the initiative’s research on adolescent substance abuse by way of illustrating its potential for parallel contributions to the childhood obesity issue. This is followed by a discussion of the conceptual framework that underlies BTG’s more recent work on youth physical activity, healthy eating, and obesity. Finally, the key findings from the papers contained in this supplement are briefly reviewed.
Section snippets
Bridging the Gap: An Overview
Bridging the Gap is a multidisciplinary, multisite collaborative endeavor intended to substantially improve knowledge of the impact of policies, programs, practices, and other environmental influences on adolescent health behaviors. The initiative consists of two integrated components: the Youth, Education, and Society (YES) project based at the University of Michigan’s Institute for Social Research (ISR) and the ImpacTeen project based at the University of Illinois’ Health Policy Center. From
Monitoring the Future Data on Student Behaviors
Much of the initiative’s efforts are built around the Monitoring the Future study, directed by Lloyd Johnston and colleagues at the University of Michigan’s ISR, and supported by the National Institute on Drug Abuse (NIDA). MTF has been conducting school-based surveys of high school seniors since 1975 and of 8th- and 10th-grade students since 1991. A nationally representative sample of approximately 45,000 to 50,000 adolescents in about 420 schools is surveyed each spring, with extensive
The YES Surveys of School Administrators
The YES project, which is supported entirely by grants from the RWJF, annually surveys school administrators in the nationally representative half-sample of MTF schools cycling out of the MTF study that year. Beginning with the 1997–1998 school year, and each year since, a survey instrument—the School Policies and Programs Questionnaire—has gathered detailed information on each school’s alcohol, tobacco, and illicit drug–related policies and their implementation, the various prevention and
ImpacTeen Data on Community, State, and Commercial Influences
In order to assess the effects of policies, programs, and practices at the community and state levels on adolescent substance use and related outcomes, a substantial amount of new information had to be developed or gathered from archival sources and then integrated with the MTF data on youth and the YES data on schools. This work was conducted as part of the ImpacTeen component of BTG and included information on state and community policies and other environmental factors, as well as on
Bridging the Gap’s Research Findings on Alcohol, Tobacco, and Illicit Drug Use
These databases, individually and in various combinations, have been used in numerous analyses that have improved the understanding of the extent of, and changes in, policies, programs, practices, and other environmental influences and their associations with adolescent substance use and abuse. Over 100 peer-reviewed articles, book chapters, chart books, and other publications have resulted from BTG’s research to date. These are listed, and in a number of cases directly available, on the
Monitoring the Future Surveys and Adolescent Obesity
The MTF surveys continue to be a primary source of information on the relevant youth outcomes, other relevant behaviors, and socioeconomic and demographic factors. Since 1986, the MTF survey of high school seniors has included questions on student height and weight, allowing the construction of BMI and other indicators reflecting overweight and at-risk-for-overweight youth. Comparable questions specific to particular questionnaire forms were included when MTF added its 8th- and 10th-grade
Youth, Education, and Society Survey
As BTG’s efforts have increasingly focused on adolescent obesity, the annual YES surveys of middle and high school administrators have been modified to encompass relevant measures. For example, extensive physical education and other physical activity–related items were introduced in 2003; extensive items on the school food and beverage environment and on commercial contracts in schools were added in 2004; and extensive questions on school wellness policies, programs, and practices were added in
ImpacTeen Data Collections
The ImpacTeen community data collections were conducted annually from 1999 through 2003 in the communities around the 2nd-year half-sample of schools cycling out of the MTF surveys. “Communities” were defined by the geographic area from which the MTF schools drew the vast majority of their students; in less-urban settings, this could include several towns and small cities, while in highly populated urban settings, it could be a relatively small section of a large city. As part of the general
Archival Databases
The ImpacTeen component of BTG continues to gather information on numerous factors that may affect youth health-related behaviors, including physical activity, diet, and obesity. These data are drawn from a variety of publicly accessible and commercial databases and are being used in a range of analyses, both individually and in combination with other databases collected originally or obtained by BTG. Archival data of the following types have been used in several of the papers contained in this
BTG and Other Papers in this Supplement
The papers contained in this supplement1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 highlight the breadth of BTG’s research on the policy and environmental factors that are potentially important determinants of obesity-related behaviors and outcomes among adolescents, along with related efforts to identify and track relevant state policies. Given the significant disparities in the prevalence of physical inactivity, unhealthy eating, and obesity-related outcomes among youth in different
Discussion
Extensive research has demonstrated the importance of a range of policy, programmatic, and other environmental influences in affecting health behaviors. The Bridging the Gap program created 10 years ago and supported by the Robert Wood Johnson Foundation—and other spin-off projects from this effort—have made numerous contributions to the evidence base on the impact of these factors on adolescent tobacco, alcohol, and illicit drug use and related outcomes. The accumulation of this evidence has
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2020, Journal of School Health